Erectile dysfunction (ED) is not a topic many men want to think about or discuss. But the fact is, according to the Massachusetts Male Aging Study (MMAS), at age 40, forty percent of men are affected and nearly seventy percent of men are affected at age 70.  

ED has been plaguing men for millennia. In the Middle Ages, ED was considered a sign of possible demonic possession, to be cured by exorcism.  

In the early to mid-19th century, ED was believed to be the result of masturbation and sexual excesses while Freud and his colleagues hypothesized that penile function was controlled by the mind.  

Masters and Johnson similarly positioned ED as a mental disorder, proposing that the problem was behavioural. 

Only in the past 30 years has penile dysfunction been associated with other health conditions.  

Diagnosing Erectile Dysfunction 

This lack of understanding about why ED happens – and assumption that it stems from mental illness – has likely led to many men feeling shame and embarrassment and may lead some men to not speak with their doctors (or anyone) about it at all.  

Not opening up about ED can lead to men simply not getting the treatment they need, potentially resulting in serious complications down the road.  

But how do you know you have ED in the first place? Erectile dysfunction is generally a progressive disease, so early on it may include annoying difficulties in getting or maintaining an erection or noticing that erections might not be as firm as normal.  

If this progresses over time and you’re having difficulties in getting or maintaining an erection after several encounters, you may have erectile dysfunction. This is a good time to call your doctor and be open about what you’re encountering.  

To find the cause of ED your doctor will ask about your sexual history and do a physical examination. During this examination, the doctor will check your blood pressure, check your penis and testicles for any problems and order blood tests to check hormone levels.  

Your doctor may also order blood and urine tests and might recommend you undergo a nocturnal penile tumescence (NPT) test, intracavernosal injection test or a Doppler ultrasound to arrive at the proper diagnosis. 

Erectile dysfunction is complex and can be the result of physical or mental problems, or a mix of both. It is important to have a thorough examination to determine the cause, as a significant body of evidence now suggests that ED and cardio and cerebrovascular diseases share the same risk factor profile. ED can be warning sign of cardiac illness in men. 

Atherosclerosis and Erectile Dysfunction 

Anything that interferes with the nervous system or blood circulation could lead to erectile dysfunction. Physical issues like heart disease, high cholesterol, high blood pressure, diabetes, obesity, and smoking can all cause erectile dysfunction.  

Additionally, depression, anxiety, stress, relationship problems, and other mental health concerns can trigger ED.   

However, a common cause of ED, and eventually full-blown heart disease, is atherosclerosis. Atherosclerosis is the accumulation of cholesterol-filled plaque inside blood vessels, causing the vessels to narrow and slow down blood flow.  

This can happen to not only the blood vessels supplying the heart (coronary arteries), but also blood vessels throughout the entire body, including the penis. 

Scientists have recently discovered that because the arteries in the penis are much smaller than those in the heart, atherosclerosis often affects the penis first, followed by the heart and brain, and the legs last.  

For this reason, scientists have found that ED can be a warning sign that a heart attack or a stroke may follow, often in the next 3 to 5 years.  

According to Hopkins Medicine, men in their 40s who have erection problems (but no other risk factors for cardiovascular disease) run an 80% of developing heart problems within 10 years. 

Risk Factors  

Harvard’s Dr. Michael P. O’Leary, explained that erections “serve as a barometer for overall health,” and that erectile dysfunction can be an early warning sign of trouble in the heart or elsewhere.  

ED is present in 50% of men with a history of cardiovascular disease (CVD). One out of eight men with ED reports previous CVD, leading scientists to believe that ED is a predictor of CVD events, with the strongest association seen in younger men in their 40s and 50s. 

Not all cases of ED will point to cardiovascular disease but identifying risk factors can help guide medical practitioners when deciding if further investigation or optimization of cardiovascular health is needed.  

Risk factors to pay attention to are: 

  • Age 
  • ED severity and duration
  • The presence of other cardiovascular risk factors such as diabetes, smoking, high cholesterol, lack of exercise, high blood pressure.
  • Poor diet: not eating enough vegetables and fruits, consuming too much saturated fats and/or trans fats and salt common in processed foods.
  • Sleep Apnea
  • Family history of heart diseases and conditions 
  • Obesity

“The onset of ED should prompt men to seek comprehensive cardiovascular risk evaluation from a preventive cardiologist,” Michael Blaha, MD, MPH, associate professor of medicine at the Johns Hopkins School of Medicine in Baltimore, Maryland noted.  

“It is incredible how many men avoid the doctor and ignore early signs of cardiovascular disease, but present for the first time with a chief complaint of ED.  This is a wonderful opportunity to identify otherwise undetected high-risk cases.” 

ED Treatment 

Depending on the cause of the ED, your medical practitioner will recommend a course of action to make sure you’re getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.  

Oral medications are an option that many men choose, however they do not work for everyone and are not recommended for people who just had prostate surgery or have diabetes.  

Oral medications include Sildenafil (Viagra), Tadalafil (Adcirca, Cialis), Vardenafil (Levitra, Staxyn) and Avanafil (Stendra). All these medications enhance the effects of nitric oxide, which is a natural chemical your body produces that relaxes muscles in the penis. This in turn increases blood flow, allowing for an erection. 

Other medications for ED include Alprostadil self-injection or urethral suppository. Testosterone replacement may be prescribed for men whose erectile dysfunction might be complicated by low levels of testosterone.  

Psychotherapy is another important strategy for managing erectile dysfunction if there is a mental health component to it.  

Additionally, solutions such as vacuum therapy or a penile implant may be worth considering.  

If the underlying cause of ED is atherosclerosis, there are several lifestyle modifications you can make that, along with medication, may help you avoid debilitating coronary heart disease. 

  • Lifestyle changes 
  • Diet  
  • Exercise
  • Stop smoking
  • Limit alcohol and avoid binge drinking
  • Weight management
  • Manage stress
  • Control cholesterol
  • Control high blood pressure

While erectile dysfunction may be a challenging topic to discuss with your partner, friends or even your doctor, it’s important to remember that it’s not just about your sex life; it could also serve as a valuable signpost for something more sinister going on with your health. Speaking up about it could save your life.  

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