Polio survivors in the UK may wonder whether their historical infection could contribute to erectile dysfunction later in life. Whilst poliomyelitis primarily damages motor neurones responsible for voluntary movement, it typically spares the autonomic nerve pathways that govern sexual function. Evidence directly linking polio to erectile dysfunction is limited. However, the physical limitations, chronic fatigue, pain, and psychological burden associated with polio—particularly post-polio syndrome—can indirectly affect sexual health and intimacy. This article examines the relationship between polio and erectile dysfunction, explores contributing factors, and outlines evidence-based management strategies for polio survivors experiencing sexual health concerns.

Understanding Polio and Its Long-Term Effects

Poliomyelitis, commonly known as polio, is an infectious disease caused by the poliovirus that primarily affects the nervous system. Whilst widespread vaccination programmes have virtually eliminated polio in the UK—with the last indigenous case in 1984—many individuals who contracted the disease decades ago continue to experience its lasting effects. The virus specifically targets anterior horn motor neurones in the spinal cord and motor nuclei in the brainstem, leading to muscle weakness, paralysis, and in severe cases, respiratory complications. Sensory and autonomic nerve pathways are typically spared.

The acute phase of polio infection typically occurred during childhood, with symptoms ranging from mild flu-like illness to severe paralysis. Many survivors recovered substantial function through rehabilitation, though some degree of weakness often persisted. The extent of neurological damage varied considerably between individuals, depending on which motor neurones were affected and the severity of the initial infection.

Long-term complications following polio can be diverse and may include:

• Persistent muscle weakness and atrophy

• Joint deformities and chronic pain

• Respiratory difficulties

• Fatigue and reduced stamina

• Psychological impacts including depression and anxiety

Decades after the initial infection, some polio survivors develop new symptoms—a condition known as post-polio syndrome (PPS). This late-onset deterioration affects an estimated 25–50% of polio survivors, typically emerging 15–40 years after recovery from the acute illness. Understanding these long-term effects is crucial for addressing the comprehensive health needs of polio survivors, including aspects of sexual health and function that may be impacted by the disease's neurological consequences or by the broader physical and psychological burden of living with disability.

References: NHS (Polio), NHS (Post-polio syndrome), UK Health Security Agency immunisation guidance.

Can Polio Cause Erectile Dysfunction?

Erectile dysfunction (ED) is not a recognised common or typical feature of acute polio or post-polio syndrome. The poliovirus primarily damages motor neurones responsible for voluntary muscle control, whilst autonomic nerve pathways—which govern involuntary functions including sexual arousal and erection—are usually spared. Evidence directly linking polio to erectile dysfunction is limited, and where ED occurs in polio survivors, the causes are typically multifactorial rather than a direct result of the virus itself.

Erectile function depends on an intricate interplay between the nervous system, vascular system, and hormonal factors. The autonomic nervous system relies on nerve pathways in the lower spinal cord (specifically the sacral segments S2–S4) to coordinate erection. In the rare instances where polio caused damage to these particular spinal cord regions during acute infection, it could theoretically impair the nerve signals necessary for achieving and maintaining an erection. However, such autonomic involvement is uncommon in polio, and there is no robust prevalence data to support this as a frequent mechanism.

It is important to recognise that many factors may contribute to erectile dysfunction in polio survivors beyond any direct neurological effects of the virus. Physical limitations resulting from muscle weakness and mobility impairments can affect sexual activity and confidence. Chronic pain, fatigue, and the psychological burden of living with disability may also impact sexual desire and performance. Additionally, polio survivors are subject to the same age-related and lifestyle factors that affect erectile function in the general population, including cardiovascular disease, diabetes, hypertension, and the effects of various medications (such as selective serotonin reuptake inhibitors, beta-blockers, thiazide diuretics, and 5-alpha-reductase inhibitors).

Erectile dysfunction can be an early marker of cardiovascular disease. NICE guidance recommends that all men presenting with ED should undergo cardiovascular risk assessment (for example, using QRISK3) and optimisation of modifiable risk factors such as smoking, diet, physical activity, and blood pressure control. Any erectile difficulties experienced by polio survivors warrant comprehensive medical assessment to identify all contributing factors rather than attributing them solely to the historical polio infection.

References: NHS (Erectile dysfunction), NICE Clinical Knowledge Summaries (Erectile dysfunction).

Post-Polio Syndrome and Sexual Health

Post-polio syndrome (PPS) represents a distinct clinical entity that can significantly impact various aspects of quality of life, including sexual health and intimacy. This condition manifests as new or worsening symptoms in individuals who previously recovered from acute poliomyelitis, typically occurring several decades after the initial infection. The hallmark features of PPS include progressive muscle weakness, severe fatigue, muscle and joint pain, and reduced endurance. Whilst PPS does not directly cause erectile dysfunction through a specific neurological mechanism, its symptoms can indirectly affect sexual function and intimacy through physical, psychological, and relational pathways.

The mechanisms underlying PPS are thought to involve the gradual deterioration of motor neurones that were damaged but not destroyed during the original infection. Over time, these compromised neurones may become unable to maintain the enlarged motor units they developed during recovery, leading to progressive weakness. The profound fatigue associated with PPS—often described as overwhelming and not relieved by rest—can substantially diminish libido and the energy required for sexual activity.

Sexual health concerns in individuals with PPS extend beyond erectile function alone. Both men and women may experience:

• Reduced sexual desire due to chronic fatigue and pain

• Physical limitations affecting positioning and movement during intimacy

• Body image concerns related to muscle atrophy and assistive device use

• Psychological factors including depression, anxiety, and relationship stress

The progressive nature of PPS can create additional psychological challenges, as individuals may grieve the loss of previously regained function. This emotional burden, combined with the physical symptoms, can create a complex interplay of factors affecting sexual health. Healthcare professionals should recognise that sexual function is an important component of overall wellbeing for PPS patients and address these concerns as part of comprehensive, holistic care.

References: NHS (Post-polio syndrome).

Managing Erectile Dysfunction After Polio

Addressing erectile dysfunction in polio survivors requires a comprehensive, individualised approach that considers the multifactorial nature of sexual health concerns in this population. The first essential step involves thorough medical assessment to identify all contributing factors, as treatment strategies will vary depending on whether ED stems primarily from vascular issues, psychological factors, medication effects, or—most commonly—a combination of these elements.

Initial assessment by your GP should include:

• Cardiovascular risk assessment (for example, QRISK3) and optimisation of modifiable risk factors

• Blood tests: HbA1c or fasting glucose, fasting lipid profile, morning total testosterone (repeated if low), and—if clinically indicated—prolactin and thyroid function

• Medication review to identify drugs that may contribute to ED (such as SSRIs, beta-blockers, thiazides, 5-alpha-reductase inhibitors)

• Assessment of psychological wellbeing and relationship factors

Pharmacological interventions remain a cornerstone of ED management. Phosphodiesterase type 5 (PDE5) inhibitors—including sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra)—work by enhancing blood flow to the penis. These medications require sexual stimulation to be effective and can often help even when some degree of nerve or vascular compromise is present. Your GP can assess suitability for these treatments, considering potential contraindications and interactions.

Important safety information for PDE5 inhibitors:

• Contraindications: Do not use if you take nitrates (including GTN spray or tablets) or recreational drugs containing nitrites (poppers/amyl nitrite), or the medicine riociguat. Do not use if you have unstable cardiovascular disease, recent stroke or heart attack, severe liver impairment, hypotension, or hereditary retinal disorders such as retinitis pigmentosa.

• Caution with alpha-blockers: If you take alpha-blockers for prostate symptoms or blood pressure, your doctor will advise careful timing and dosing to minimise the risk of low blood pressure.

• Common side effects: Headache, flushing, nasal congestion, indigestion, dizziness. Rarely, sudden vision or hearing loss—seek urgent medical attention if this occurs.

• Priapism: Seek urgent medical attention if an erection lasts longer than four hours, as this can cause permanent damage.

For individuals who cannot use or do not respond to oral medications, alternative options include:

• Topical alprostadil cream (Vitaros) applied to the tip of the penis

• Intracavernosal injections (alprostadil) administered directly into the penis—carries a risk of priapism; you will receive training on safe use

• Urethral suppositories containing alprostadil

• Vacuum erection devices that mechanically draw blood into the penis

• Penile implants for refractory cases (surgical option, via urology referral)

Non-pharmacological approaches are equally important. Physiotherapy and occupational therapy can help optimise physical function and suggest adaptive techniques or positioning aids that accommodate mobility limitations. Psychological support, including psychosexual counselling or cognitive behavioural therapy, addresses the emotional and relational aspects of sexual dysfunction. Fatigue management strategies—such as planning intimate activities for times of peak energy and incorporating rest periods—can be particularly valuable for those with PPS. Lifestyle modifications including regular appropriate exercise, healthy diet, smoking cessation, and moderation of alcohol intake support overall vascular health and may improve erectile function.

Important safety advice:

• Only obtain ED medicines from regulated UK pharmacies (online or in person). Counterfeit or unregulated products purchased online may be unsafe, ineffective, or contain harmful ingredients.

• Report any suspected side effects of ED treatments via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

References: NICE Clinical Knowledge Summaries (Erectile dysfunction), MHRA/EMC Summaries of Product Characteristics for sildenafil, tadalafil, vardenafil, avanafil, and alprostadil preparations, MHRA Yellow Card scheme.

When to Seek Medical Advice

Erectile dysfunction, whilst common and often treatable, should never be dismissed as an inevitable consequence of ageing or disability. Polio survivors experiencing ED should seek medical advice promptly, as sexual health is an important component of overall wellbeing and quality of life. Your GP is the appropriate first point of contact and can conduct a comprehensive assessment to identify underlying causes and recommend suitable treatment options.

You should contact your GP if you experience:

• Persistent or recurrent difficulty achieving or maintaining erections sufficient for sexual activity

• Sudden onset of erectile difficulties, which may indicate an acute medical issue

• New painful curvature or deformity of the penis (possible Peyronie's disease)

• Significant psychological distress, relationship difficulties, or reduced quality of life related to sexual function

• Concerns about medication side effects that may be affecting sexual performance

Seek urgent medical attention (call 999 or attend A&E) if erectile dysfunction is accompanied by:

• Severe chest pain during sexual activity or suspected heart attack

• An erection lasting longer than four hours (priapism)—this is a medical emergency requiring immediate treatment to prevent permanent damage

• Sudden loss of vision or hearing after taking ED medication

• Penile trauma or blood in the urine

Your GP will typically conduct a thorough history and examination, including assessment of cardiovascular risk factors (using tools such as QRISK3), hormonal status, and psychological wellbeing. They will arrange blood tests to check for diabetes, cholesterol abnormalities, and testosterone levels (morning sample, repeated if low; prolactin and thyroid function if clinically indicated). A medication review will identify any drugs that may contribute to ED. Depending on findings, referral to specialist services—such as urology, endocrinology, or psychosexual therapy—may be appropriate. For polio survivors, coordination with rehabilitation medicine specialists familiar with PPS can ensure holistic management that addresses the unique challenges of living with the long-term effects of poliomyelitis whilst optimising sexual health and intimate relationships.

References: NHS (Erectile dysfunction), NICE Clinical Knowledge Summaries (Erectile dysfunction).

Frequently Asked Questions