One of the most repeated myths of COVID-19 vaccination concerns fertility.
Do the COVID-19 vaccines cause swollen testicles, erectile dysfunction (ED) and lower sperm count? No, but COVID-19 infection can cause each of these issues.
Urologist Chris Deibert, MD, treats ED and other men's health conditions. Here Dr. Deibert walks through the research on men's fertility after COVID-19 infection and, separately, COVID-19 vaccination.
After COVID-19 infection
"A significant percentage of men will experience testicular swelling or swelling of the epididymis after symptomatic COVID-19 infection," says Dr. Deibert.
A recent review of male reproductive health estimates that "10% to 22% of men with acute COVID-19 infection develop orchitis or epididymo-orchitis." Orchitis is the medical term for testicular swelling or inflammation.
COVID-19 isn't the first infection to cause swollen testicles. "A lot of infections can cause testicular swelling, including E. coli bacteria, gonorrhea, chlamydia and mumps," says Dr. Deibert.
Except for unconfirmed reports on social media, there's no evidence that the COVID-19 vaccination is linked to testicular swelling. It's important to treat personal stories differently than scientific research. Dr. Deibert says he hasn't seen any evidence here in Omaha or nationally linking swollen testicles and COVID-19 vaccination.
If you're curious about how mRNA vaccination works, find out how long spike proteins last in the body.
After COVID-19 infection
A small, self-reported survey of Italian men suggests a link between ED and COVID-19 infection. This study found that reported ED was higher in COVID-19-positive men.
Men reporting erectile dysfunction with:
- Prior COVID-19 infection: 28%
- No COVID-19 infection: 9%
"It appears that the virus can go to all parts of the body when someone is symptomatically ill. Dead virus has been found in erectile tissues after severe, acute infection," says Dr. Deibert. "But it's not totally clear if or how the virus causes erection issues."
The researchers did not find viral particles in penis biopsies of two other men with no history of COVID-19 infection.
Make an appointment with a men's health doctor by calling 800.922.0000.
"I've not seen any patients who developed erectile issues after vaccination alone, nor have I heard any reports of that happening," says Dr. Deibert.
After reviewing research databases, the American Society for Reproductive Medicine says, "No evidence of any connection between COVID-19 vaccines and male infertility was found, but there were 50 reviews, 17 commentaries/letters to editors and nine original articles on how COVID-19 disease could possibly impact male fertility."
After COVID-19 infection
It appears that COVID-19 infection can lower sperm counts, at least temporarily. A small study compared the median sperm counts of COVID-19-positive men with sperm counts of COVID-19-negative men.
Median sperm count of men:
- Without COVID-19 infection: 21.5 million
- With COVID-19 infection: 12.5 million
Dr. Deibert says, "There's some reassuring data that the vaccine doesn't change sperm count."
A small, peer-reviewed study measured 45 men's sperm counts before and after COVID-19 mRNA vaccination. The study reported that there were "no significant decreases in any sperm parameter among this small cohort of healthy men" after two doses of either Moderna or Pfizer vaccines.
In summary: COVID-19 vaccines do not affect men's fertility, but COVID-19 infection does
To sum up what we know so far:
- COVID-19 vaccines are not linked to swollen testicles, erectile dysfunction or lower sperm counts
- Billions of COVID-19 vaccines have been given worldwide. If a link between fertility and vaccination exists, where is the clinical evidence?
- COVID-19 infection can cause swollen testicles, erectile dysfunction and lower sperm counts
Men's fertility: what the research so far says
|COVID-19 infection||COVID-19 vaccines|
|Swollen testicles||Estimated that 10% to 22% of men with COVID-19 infection experience swollen testicles1||No evidence of swollen testicles after vaccination2|
|Erectile dysfunction (ED)||ED more likely in men with a prior COVID-19 infection3; Viral particles found in penis biopsies4||No evidence of ED after vaccination2|
|Sperm counts||COVID-19 can lower sperm count in some men temporarily5||Sperm counts the same after vaccination6|
- Nassau DE, Best JC, Kresch E, Gonzalez DC, Khodamoradi K, Ramasamy R. Impact of the SARS-CoV-2 virus on male reproductive health [published online ahead of print, 2021 Aug 17]. BJU Int. 2021;10.1111/bju.15573. doi:10.1111/bju.15573
- Watson RE, Nelson TB, Hsu AL. Fertility considerations: The COVID-19 disease may have a more negative impact than the COVID-19 vaccine, especially among men. Fertility and Sterility online. 2021.
- Sansone A, Mollaioli D, Ciocca G et al. "Mask up to keep it up": Preliminary evidence of the association between erectile dysfunction and COVID‐19. Andrology 2021; 9: 1053–9
- Kresch E, Achua J, Saltzman R et al. COVID‐19 endothelial dysfunction can cause erectile dysfunction: histopathological, immunohistochemical, and ultrastructural study of the human penis. World J Men's Health 2021; 39: 466. 10.5534/wjmh.210055
- Best JC, Kuchakulla M, Khodamoradi K et al. Evaluation of SARS‐CoV‐2 in human semen and effect on total sperm number: a prospective observational study. The World Journal of Men's Health 2021; 39: 489
- Gonzalez D, Nassau D, Khodamoradi K et al. Sperm parameters before and after COVID-19 mRNA vaccination. JAMA 2021; 326(3): 273-274