How Age Forces Rock Singers to Adjust: ‘It Happens to All of Us’

Gary Graff | Published: July 12, 2022

This article is a repost which originally appeared on Ultimate Classic Rock

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· The human voice continues to change via aging.

· Training along with rest and any necessary treatment can help you to get the most out of your voice.

· Arnica is considered a good supplement to speed healing for many issues.

During an interview a few years back, Billy Joel discussed the challenges of maintaining his singing voice as he got older.

“There was a moment back in, oh, [the ’90s], when I said goodbye to that high note in ‘An Innocent Man,'” he told this writer. “It was there, but I could tell that was probably the last time I’d hit it, so it was like, ‘See ya. That’s it for Billy’s high note.’ It happens to all of us. That’s just reality.”

It’s a reality that’s being noticed more and more these days, as music fans notice the toll age is taking on some of their favorites’ voices. Jon Bon Jovi, Journey’s Arnel Pineda and Vince Neil are among those who have made news this year over reported vocal issues. Neil — currently playing stadiums with a reunited Motley Crue — even ended a June 2021 show prematurely while having a hard time singing.

A recent bout with COVID-19, meanwhile, was blamed for Rod Stewart’s subpar performance at Queen Elizabeth II’s Diamond Jubilee concert on June 4 in London. “I apologize,” he later tweeted. “I thought it better it to make an appearance rather than let everyone down so sorry.”

And more and more artists are speaking out about the matter, acknowledging that time is not always on their side — or their voices’.

“Obviously within the next five years, I think my voice will go. Age will get it in the end,” the Who’s Roger Daltrey told this writer in 2019. He was diagnosed with vocal cord dysplasia in 2010, but after two surgeries feels that his voice is “better now than it’s been in 25 years.” Daltrey’s continuing on The Who Hits Back! tour of North America this year and is also playing solo dates in Europe.

“It’s only a small little muscle,” Daltrey notes, “but it’s like any other muscle in the body. Age is not usually kind to voice. I’m very aware that at my age, if I stop singing for any length of time, then my voice won’t be there as I need it — in quite a short space of time. I’ve been very fortunate. I can still roar like I used to, but only by taking good care of it.”

That, according to voice professionals, is the key. “We know aging affects multiple systems of the body — the skeletal system, the muscular system, among others,” Dr. Michelle Adessa, a clinical speech-language pathologist in the Cleveland Clinic’s Voice Center, tells UCR. “A lot of those same concepts apply to the aging of the voice, but then there’s an overlay of the complexities of singers’ voice demands on top of that.”

Adessa works with singers regularly, and she says the vocal aging issues include vocal fold atrophy, in which the vocal cords don’t close as tightly as they did before, as well as hormonal changes that make men’s voices higher and women’s voices lower. Adessa adds, however, that “not one size fits all.” Vocal tremors, a lessening of flexibility, increased raspiness and changes in clarity and power are all issues she frequently sees in her singing patients as they age. Wear and tear often leads to polyps and lesions, sometimes requiring surgical repair.

“With singers, especially rock singers, we certainly don’t want to discount the idea of vocal cord trauma, which just means injury,” Adessa explains. “People who use their voice a lot tend to injure their voice a lot — not every singer, but you’re at greater risk if you use your vocal cords more. The top layer of the vocal cord is not as forgiving compared to other muscles in the body.

“And the particular requirements of rock singers — increased volume, certain kind of stylistic things they do with their voice, may lead to increased risk of vocal trauma. There’s more chance for things like scarring.”

It becomes a question, then, of not if but when singers will have to deal with age’s effect on their voices. Many have adjusted techniques and circumstances.

Peter Gabriel, for instance, told The Quietus in 2011 that he will “cheat on occasion. I used falsetto rather than full voice in some bits. There’s a particular high note on ‘Don’t Give Up.’ But I think my voice has probably dropped a tone … and most of the songs that have high notes I’ve had to lower a tone for the set. On the other hand, you get given some notes down the bottom end. You only have to look at people like Johnny Cash, Bob Dylan or Leonard Cohen, who have done more with their old voice than they were able to do with their youthful voice.”

Heart’s Ann Wilson, meanwhile, told UCR she uses arnica pellets after shows: “That helps with bruising and swelling. And I drink a lot of water and try to get sleep.” Whitesnake’s David Coverdale, who also had both knees replaced, acknowledged to Antihero that he’s surrounded himself with band members “who are good enough to be frontman singers. … Listen, I cannot hit all the notes I used to all by myself.”

More and more singers are also adding vocal coaches and therapists to their teams to help them both recover and maintain their prowess. When Kenny Loggins started losing his voice in 2020, he sought out Los Angeles vocal coach Ken Stacey, himself a singer with bands such as Ambrosia and an adherent of the Bel Canto (“beautiful voice” in Italian) method that kept Tony Bennett singing at a high level through his 80s.

“It suddenly dawned on me I should be working with a trainer to keep my voice in shape,” Loggins told The Washington Post during a recent streaming interview. “We worked five days, six days a week.” Loggins said his voice was back to performing par within half a year.

“A human voice is not meant to go at the pace of the economy that the music industry insists,” Stacey, who’s also toured with Elton John and was part of Michael Jackson’s This Is It band, tells UCR. “The entire industry is built on the premise the artist is going to stay out there and work. The problem is that is not conducive to a healthy voice. A lot changes in the voice, and when you expect yourself to tour like you did back when you were 18 or in your 20s and 30s, it doesn’t work the same way.”

Stacey favors a holistic approach with his clients, focusing not only on technique and mechanics but also on personal lifestyle, diet and stress management, among other factors.

“When you hear about someone having to have vocal lessons, that means that for whatever reason their vocal cords are worn: They’re tired; they’re abused,” Stacey says. “They might be singing too much. They might not be getting enough rest between singing. Are there stressors in their life that are leading to stress on their vocal cords?”

Stacey says he’s as likely to steer his clients toward therapy, meditation or journaling as he is to assign specific vocal exercises. The Cleveland Clinic’s Adessa adds that “basics” such as hydration, sleep and general exercise “have a huge impact on the voice … so we examine those as factors in vocal health, as well.”

Stacey says “it’s so imperative that singers of every ilk and every style get good information about how to maintain the health of their voices.” He also uses “visualizing” as part of his regimen. “If you had a guitar, I can say, ‘OK, hit this string. See how your pressure is holding that string? What if you do this different thing …’ In the case of the voice, the instrument’s inside you. You have to learn and envelop a sense of awareness of when your instrument is firing at its best and how you experience that sound. and what it’s like to hear that sound not behind your ears but in front of you and project it at any volume.”

The result, of course, is that as singers age they won’t be able to sing like they used to. During a recent appearance on The Jasta Show (as Blabbermouth reports), former Queensryche frontman Geoff Tate acknowledged that he “can’t hit those high notes like that anymore in standard tuning” and, like many of his peers, has adjusted by lowering the song keys to accommodate.

“Tuning down a half step makes a huge difference because you’re not just killing yourself to hit it a note, and you can do it consistently seven days a week,” Tate explained. “If you are tuned up to standard tuning, I think you’d probably only get three shows before you’d need to take a break — and economically that’s just really, really hard to do.”

Adessa, meanwhile, endorses that strategy no matter how many nights a week you’re talking about. “If you have to lower your key by a half-step, a step, after you’ve been singing for 45 years or something, I think that’s a reasonable accommodation,” says Adessa, who also works with clients on the pacing of their sets.

“If it makes it easier for you to do and to reach your goals and just to keep singing well, why not do it? The goal is to help keep people singing.”

 

Biohacking and Optimising Your Health During Covid-19

How to Optimise Your Health During Covid-19 With Biohacking

By Dr Jonathan Seah | 14 Mar 2022

This article is a repost which originally appeared on PRESTIGE

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· Dietary biohacks can be used for more efficient recovery from illnesses like Covid-19.

· It is possible to potimize the health beyond functional levels with diet and supplementation.

· Plant based and ketogenic diets are considered optimal for dealing with Covid-19.

For most of the past two years since the start of the COVID-19 pandemic, we’d been relatively fortunate in Hong Kong compared to many other cities in the world, without full lockdowns, mass testings, and most importantly, significant numbers of severely sick and dying people.

Unfortunately, this has all changed these past two months, with almost 500,000 cases and 2,000 deaths[1]. While most of these have been amongst the unvaccinated, elderly or chronically ill, some younger people and even children have been affected. Even though most of my friends are already vaccinated, they wanted to know if there was anything else they could do to improve their chances if infected. So after a chat with some LifeClinic doctors, I’ve summarized some suggested biohacks below – all of which are backed by peer-reviewed scientific research (links to the research papers are at the end).

Before I begin, it might be useful to understand how my medical philosophy differs from that of regular doctors. Most “conventional” doctors were taught, like I was over 30 years ago, that there are essentially only two states of health – either you are sick, or you are not sick. “Functional” medicine doctors, however, who are conventional doctors with extra related training, believe that it is possible to achieve an even better, “optimal” level of health – essentially a super-powered state that will allow you to function better than the average person at both work and play (potentially more energy, better memory, better sex, look younger), and to possibly live longer.

While media attention has focused on Hollywood and Hong Kong movie stars and Silicon Valley billionaires who see functional medicine doctors reverse both their internal and external ageing with advanced treatments like intravenous NAD+, peptides, exosomes, or cytokines, I personally believe that much of the benefits of functional medicine – especially with regards to improving your body’s immune functions to potentially reduce the severity of a COVID-19 infection – can be achieved with relatively inexpensive micronutrients you can purchase yourself[2].

What causes severe Covid-19 disease and death

As we have now seen over the past 2 years, about 80 percent of people who get COVID-19 have no symptoms or only mild symptoms, 14 percent get severe symptoms like pneumonia, and 5 percent get critical symptoms like respiratory distress or multi-organ failure, and about 2 percent die[3]. The mechanism for these bad outcomes is still being investigated, but much of the research points to abnormal immune responses (culminating in what has come to be called a “cytokine storm”) and the presence of chronic inflammation. We believe this is probably why the outcomes are often worse for older people[4], (who typically have aged immune systems), and for those with some pre-existing illnesses that cause systemic inflammation (like diabetes, high blood pressure, and cardiovascular disease)[5].

So, the question then becomes – what are some simple things we do ourselves to reduce the chronic inflammation in our bodies, and to rejuvenate our immune systems?

The best Covid-19 diets: Plant-based and clean keto

An unhealthy diet could increase your risk factors for a severe COVID-19 infection[6]. Over the past year, there have been a few very large research studies that have demonstrated quite clearly that what you eat can affect how your body reacts to COVID-19.

One of the most important was a study conducted amongst almost 3,000 front-line health care workers (doctors and nurses) across 6 countries, which showed that those who followed a largely plant-based diet (mostly vegetables and plant proteins, and less red and processed meats and sweetened beverages and alcohol), had a 73 percent lower likelihood of developing moderate-to-severe COVID-19 infections[7]! This is possibly because a plant-based diet often has more micronutrients that are essential for the proper functioning of the body’s immune system, such as polyphenols, carotenoids, dietary fibre, vitamins A, C, E, and folate, and minerals like iron, potassium, and magnesium. Or because the virus itself is weakened in a nutrient-dense environment[8]! Also, in this same study, those who ate a plant-based diet together with fish had a 59 percent lower chance of moderate-to-severe COVID-19 infection. In this case, it is thought that the mechanism of action might be a reduction of chronic systemic inflammation. Fish is an important source of vitamin D and omega-3 fatty acids, which have anti-inflammatory effects on the body. (Diazepam online)

An even larger study, this time of almost 600,000 people, also showed that those who ate diets characterized by more healthy plant-based foods correlated with a 41 percent lower chance of severe COVID-19 infections[9].

Separately, there has also been a lot of interest in investigating if ketogenic diets could be beneficial in COVID-19 patients. One study conducted in Italy on 102 hospitalized patients showed that those fed with a low-calorie ketogenic diet had a lower admission to the ICU and a lower death rate than those fed on a low-calorie standard (Mediterranean) diet[10]. This could be because a ketogenic diet can better regulate glucose metabolism and reduce systemic inflammation, as the SARS-CoV-2 virus seems to grow more quickly in a high glucose environment[11] and maybe why many diabetics have a severe COVID-19 infection. Additionally, the ketone bodies generated when a body is in ketosis appear to not only serve as fuel but also to promote resistance to oxidative and inflammatory stress[12] which can contribute to severe symptoms. Lastly, over time, ketogenic diets can reduce obesity and hypertension, which could also help improve COVID-19 outcomes.

So what are the key takeaways from this section? To increase your chances of a good outcome in case of infection, try to have a mostly plant-based diet or a “clean” ketogenic diet – that is to say, one that uses mostly plant fats, and fewer animal fats which of course can themselves be very inflammatory.

Biohacking: Your micronutrient heroes

Dietary insufficiency of vitamins and minerals has been observed in high-risk COVID-19 patients, which may account for the increased risk of severe infections. It is also noted that much of the evidence surrounding supportive micronutrient use in COVID-19 utilize doses too high to come just from diet. This is why, given the simplicity, relatively low cost and low risk, supplementation during this period might make sense for many people. The doctors at LifeClinic usually make customized supplement recommendations based on the results of some specialized blood tests and track your micronutrient levels over time. This is because everyone’s biology and needs are different. However, since not everybody will have the opportunity to have this done, I am sharing with you what many functional doctors recommend, and what I take myself! By the way – several of these supplements can also increase sex drive and the ability to achieve orgasm, so think of this as an additional benefit if you are in quarantine with your significant other[13][14].

Vitamin D

Vitamin D is a fat-soluble vitamin, that is both ingested via foods, as well as made by our bodies in the presence of sunlight – another reason my family loves to go hiking! Vitamin D insufficiency could affect almost 50% of the population worldwide[15]. Essential for a healthy lining in our throats to protect against the initial viral entry into our bodies[16], vitamin D is also critical for a healthy immune system. The primary effects of vitamin D in COVID-19 infections are to reduce the viability of the virus and the excessive inflammatory response[17]. In a study conducted on 212 COVID-19 cases, the probability of having a mild disease was correlated to high levels of vitamin D, and, as the vitamin D levels decreased, the risk of severe disease increased. In fact, in COVID-19 hospitalizations with vitamin D deficiencies, treatment with vitamin D shortened the hospital stays and decreased the death rate by more than twice[18]! Yulia and I take 5,000 IU of D3, and we give our son a few drops of D3 liquid every day. You might need more if your levels are low[19].

Vitamin C

Vitamin C is a water-soluble vitamin that cannot be made by humans, which means that it is not well stored in our bodies and must be taken regularly through food or supplements. In addition to being necessary for the body’s outer protective layers (skin and mucosa) and being a powerful antioxidant, it also has critical roles in immunity, including proper white cell movement and antibody production. While most conventional family doctors believe that just 90-120 mg daily[20] of vitamin C is sufficient, I would recommend higher doses to potentially help improve infection recovery times[21], as has been seen with the common cold and even pneumonia[22]. There is even documentation of more than 10,000 mg a day of vitamin C given intravenously (IV) as part of a successful COVID-19 hospital treatment programme[23]. Given that, at home, we can only use oral Vitamin C, Yulia and I take about 1,000 to 2,000 mg a day, and we give our son about 200 mg.

Zinc

Zinc is a key trace mineral that has many potential health benefits against COVID-19 infections, via improving the immune response, minimizing the inflammation, preventing lung injury, and inhibiting viral growth through the interference of the viral genome transcription, protein translation, and attachment[24][25]. It has been shown that zinc supplementation can increase the number of T cells and NK (natural killer) cells in your body – important parts of the immune system, and conversely zinc deficiency can lower the number of white blood cells that fight infections[26]. Several studies are currently ongoing to further investigate the effects of zinc on COVID-19 symptoms and outcomes[27]. We take between 30-50mg of zinc a day.

Quercetin

Quercetin is a natural substance known as a polyphenol. Its main natural sources in food are vegetables like onions and broccoli; fruits like apples, berry crops, and grapes; and some herbs; tea; and wine. It is an antioxidant and anti-inflammatory, can affect human immune functions, and also has antiviral properties. In a recent randomized study with 152 COVID-19 patients, it was found that in those who received quercetin 500 mg twice a day as supportive therapy, there were statistically significant improvements in all the clinical outcomes measured (the length of hospitalization, the need for oxygen therapy, progression to intensive care units, and death). The results also confirmed the very high safety profile of quercetin and its possible anti-fatigue and pro-appetite properties[28]. Yulia and I are currently following this protocol – 500 mg twice a day.

Omega-3 Fish Oil

Omega-3 fish oils are polyunsaturated fatty acids and include both eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids, and are known to have immunity and anti-inflammatory, and antiviral properties, and may even improve oxygenation in COVID-19 patients[29]. In a double-blind, randomized clinical trial conducted on 128 critically ill COVID-19 patients, omega-3 supplementation improved the levels of several parameters of respiratory and renal function[30]. However, on the negative side, there is also a possibility that they can make cell membranes more susceptible to non-enzymatic oxidation, so it is best to not overdo it. Yulia and I take 1,000 mg a day.

Probiotics

Maintaining good gut health is critical for a strong immune system. Our gastrointestinal system has trillions of microorganisms that live in harmony with us (this is known as your “gut biome”). They not only protect against harmful pathogens like the virus causing COVID-19 but also are a major “training ground” for our immune system. With modern living characterized by too much stress, refined carbohydrates, pollutants, medications and antibiotics, this protective lining can be severely weakened. Probiotics strengthen this barrier and can activate various protective immune factors such as IgA antibodies, cytotoxic T-cells and antimicrobial proteins. Recently a research study done right here in Hong Kong showed that there was a distinct correlation between the amount of certain healthy gut bacteria and the level of COVID-19 antibodies that developed after vaccinations[31]. I would recommend including a decent probiotic in your supplementation regime.

Of course, if you suspect your micronutrient levels are very low and you want a quick boost to your immunity, it might not be a bad time to get a consult with a functional medicine doctor or practitioner to evaluate if you might benefit from IV micronutrient therapy. However, if you’ve already been vaccinated and don’t have any major chronic illnesses, the above diet and supplements, in combination with some physical activity, would probably be enough to sufficiently improve your and your family’s chances of having just mild or no symptoms if you were to get COVID-19 infection – which for most of us will inevitably happen at some point! There are a few other micronutrients that you could consider adding, for example, selenium, magnesium and liposomal glutathione, but they’re not as easy to obtain locally. In any case, the very fact that you’ve actually read through this article means that you’re probably already doing all the right things. The very best wishes from our family to yours during this challenging time in Hong Kong!

[1] Centre for Health Protection of the Department of Health, last updated as of 6 March 2022.
[2] Please note that you should not start any type of supplement regime without first consulting a suitably trained professional.
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Q&A: Can COVID-19 cause erectile dysfunction? | Expert Opinion

Q&A: Can COVID-19 cause erectile dysfunction? | Expert Opinion

One of the less-publicized reported repercussions of COVID-19 infection has been male sexual health, specifically erectile dysfunction (ED).

Erections require blood flow to the penis, so erectile dysfunction often results from conditions that restrict blood flow or damage nerves and arteries.

by Joceline S. Fuchs, For the Inquirer

Published Feb 19, 2021

This article is a repost which originally appeared on The Philadelphia Inquirer

Edited for content

More than 850,000 Pennsylvanians have tested positive for COVID-19, and while the vast majority of those infected are recovering, long-term effects of the disease are still largely unknown. While pulmonary, cardiac and neurologic complications from COVID-19 are widely recognized, one of the less publicized reported repercussions of infection has been on male sexual health, specifically erectile dysfunction (ED).

More men are experiencing and seeking medical care for sexual dysfunction during the pandemic, with the greatest increase seen in younger men in their 40s and 50s.

A July study published in the Journal of Endocrinological Investigation examined the effects of COVID-19 on male sexual and reproductive health. The study identified a correlation between COVID-19 and ED, likely caused by many factors, ranging from physiological changes to changes in the way we interact with others.

One of the hallmarks of a COVID-19 infection is an exaggerated inflammatory response. The resulting storm of pro-inflammatory signals, called cytokines, causes inflammation of the lining of blood vessels. (https://marchfss.com/) The hyperinflammatory state triggered by COVID-19 infection can cause vascular damage, ultimately disrupting blood flow — the key component of getting and maintaining an erection.

ED has long been recognized as an excellent marker for physiological well-being. Specifically, ED functions as the “canary in a coal mine” for cardiovascular disease, often predating symptomatic heart disease up to several years in advance. People with preexisting medical conditions are at higher risk for serious COVID-19 infection, but the converse is also true: COVID-19 infection can worsen preexisting medical conditions, such as heart disease and diabetes.

In addition, many of the medications used to treat common heart conditions can have a negative effect on erectile dysfunction. The decline in overall health in COVID-19 survivors and the medications used to manage this can both result in ED.

Also, mental and emotional health plays a large role in men’s sexual health. Being in the right mindset is a vital component of achieving an erection and having a satisfactory sexual experience. There is no doubt that there has been a negative mental and emotional toll from the pandemic regardless of personal COVID-19 infection. The impact of social isolation, worry for family and self during the pandemic, and economic toll from quarantine is demonstrated with increasing rates of stress, anxiety and depression. All of these feelings can be detrimental to sexual function.

With COVID-19 having such a sweeping effect on our daily lives, finding ways to improve quality of life has become more important than ever. ED is more common than most men realize — it is recognized in more than 50% of men over the age of 50 — and may be occurring at even higher rates during the pandemic.

If you are experiencing ED, you should speak to your doctor or urologist to be evaluated and discuss treatment options. And remember that one of the best ways to lower your risk of long-term complications from COVID-19 is to prevent infection in the first place by getting vaccinated when you can, observing social distancing, masking, and using good hand hygiene.

Joceline S. Fuchs is a board-certified urologist with MidLantic Urology in Abington.

How Pornography Use Affects Couples Sexual Health

How Pornography Use Affects Couples Sexual Health

Emerging research provides clues on how, and for whom, pornography affects sex.

Posted Jan 11, 2021

This article is a repost which originally appeared on Psychology Today

Edited for content

According to a 2018 Gallup poll, pornography use is seen as morally acceptable among a rising percentage of Americans, moving from 30 percent approval in 2011 to 43 percent by 2018. This trend follows overall movement toward more liberal beliefs across the boards. When it comes to pornography, the biggest changes were seen among unmarried people and adult males under age 49. Factors such as religion and political orientation affect porn acceptance, with a far smaller percentage of conservative and religious people finding porn morally OK.

Despite growing acceptance, there is serious concern that pornography causes real harm: exploitation and risk to performers, damage to the capacity for healthy relationship and interfering with relationship and sexual satisfaction, addictive potential, illegal activity supporting human trafficking and child abuse, and contribution to the general societal trend to objectify and present unrealistic expectations for physical attributes as well as what healthy sexual behavior is. These are public health and human rights concerns, overlapping with moral concerns and calls for ethical porn, just as trauma and moral injury overlap, requiring greater attention and activism.

Pornography and long-term relationship

Of particular interest is the impact of pornography on marriage. According to a study in the Journal of Sexual Research (2018), pornography has a negative impact on most committed relationships. There are exceptions, but they are not typical. Looking at over 6000 couples, they found that anxiety about the relationship (anxious attachment) was associated with greater relationship satisfaction with own pornography use by men and lower satisfaction when women used porn.

Men were three times more likely to report porn use, and marginally more accepting of pornography. In general, they found that low pornography acceptance among porn users was associated with lower relationship satisfaction, though for men only higher acceptance was associated with greater relationship satisfaction. Pornography use was generally associated with anxious attachment and lower relationship satisfaction. However, work on how pornography use affects sexual satisfaction requires further study.

To understand the connection between pornography and sexual health, Vaillancort-Morel and colleagues, in their recent study in the Archives of Sexual Behavior (2021) surveyed 217 couples, including 72 same-sex couples, together at least one year, and sexually active, who completed approximately one month of daily reports.

They estimated pornography use, and whether it was solitary, with their partner, or both; sexual satisfaction on days sexually active, using the Global Measure of Sexual Satisfaction; sexual distress using the Female Sexual Distress Scale-Revised (also validated for men) estimating distress about sex life, inferiority feelings because of sexual issues, and sexual worries; sexual function via the Monash Female Sexual Satisfaction Questionnaire (with men’s version), asking about sexual desire, receptiveness, ease of arousal, quality of erection or lubrication, orgasm and experience of pleasure; and frequency of masturbation.

Findings

In terms of basic statistics, in this convenience sample, over 35 days half of couples reported pornography use on the same day they had sex. By and large, pornography use was not related to sexual health on most study measures. While future research is warranted to look at a more diverse sample, pornography use here was not associated with sexual satisfaction, ease of sexual arousal, orgasm, or pleasure, and did not strongly relate to sexual distress overall. Masturbation was unrelated to one’s own or partner’s sexual satisfaction, distress or function.

However, there were two significant findings. First, solo pornography use on days when couples had sex was related to increased partner sexual distress. The negative impact on partner distress was true for both men and women, suggesting increased feelings of inadequacy and potential lower quality of sexual engagement (e.g. the partner who used porn may have had changes in behavior and emotions during sex) on those days they had sex when their partner used pornography without them.

Study authors note that some people using pornography alone on days they had sex might have had sex with partners before using pornography, in which case partner distress may be related to later pornography use.

Second, women reported better lubrication on the days pornography was used, whereas men did not report better quality erection, the analogous measure. Authors note that prior research points toward an entourage effect, where couples pornography use is associated with greater sexual openness, that it may help couples normalize, talk about and play out sexual fantasies, and general facilitate sex positivity.

This is in line with research showing that women’s sexual satisfaction is directly related to how well women express what works for them (2017), and couples talk about and maintain a positive attitude toward, sex (2017). This can be further facilitated by couples groups in which couples speak together about intimate issues, thereby increasing overall relationship satisfaction (2017).

Further considerations

Sexual and relationship issues are on the rise, driven by COVID-19-related stress, loneliness and depression, with increased conflict and decreased intimacy (2020). For many couples, pornography has a corrosive effect, much like infidelity in some ways. As with infidelity (2019), open marriage, or parenting marriages, sexual activity outside the couple may also be stabilizing, a factor strongly affected by moral and social norms.

For other couples, those more accepting of pornography and generally sex positive, with more secure attachment to one another, pornography may be useful and pleasurable component of their sex life—as long as it does not cause insecurity in partners or negatively impact sexual behavior and attitudes. The research discussed here, while preliminary, serves as a springboard for discussion and may offer insight for some couples.

As pornography acceptance is a crucial factor, finding out how aligned partners are on pornography is a key part of talking about sexual and relationship satisfaction. Given that sexual satisfaction tends to decline in the majority of marriages over time (2019), it’s important to talk about sex openly for couples seeking long-term stability and satisfaction.

Note: An ExperiMentations Blog Post (“Our Blog Post”) is not intended to be a substitute for professional advice. We will not be liable for any loss or damage caused by your reliance on information obtained through Our Blog Post. Please seek the advice of professionals, as appropriate, regarding the evaluation of any specific information, opinion, advice, or other content. We are not responsible and will not be held liable for third party comments on Our Blog Post. Any user comment on Our Blog Post that in our sole discretion restricts or inhibits any other user from using or enjoying Our Blog Post is prohibited and may be reported to Sussex Publishers/Psychology Today. Grant H. Brenner. All rights reserved.

 

Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

J Endocrinol Invest. 2020 Jul 13 : 1–9.
doi: 10.1007/s40618-020-01350-1 [Epub ahead of print]
PMCID: PMC7355084
PMID: 32661947

A. Sansone,1 D. Mollaioli,1 G. Ciocca,2 E. Limoncin,1 E. Colonnello,1 W. Vena,3,4 and E. A. Janninicorresponding author1

This abstract is a repost which originally appeared on PMC-NCBI

Edited for content

Abstract

Purpose

The COVID-19 pandemic, caused by the SARS-CoV-2, represents an unprecedented challenge for healthcare. COVID-19 features a state of hyperinflammation resulting in a “cytokine storm”, which leads to severe complications, such as the development of micro-thrombosis and disseminated intravascular coagulation (DIC). Despite isolation measures, the number of affected patients is growing daily: as of June 12th, over 7.5 million cases have been confirmed worldwide, with more than 420,000 global deaths. Over 3.5 million patients have recovered from COVID-19; although this number is increasing by the day, great attention should be directed towards the possible long-term outcomes of the disease. Despite being a trivial matter for patients in intensive care units (ICUs), erectile dysfunction (ED) is a likely consequence of COVID-19 for survivors, and considering the high transmissibility of the infection and the higher contagion rates among elderly men, a worrying phenomenon for a large part of affected patients.

Methods

A literature research on the possible mechanisms involved in the development of ED in COVID-19 survivors was performed.

Results

Endothelial dysfunction, subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics all contribute to the potential onset of ED. Additionally, COVID-19 might exacerbate cardiovascular conditions; therefore, further increasing the risk of ED. Testicular function in COVID-19 patients requires careful investigation for the unclear association with testosterone deficiency and the possible consequences for reproductive health. Treatment with phosphodiesterase-5 (PDE5) inhibitors might be beneficial for both COVID-19 and ED.

Conclusion

COVID-19 survivors might develop sexual and reproductive health issues. Andrological assessment and tailored treatments should be considered in the follow-up.

Keywords: COVID-19, SARS-CoV-2, Erectile dysfunction, Sexual dysfunction, Male hypogonadism, Cardiovascular health

Introduction

The global outbreak of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents an unprecedented challenge for healthcare. Despite social distancing and isolation measures, the number of affected patients is growing daily. Hyperinflammation and immunosuppression are prominently featured in COVID-19 [, ], resulting in a cytokine storm [] ultimately leading to development of micro-thrombosis and disseminated intravascular coagulation (DIC). This cytokine storm is strongly associated with the development of interstitial pneumonia (IP) []; however, although lungs are the primarily targeted organs, the cardiovascular system is globally affected. Evidence in this regard supports the notion that the exaggerated production of early response proinflammatory cytokines, such as tumor necrosis factor (TNF), interleukin-1β, -6, and -10 (IL-1β, IL-6, and IL-10, respectively), increases the risk of vascular hyperpermeability, possibly progressing to multiple organ failure and, ultimately, death []. The presence of vascular dysfunction at multiple levels, including pulmonary embolisms, alveolar hemorrhage, microangiopathy and vasculitis has been ascertained in post-mortem examination [, ]. Additionally, both venous and arterial thromboembolic complications, including endothelial inflammation, have been reported [, ]. Indeed, a growing body of evidence seems to support the theory that the endothelium is targeted by the SARS-CoV-2 []; most importantly, the endothelium expresses the protein angiotensin-converting enzyme 2 (ACE2) [, ], through which the virus can access host cells []. Endothelial dysfunction is, therefore, a pivotal determinant of COVID-19 symptoms [, ].

As of June 12th, 2020, more than 7.5 million COVID-19 cases have been confirmed worldwide, with more than 420,000 lives lost due to the disease []. More than 3.5 million subjects have recovered from COVID-19; however, the long-term consequences of the disease are still largely unknown. Data from 2002–2004 epidemics of SARS suggest that cardiovascular sequelae, such as microangiopathy, cardiomyopathy and impaired endothelial function, are to be expected also in COVID-19 patients [, ]. However, while similarities with SARS have been identified, COVID-19 is largely more prevalent due to its high transmissibility, and its consequences, even for recovered patients, are likewise more worrying. Additionally, new evidence is suggesting that autoimmune conditions, such as type 1 diabetes mellitus, might be triggered by the onset of COVID-19 [], therefore, worsening the risk profile for survivors.

These findings can be extremely relevant for male sexual health: indeed, based on these premises, there is quite enough evidence to hypothesize that consequences of COVID-19 can extend to sexual and reproductive health. We investigated the current literature to understand the long-term clinical complications for COVID-19 survivors, aiming to provide adequate information for clinicians to plan adequate and timely intervention measures.

Testosterone and COVID-19: friend or foe?

It is well established that ACE2 is the entry point for the SARS-CoV-2 in host cells []. In males, adult Leydig cells express this enzyme, therefore, suggesting that testicular damage can occur following infection []. Testicular damage in COVID-19 might, therefore, induce a state of hypogonadism as proven by decreased testosterone-to-LH ratio in patients with COVID-19, suggestive of impaired steroidogenesis resulting from subclinical testicular dysfunction [, ]. Post-mortem examinations of testicular tissue from 12 COVID-19 patients showed significantly reduced Leydig cells, as well as edema and inflammation in the interstitium []. A recent report on 31 male COVID-19 patients in Italy identified that some patients developed hypergonadotropic hypogonadism following the onset of the disease []. In the same study, lower levels of serum testosterone (total and free) acted as predictors of poor prognosis in SARS-CoV-2 men []. Whether this state of hypogonadism is permanent or temporary is a question so far left unanswered. Testosterone acts as a modulator for endothelial function [] and suppresses inflammation by increasing levels of anti-inflammatory cytokines (such as IL-10) and reducing levels of pro-inflammatory cytokines such as TNF-α, IL-6 and IL-1β []. It can, therefore, be hypothesized that suppression of testosterone levels might be one of the reasons for the large difference in terms of mortality and hospitalization rate between males and females and might also explain why SARS-CoV-2 most commonly infects old men.

On the other hand, androgens seem to play a pivotal role in COVID-19 by promoting the transcription of the transmembrane protease, serine 2 (TMPRSS2) gene. The encoded protein primes the spike protein of SARS-CoV-2, therefore, impairing antibody response and facilitating the fusion between the virus and the host cells []. This hypothesis could explain the higher prevalence of COVID-19 in men, although it would fail to explain the rationale for the higher mortality rates, as well as the worse clinical outcomes, for elderly patients.

Additional studies would, therefore, be needed to understand whether testosterone treatment might be beneficial or deleterious for the clinical course of the disease. However, independently of whether testosterone is a friend or foe for COVID-19, it should be acknowledged that the testis is a target for SARS-CoV-2 and the possibility for long-lasting consequences on the endocrine function exists, even for recovered patients.

COVID-19 and the endothelium

Solid evidence accumulated in the last decades support the notion that erectile function is an excellent surrogate marker of systemic health in general, and vascular performance in particular [], sharing plenty of risk factors with cardiovascular disease. This is described by the equation ED = ED (endothelial dysfunction equals erectile dysfunction, and vice versa) []. Vascular integrity is necessary for erectile function [], and vascular damage associated with COVID-19 is likely to affect the fragile vascular bed of the penis, resulting in impaired erectile function [, ]. COVID-19 features a state of hyperinflammation promoted by TNF-α, IL-6 and IL-1β []; the same inflammatory cytokines have been associated with clinical progression of sexual dysfunction []. It is worth noticing that the pro-inflammatory cytokines are also closely tied to testosterone levels: as previously stated, hypogonadal patients have higher concentrations of TNF-α, IL-6 and IL-1β as a result of impaired suppression. This ultimately worsens the endothelial dysfunction, further impairing erectile function. However, whether testosterone replacement therapy (TRT) would improve endothelial function is still debated, while largely beneficial in the treatment of hypogonadal men, TRT has known harmful effects if inappropriately prescribed [], and a meta-analysis study did not find any conclusive evidence of a potentially therapeutic effect of testosterone administration, neither acute nor chronic, on endothelial function []. While erection is—of course—a trivial matter for patients in Intensive Care Units (ICUs), there is reason to suspect that impaired vascular function might persist in COVID-19 survivors and even become a public health issue in the next few months. Moreover, given that erectile function is a predictor of heart disease [, ], investigating whether COVID-19 patients develop ED might also be a good surrogate marker of general cardiovascular function, improving patient care and quality of life.

A COVID eclipse of the heart: potential for cardiovascular burden

Besides the effects on endothelium, SARS-CoV-2 infection can also dramatically affect the heart and exacerbate underlying cardiovascular conditions. Reports of myocarditis in COVID-19 patients have piled up in the last months [–]; similarly, arrhythmias and acute cardiovascular events have been described in other coronavirus and influenza epidemics [–] and are likely to be expected for SARS-CoV-2 as well []. COVID-19 survivors are, therefore, more likely to develop severe cardiovascular consequences. However, treatment is not exempt from possible side effects, among which sexual dysfunctions are remarkably common. Drugs such as β-blockers and antihypertensive agents, routinely used in COVID-19 patients, have the potential to impair sexual function []; therefore, both the cardiovascular consequences and their treatment might ease progression from subclinical to a clinically overt ED [, ].

It is also worth mentioning that several cardiovascular risk factors involved in sexual dysfunctions, such as smoking [], diabetes [] and hyperhomocysteinemia [–], are also possible predictors of worse outcomes in COVID-19 patients.

Additionally, as stated in the III Princeton Consensus Panel [], sexual activity should be delayed until the cardiac condition has been stabilized in high-risk patients. Such patients include those with uncontrolled hypertension, recent myocardial infarction or high-risk arrhythmia, which are all conditions closely associated with COVID-19 [].

Reproductive health and COVID-19

Another reason for worry lies in the reported testicular damage from COVID-19 infection. In fact, ACE2 is highly expressed in the testis, suggesting the possibility of testicular infection since the early stage of the disease []. Being expressed in both Sertoli and Leydig cells [, ], ACE2 plays key roles in spermatogenesis and in the regulation of steroidogenesis. Due to the involvement of Sertoli cells, reproductive function might similarly be affected. Additionally, ACE2 is also expressed by spermatogonia, therefore, increasing the risk of SARS-CoV-2 presence in seminal fluid [, ].

Studies investigating the presence of SARS-CoV-2 in seminal fluid have, for the largest part, found no evidence of the virus [–]. However, as other studies have shown different results [], the topic of reproductive health is still largely debated. In post-mortem examinations, seminiferous tubular injury was reported despite no evidence of the virus in the testis []. Identification of SARS-CoV-2 in semen is of the utmost importance, as sperm cryopreservation is an undelayable necessity for many men, such as those who are about to start gonadotoxic treatments []. In Italy, cryopreservation procedures for oncological patients have continued during the COVID-19 pandemic, using utmost care to limit the risk of transmission; for non-oncological patients, the prospects of biological parenthood could be compromised as a consequence of delaying diagnostic semen analysis and sperm banking []. At the beginning of the pandemic, discontinuation of reproductive care except was recommended by international societies for reproductive medicine, with only the most urgent cases allowed; as containment and safety strategies have mitigated the spread of the disease, several centers for assisted reproductive technology have resumed their activity, although with very precise rules for operators [, ].

Further studies should, therefore, be designed with the aim to clarify this point, above all among “COVID-19 asymptomatic” men requiring assisted reproductive technology (ART).

The psychological burden of COVID-19

Increased rates of post-traumatic stress disorder (PTSD), depression and anxiety are expected in the general population, and even more in COVID-19 survivors, following the pandemic [–]. A parallel can be drawn between the psychological consequences of COVID-19 and those coming from similar disasters, such as the 9/11 attacks [] or earthquakes [], and similar short- and long-term treatment strategies are, therefore, needed to provide adequate care. Confinement and the illness in itself are both causes of stress; while only a minority of individuals might be more vulnerable to psychological trauma, there is no doubt that most people would experience some degree of emotional distress following isolation, social distancing, loss of relatives and friends, difficulties in securing medications, as well as the obvious economic consequences of lockdown. Sexual activity is closely associated with mental and psychological health; it is, therefore, unsurprising that sexual desire and frequency have declined in both genders during this pandemic [, ]. There is, therefore, reason to suspect that psychological suffering might exacerbate pre-existing subclinical sexual dysfunctions []. Additionally, the potential for SARS-CoV-2 transmission by kissing might lead to increased distress in the couple [], with the resulting negative effects on sexual health and on couple dynamics. Additionally, the hypogonadal state reported in COVID-19 could lead to a significant worsening in sexual desire and mood [, ].

Pulmonary fibrosis and the effects of hypoxia

It has been suggested, with on the basis of interesting evidence, that there could be substantial fibrotic consequences following SARS-CoV-2 infection [, ]. Indeed, pulmonary fibrosis is a well-acknowledged consequence of acute respiratory distress syndrome (ARDS), with further evidence coming from survivors of the 2003 SARS outbreak (caused by the SARS-CoV) [, ]. Pulmonary fibrosis impairs the physiologic lung mechanisms, reducing the pulmonary gas exchange and, therefore, impairing oxygen saturation [, ]; functional disability has been proven in ARDS patients several years after the acute phase of the disease []. There is currently no evidence concerning the possible long-term impairment of lung function following SARS-CoV-2 infection; however, considering the scale of the current pandemic and the similarities between SARS-CoV and SARS-CoV-2 [], there is sufficient reason to suspect a high rate of fibrotic lung function abnormalities in COVID-19 survivors. In such patients, the impaired oxygen saturation could impair erectile function; some evidence in support comes from animal models [, ] as well as from clinical reports [, ]. From a pathophysiological standpoint, this is hardly surprising, as oxygen is one of the substrates required for the synthesis of nitric oxide (NO) by the enzyme NO synthase, whose activity is severely blunted in hypoxia [].

Phosphodiesterase-5 inhibitors in COVID-19

Phosphodiesterase-5 (PDE-5) belongs to the PDE superfamily of enzymes, the last step of the NO/cGMP/PDE pathway and is one of the key elements in drug treatment of ED. NO activates guanylate cyclase in responsive cells, such as endothelial cells, resulting in increased concentrations of the second messenger cGMP (cyclic guanosine monophosphate), which in turn induces relaxation of smooth muscle. PDE acts downstream and reduces effects of cGMP by catalyzing its degradation: PDE inhibitors prevent degradation of cGMP, resulting in prolonged or enhanced action [].

PDE-5 is highly expressed in vascular smooth muscle cells [], and, at high concentrations, in those of the penile corpora cavernosa []; therefore, thanks to their action and due to their high affinity for the specific type 5 isoform [], PDE-5 inhibitors have been approved for their use in treatment of ED since 1998. However, a growing body of evidence has also proven their usefulness as therapeutic agents in different conditions due to their anti-inflammatory and antioxidant actions, as reported in diabetes [], hypertension and chronic kidney disease []. Sildenafil, the first PDE-5 inhibitor approved for the treatment of ED following its serendipitous discovery [], has also been investigated as a treatment for COVID-19 patients; indeed, Sildenafil improves pulmonary hemodynamics, as shown in idiopathic pulmonary fibrosis [], by reducing vascular resistance and remodeling in the pulmonary circulation []. Additionally, by inhibiting neointimal formation and platelet aggregation, sildenafil also might prove beneficial in regard to the risk of vascular injury and thrombotic complications in COVID-19 patients []. Evidence from new trials will prove fundamental to assess the clinical benefits of PDE-5 inhibition on the overall burden of COVID-19 [].

Conclusions

In conclusion, there is quite enough reason to suspect that male sexual and reproductive health could be affected in the survivors, by the sequelae of the COVID-19, both in the short and long terms (Fig. 1). Erectile function, as a surrogate marker of cardiovascular/pulmonary health, could also become extremely valuable as a quick and inexpensive first-line assessment of the pulmonary and cardiovascular complications for COVID-19 survivors. In this regard, evidence coming from diagnostic procedures, such as penile color-doppler ultrasound [] and hypothalamic-pituitary–testicular axis evaluation [], will be necessary to assess the extent to which COVID-19 has been able to impair erectile, and finally vascular, function, the former being an efficient predictor of complete restitutio ad integrum. Additionally, tailored psychological interventions would be necessary to adequately support patients who develop sexual dysfunction consequently to the containment measures.

An external file that holds a picture, illustration, etc. Object name is 40618_2020_1350_Fig1_HTML.jpg

Graphical overview of the involvement of SARS-CoV-2 in the pathogenesis of erectile dysfunction

Acknowledgements

Open access funding provided by Universitá degli Studi di Roma Tor Vergata within the CRUI-CARE Agreement. The authors are in debt with Dr. Tarek Hassan (Pfizer, New York, NY) for discussion on the role of PDE5 and of PDE5i in COVID-19 management. This paper is partially supported by the PRIN Grant #2017S9KTNE_002.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This manuscript is a review of the literature and does not contain original research either on animal or on human subjects.

Research involving human participants and/or animals

This article does not contain any studies involving animals and/or human participants performed by any of the authors.

Informed consent

For this type of study, informed consent is not required.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Blood clots cause 4-hour erection in man with coronavirus | Miami Herald

Did coronavirus cause a man to have a 4-hour erection? Doctors studied it to find out

By Katie Camero
July 02, 2020 02:30 PM

Edited for content

This article is a repost which originally appeared on The Miami Herald

Doctors in France believe the novel coronavirus could be to blame for a man’s erection that lasted more than four hours, a new case study says.

Blood clots found within the 62-year-old’s penis caused a painful case of priapism — the medical term for a prolonged erection — and is thought to have been triggered by the disease, according to the report published in June in The American Journal of Emergency Medicine.

The case appears to be the first that links penile erections to COVID-19, the team of doctors said.

“The clinical and laboratory presentation in our patient strongly suggests priapism related to SARS-CoV-2 infection,” the doctors said in the study. “This medical emergency should be recognized by healthcare professionals and treated promptly to prevent immediate and chronic functional complications.”

A significant number of coronavirus patients admitted to intensive care units form dangerous clots in their blood, several reports have shown. They are causing patients to have heart attacks, strokes, rashes and swollen fingers and toes, and can be found in the lungs, liver, kidneys and bowels, according to WebMD.

Some scientists speculate clotting is the result of an exhausted immune system that ends up turning against itself, causing a condition called “disseminated intravascular coagulation, where patients both bleed uncontrollably and clot too much at the same time,” the outlet said.

Others theorize the virus could be causing the clotting directly, but more research is needed to understand the phenomenon, experts say.

But when the patient visited a doctor feeling feverish and weak with a dry cough and diarrhea, there were no signs of a problematic erection, the study said. Clinicians gave the man antibiotics for what they thought was a bacterial infection.

Two days later, he was having breathing troubles and went to the hospital where he was “promptly intubated and mechanically ventilated,” the researchers said.

The patient’s blood pressure spiraled out of control and chest scans showed abnormalities in his lungs, but still no sign of an erection. It wasn’t until the patient was admitted into the ICU with fluid in his lungs that a “physical examination revealed previously unidentified priapism,” the study said.

Doctors drew blood from the man’s penis and found “dark blood clots and high carbon dioxide and low oxygen contents,” which means the clots were blocking blood from flowing out of the penis, Bruce Lee, a professor of health policy and management at the City University of New York, wrote in Forbes.

“When blood stays in the same place and can’t return to the lungs, it gets depleted of oxygen and loaded more and more with carbon dioxide,” Lee wrote.

Doctors injected medicine into the man’s penis which helped his condition, the study said.

“Although the arguments supporting a causal link between COVID-19 and priapism … are very strong in our case, reports of further cases would strengthen the evidence,” the researchers said.

Priapism is diagnosed when an erection goes on for more than four hours or isn’t related to sexual stimulation, according to the Mayo Clinic. It’s uncommon yet usually painful, and occurs in men in their 30s or older with certain conditions such as sickle cell anemia.

“Prompt treatment for priapism is usually needed to prevent tissue damage that could result in the inability to get or maintain an erection (erectile dysfunction),” the Mayo Clinic said.

 

Doctors claim new coronavirus ‘may cause damage to a man’s TESTICLES’ as they urge male patients to take fertility tests upon recovery

Doctors claim new coronavirus ‘may cause damage to a man’s TESTICLES’ as they urge male patients to take fertility tests upon recovery

  • Doctors in Wuhan warned the disease may affect the production of sperm
  • However no study has proved the new coronavirus will affect men’s fertility
  • The experts suggested the likelihood of serious immune damage in the testes
  • They urged recovered male patients to test sperm quality and hormone levels  
  • Coronavirus symptoms: what are they and should you see a doctor?

By Tracy You For Mailonline

This article is a repost which originally appeared on DailyMail

Edited for content

Medics from a hospital in Wuhan have suggested the likelihood that the novel coronavirus can affect the production of sperm and the formation of male sex hormones.

Although the coronavirus mainly targets one’s lungs and immune system, it can, in theory, impair a man’s abilities to reproduce, according to Wuhan’s Tongji Hospital.

The comments were made yesterday by Prof Li Yufeng and his team at the hospital’s Centre for Reproductive Medicine.

Tongji Hospital, affiliated to Huazhong University of Science and Technology, is one of the hospitals designated by the government to treat coronavirus patients since an outbreak started in Wuhan in January.

Coronaviruses are so named because their structure has jagged edges which look like a royal crown – corona is crown in Latin (Pictured, an illustration of the COVID-19 virus released by the US Centers for Disease Control and Prevention)

The comments were made yesterday by Prof Li Yufeng at the Centre for Reproductive Medicine from Wuhan’s Tongji Hospital.

According to the experts, the new coronavirus, known as SARS-CoV-2, enters human cells and causes tissue damage by binding its spike protein to cell membrane protein angiotensin-converting enzyme 2 (ACE2).

ACE2 is known to be present in other human organs apart from the lungs and can especially be abundant in a man’s testes. It can be concentrated in several cells which are directly related to the male reproductive abilities, including the germ cells, supporting cells and Leydig cells, the team claimed.

They added that during the SARS outbreak in 2002 and 2003, medics observed serious immune system damage in the testicles of some male patients.

Even though doctors did not detect the SARS coronavirus, or SARS-CoV, in patients’ testicles, they could suffer inflammation in their sexual organs, the study said.

In a report released by the hospital, Prof Li and his team showed a graphic (above) illustrating the cells in a healthy testicle. They studied the impact of SARS coronavirus on male patients

Another image released by the team shows the cells in a patient’s testicle after he recovered from an infection caused by the SARS coronavirus. The medics have warned of similar inflammation to men struck down with the novel coronavirus, which has killed at least 4,718

Since the new coronavirus is highly similar to the SARS coronavirus and the two share the same host cell receptor ACE2, the team concluded that, in theory, the new coronavirus could cause damage to men’s testicles.

‘Therefore, for men who have had the infection, especially those who need to reproduce, it is best to undergo relevant fertility tests, such as sperm quality and hormone level tests, upon recovery to detect possible problems as soon as possible,’ a hospital report wrote.

More than 100 countries are now fighting the fast-spreading contagion, which was first detected Wuhan in central China.

China today declared that ‘the peak of the coronavirus in the country has passed’.

The World Health Organization yesterday declared the coronavirus outbreak a pandemic after blaming ‘alarming levels of inaction’ by governments across the planet for fuelling the crisis.

While China today declared that ‘the peak of the coronavirus in the country has passed’.

The disease has killed at least 4,718 people and infected more than 126,000 across the world.