Atherosclerosis and Erectile Dysfunction


Erectile dysfunction is a widespread problem. Up to 39% of 40-year-old men report some degree of erectile dysfunction, and two-thirds of men over age 70 have significant symptoms.

Erectile dysfunction isn’t life-threatening, but that doesn’t mean it’s not serious. Men with erectile dysfunction (ED) are more likely to feel depressed and report less enjoyment in life.

Thanks to advertisements for drugs that treat it, you may have heard more about erectile dysfunction than you ever cared to. But did you know that atherosclerosis — hardening of the arteries — is the main cause of ED?

The link between atherosclerosis and erectile dysfunction is well known to doctors. If you have ED, understanding the connection might just save your life.

Atherosclerosis and Erectile Dysfunction: Slowing the Rush

The blood supply to the penis comes from arteries in the abdomen (belly). Smaller arteries branch off to carry blood down into the penis. When it’s time for an erection, these arteries dilate. More blood flows into the penis, causing it to swell.

The rush of blood creates high pressure in the penis that also slows down the flow of blood out of the penis. This produces a firm erection that can be maintained until orgasm — if the blood vessels are healthy.

Atherosclerosis and Erectile Dysfunction: Dam Blockages?

To get and maintain an erection, blood vessels in the penis have to be robust, to rapidly increase blood flow. Erectile dysfunction usually means blood vessels everywhere aren’t in perfect health. This can be a signal of increased risk, long before blockages from atherosclerosis form.

To understand what goes wrong, think of blood flow as a river over a dam. Engineers control the flow: they can increase flow to make rapids, or narrow it to a trickling stream.

A similar mechanism is at work in your arteries. In your penis, blood flow needs to open wide during sexual arousal. Likewise, you need wide open blood flow to your heart’s arteries during exercise. The inside lining of blood vessels (endothelium) releases chemicals on demand to accomplish this.

The endothelium can be damaged by high cholesterol, high blood pressure, smoking, or diabetes. They also cause atherosclerosis.

Once damaged, the endothelium can’t expand arteries to increase blood flow as well. Less blood flow into the penis means a less firm erection.

Atherosclerosis and Erectile Dysfunction: An Early Warning Sign

The endothelium also acts like a maintenance crew that prevents atherosclerosis plaques from developing. Damage to the endothelium occurs before blockages from atherosclerosis appear.

Doctors have long recognized erectile dysfunction as an “early warning sign” for atherosclerosis. Difficulty with erections usually means atherosclerosis is developing. Erectile dysfunction can also mean atherosclerosis is already present, in the arteries of the heart or brain.

Most men with erectile dysfunction have risk factors for atherosclerosis, including:

  • Family history of atherosclerosis
  • High cholesterol levels
  • Cigarette smoking
  • High blood pressure
  • Diabetes
  • Obesity

Diabetes seems to be particularly hard on the arteries in the penis. As many as half of diabetic men in their 50s report some degree of impotence.

For these reasons, erectile dysfunction is a red flag that demands attention. Experts agree that all men with ED should undergo “risk profiling” for atherosclerosis of the heart.

Of course, other factors besides atherosclerosis can cause erectile dysfunction. Problems with nerves, hormones, and emotional factors must be ruled out. Seeing a doctor can sort this out.

Atherosclerosis and Erectile Dysfunction: Temporary Treatments

So far, there is no proof that treating atherosclerosis improves erectile dysfunction. Oral drugs available for erectile dysfunction are among a class of drugs called phosphodiesterase inhibitors:

  • Cialis (tadalafil)
  • Levitra (vardenafil)
  • Staxyn (vardenafil)
  • Stendra (avanafil)
  • Viagra (sildenafil)

These drugs work by improving blood flow into the penis temporarily. However, they don’t improve the underlying problem in erectile dysfunction. They also don’t prevent or treat atherosclerosis elsewhere in the body.

The only way to slow down or prevent atherosclerosis is to reduce your risk factors. Don’t smoke. Get your cholesterol and blood pressure under control. Exercise regularly. Eat right.

Erectile dysfunction can be an early warning sign for serious complications of atherosclerosis. If you suffer from poor erections or impotence, take it seriously. See your doctor, and ask if more than your sex life may be at risk.


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