Erectile Dysfunction: A Blessing in Disguise

Myles Spar, M.D.
Updated

How could having difficulty getting or maintaining erections be a blessing? It is not because Erectile Dysfunction (ED) allows men to develop their emotional sides or think about sex less. It is because ED can be a warning sign of more serious and even life threatening problems on the horizon --problems that could be averted if the warning signs are heeded.

Several studies have shown thatmen with ED have a significantly higher risk of cardiovascular disease- heart attacks and strokes. In fact, many of the causes of ED are also risk factors for atherosclerosis; the condition in which fatty plaque builds up in blood vessels, causing restricted blood flow.

For a man to achieve and maintain an erection, several things must happen. He must be sexually stimulated. Whatever the trigger of stimulation, a message is sent by the nervous system to the blood vessels of the penis to let more blood into the tissues of the penis and less blood out. For this to happen, the vessel that fills up the penile tissues (the penile artery) must respond to the nerve stimulation, dilate and have good flow with minimal blockages. Chemicals also get triggered in the penis that prevent the blood from easily flowing out, so that the tissues can stay filled with blood and engorge.

In ED, the problem may be anywhere in this chain of events. Sometimes the stimulation is the difficult part due to depression, stress or even low testosterone causing a lack of libido. Sometimes the nerves are not functioning normally, as in poorly controlled diabetes, after trauma or surgery or because of some medications. But many times all this functions normally, and a man can feel desire and a sense of stimulation, however the erection just doesn't arise because the blood flow is restricted.

Causes of ED

  • Depression / low libido

    • Stress

    Performance Anxiety

    Medications

    Trauma

    Neurologic (stroke, back injury, post prostate surgery)

    Low Testosterone

    VASCULAR

    This last category, vascular, is one of the most common causes of ED. The penile artery, like arteries around the heart and leading to the brain, can become blocked with plaque from atherosclerosis. If this happens in an artery leading to the heart, the result is a heart attack. If this happens in an artery leading to the brain, the result is a TIA or stroke. When atherosclerosis affects the penile artery, erections don't happen.

    The key point here is that the same things that cause blockages in the arteries to the heart and brain cause blockages in the penile artery. But, because the penile artery is smaller than these other arteries, the first symptoms of such blockages may be felt in the penis. So, the earliest sign of this process of atherosclerosis may be ED. This doesn't mean that only the penile artery is affected, it means that is the first place the disease of atherosclerosis may be presenting itself.

    Most men with ED keep it to themselves. They may feel embarrassed or frustrated or angry, but they most likely will either convince themselves it is temporary (as their partner will certainly reassure them it is) or go online and order some Viagra. And Viagra (or Cialis or Levitra) will help for a while. These drugs may help to open the arteries a little, but their main function is in a different part of the vascular process that allows for erection (the corpus cavernosa). As long as the blockage to blood flow in the artery is only partial, these drugs will help. But, if atherosclerosis is not addressed, it will progress and eventually block so much flow that eventhese drugswon't help to achieve or maintain erections.

    Here is where the blessing comes in. That man experiencing ED is getting a wake-up call, because the same disease of atherosclerosis that may be causing the ED would also be present in the rest of the body. So, symptoms of erectile dysfunction can be animportant warning signfor the man suffering from ED to see his health care provider not only for a prescription for Viagra, but for a full assessment of his cardiovascular health.

    What to do if you have Erectile Dysfunction

    1 - See your doctor

    ED may be a sign of a larger disease of atherosclerosis. Your doctor should test you for things that can be contributing factors such as those listed here.

    2 - Have your blood sugar checked

    High blood sugar, or Diabetes, is a large risk factor for atherosclerosis and also damages the nerves, causing a double whammy effect on erections. If your blood sugar is high, it can be treated with diet, oral medications or insulin.

    3 - Have your blood pressure checked

    High blood pressure is often asymptomatic, but still causes damage to blood vessels making them more likely to be clogged with plaque.

    4 - Find out if you are overweight

    Being overweight is a common risk for atherosclerosis. Even without such hardening of the arteries, studies have shown thatlosing weight directly improves erectile function.

    5 - Have your cholesterol checked

    High cholesterol is a key risk factor for building up fatty plaque in the arteries, including the penile artery. Your total cholesterol as well as LDL, HDL and Triglycerides should all be checked if you have ED. If your LDL or Triglycerides are high or your HDL is low, treating these with diet, exercise, supplements and/or medications could reverse some of the plaque build up and improve symptoms of ED.

    6 - Have your Testosterone checked

    Low Testosteroneis another cause of ED, separate from the atherosclerosis cause discussed here. But low T can and should be treated , thereby improving ED.

    7 - Ask your doctor about other tests for cardiovascular health

    Doppler ultrasounds of the carotid arteries, CRP and homocysteine levels are all important (albeit controversial) measures of cardiovascular disease risk. I would argue that if you have ED that is not caused by neurologic problems or low Testosterone, you are at higher risk of cardiovascular disease and warrant having these tests done.

    Now we come to the preventive side of things. If many men with ED have the problem because of atherosclerosis, then many men canavoidED by preventing atherosclerosis from developing.One studyfollowing 570 men for 25 years found that those who smoked, had high cholesterol or were overweight were more likely to develop erectile dysfunction over time. So, in addition to regular sex being a good way to prevent the development of ED, paying attention to risks for cardiovascular disease also can lower your chance of developing erection problems.

    Men without ED should know that, if they want to maintain their ability to have strong erections, they should live the same healthy lifestyle that helps to avoid cardiovascular disease in general - avoiding smoking, exercising regularly, watching cholesterol and fat intake and keeping blood pressure in the normal range. This will keep blood flowing everywhere it is needed.