The Multidimensional Impact of COVID-19 and Post-COVID-19 Conditions on Sexual and Reproductive Health: A Systematic Review

Abstract

Coronavirus disease 2019 (COVID-19) has been associated with sexual and reproductive disturbances, but whether these findings reflect transient systemic illness or persistent dysfunction remains uncertain. We systematically searched PubMed, Scopus, Web of Science, Virtual Health Library, World Health Organization Global Index Medicus, and Embase for human studies published from 2020 through 2025, supplemented by ResearchRabbit citation- and similarity-based screening; the final update was performed in June 2026. Eligible studies assessed sexual, reproductive, psychological/behavioral, or biological outcomes in individuals with acute or post-COVID-19 conditions. Three reviewers independently extracted and verified data, using design-specific National Institutes of Health, Joanna Briggs Institute, and Mendelian-randomization-specific frameworks to assess risk of bias. Because of substantial clinical and methodological heterogeneity, results were synthesized narratively. The final synthesis included 218 eligible reports, corresponding to 214 conservative study/cohort units after confirmed companion/derived-publication linkage. Erectile dysfunction was the most consistent sexual outcome, whereas reproductive studies mainly reported reduced semen quality and alterations in testosterone and gonadal-axis markers, often appearing short-term. Inflammatory, oxidative, endocrine, vascular, histopathological, molecular, and psychosocial findings supported a multidimensional framework. However, the evidence was predominantly male-focused, observational, and heterogeneous, limiting causal and long-term inference. COVID-19 may affect sexual and reproductive health through interacting biological and psychosocial pathways, but persistent infertility or definitive reproductive impairment remains unconfirmed. The protocol was not registered; no specific external funding was received.