How is Men's Sexual Health Affected by Sickle Cell Disease?

Sickle cell disease (SCD) is a condition people are born with that changes the way their body makes red blood cells. Instead of being donut-shaped and squishy, they form into a C-shape (sickled) and are stiffer and tend to clump together, which can make it harder for oxygen to travel through the bloodstream.

Signs that someone may have SCD can begin showing up around 5-6 months in babies:

• Severe pain in the back, legs, arms, and sometimes chest
• Fatigue/weakness/paleness
• Yellowish skin and eyes (jaundice)
• Swollen joints, hands, and feet
• Stroke

The Centers for Disease Control and Prevention (CDC) estimates that around 100,000 Americans have SCD. These numbers are primarily African and Hispanic Americans, with children and adolescents making up 40% of all US patients. This may be because the average age of mortality for those with SCD is around 45. However, with increasing access to technology and information, this may change over the next decade.

The main complications of SCD include anemia, chest pain and complications, and bone tissue death due to lack of blood flow. Other complications include blood clots, lung infections, leg ulcers, vital organ damage, hypertension, sleep apnea, vision problems, or blindness. What about sexual health complications, you ask?

Priapism and Erectile Dysfunction

One direct complication of SCD is priapism, or an erection that lasts longer than two hours. In fact, priapism is reported by 32-40% of men with SCD. For men with SCD, priapism often occurs for periods of time averaging four hours or longer. While some studies have reported that exercise, cold showers, ice packs, and pseudoephedrine (Sudafed) use can help resolve a priapism, the American Urological Association (AUA, which sexual health professionals follow) guidelines are clear that these remedies are not reliably successful. So, if approaching 4 hours, emergency help needs to be sought out to prevent permanent changes resulting in erectile dysfunction (ED).

Men with SCD tend to have frequent priapism episodes, which may translate into sexual distress or avoidance of sex altogether for fear of an episode. Most of the time, these episodes start during sleep, which may be worsened by undiagnosed sleep apnea. Sleep apnea has been linked to ED in other research, but in men with SCD, the increased hypoxia (lack of oxygen) overnight increases the risk of priapism episodes, which can directly impact sexual quality of life.

ED in men may also be worsened by hypogonadism. Hypogonadism is when the body produces less testosterone than normal (<300 ng/dL) with symptoms of low testosterone, such as low libido, low energy, and issues with erections. While there is no confirmed reason for a higher prevalence of hypogonadism in men with SCD, there are a few theories.

The most popular theories include testicular failure, zinc deficiency, and low blood flow to the testicles during episodes of sickling. Hypogonadism may also influence fertility rates in SCD men, and some SCD treatments may independently impact sperm production, which is important for patients to be aware of.

Treatment Options

The goal of treatment for SCD is to reduce the number of pain crises and prevent organ damage. The most common disease-modifying medication for SCD is hydroxyurea, which helps to increase hemoglobin, the protein that helps oxygen move through the bloodstream. This and other medications are often managed by hematologists (blood experts).

Other options for SCD treatment include stem cell transplants, which have had cure rates reach 90%, and are recommended for SCD patients of pre-school age. Both hydroxyurea and stem cell transplants may interfere with fertility.

From a urologic standpoint, prevention and rapid treatment of priapism is key to optimizing sexual function and reduce risk of severe ED. There are several strategies that sexual medicine-trained urologists will employ for risk reduction from low-dose sildenafil or tadalafil, daily finasteride, or even using muscle spasm medications such as baclofen.

For patients who have had a prolonged episode of priapism, erectile function may not recover, and the main treatment in these cases is penile prosthesis surgery. These cases are more complex than other types of penile implant cases and should be managed by a fellowship-trained surgeon who has experience with this population.

Key Takeaways

• Sickle cell disease causes blood flow-related complications, including anemia, joint and extremity pain, common in those of African, Central/South American, Mediterranean, Middle Eastern, and Asian descent.
• Men with SCD may face sexual dysfunction, including erectile dysfunction, priapism, and dysfunction associated with sleep apnea and hypogonadism. Priapism is an emergency.
• If you have sickle cell disease and are experiencing any of the sexual health complications listed above, it may be beneficial to speak with a sexual health professional.

Resources:

Borrell, J. A., Bettencourt, A., Furtado, T. P., Gu, C., Ye, N., Andino, J. J., Eleswarapu, S. V., & Mills, J. N. (2026). Risk factors, diagnosis, and long-term erectile dysfunction outcomes in priapism: A retrospective analysis of 186 cases from a single institution. International Journal of Impotence Research, 38(1), 23–29. https://doi.org/10.1038/s41443-025-01076-9

management strategies for sickle cell disease related ischaemic and stuttering priapism. International Journal of Impotence Research, 37(10), 819–825. https://doi.org/10.1038/s41443-024-01008-z

Idris, I. M., Abba, A., Galadanci, J. A., Mashi, S. A., Hussaini, N., Gumel, S. A., Burnett, A. L., & DeBaun, M. R. (2020). Men with sickle cell disease experience greater sexual dysfunction when compared with men without sickle cell disease. Blood Advances, 4(14), 3277–3283. https://doi.org/10.1182/bloodadvances.2020002062

Mangla A, Agarwal N, Maruvada S. Sickle Cell Anemia. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482164/

Smith-Whitley, K. (2014). Reproductive issues in sickle cell disease. Blood, 124(24), 3538–3543. https://doi.org/10.1182/blood-2014-07-577619