Is erectile dysfunction a sign of heart disease?

Never mind all of those commercials advertising erectile dysfunction (ED) medications, filled with romantic innuendo and images of happy couples strolling hand-in-hand on the beach. For many men, ED is embarrassing to talk about. What many men don’t know is that ED could signal other serious health risks, including heart disease, and should be assessed.

“Beyond embarrassment, a man may not talk about ED because he doesn’t have a sexual partner,” says Dr. Robert Eisenberg, a board-certified urologist specializing in men’s sexual health, affiliated with Sharp Grossmont Hospital. “If he does, perhaps there’s a perception — whether perceived or real — that the partner isn’t interested in sex, so why say anything.”

“Some men just never bring it up because it’s something that may otherwise be overlooked during a typical office visit,” he added. “But they should.”

ED, which happens when there’s interest in sex, but an inability to get and keep an erection, can be an early warning sign of current or future heart problems.

“The small vessels of the penis are affected the same as the small vessels of the heart by conditions such as hypertension, diabetes and elevated cholesterol. Therefore, ED, in a way, can be a sign of early cardiovascular disease or part of the global effects of poor cardiovascular health,” says Dr. Eisenberg.

While causes vary, vascular conditions and diabetes are often the culprits behind ED. “Hypertension and atherosclerosis tend to affect the small arteries in our body such as those that feed oxygenated blood to the heart, the brain and to the penis. That’s why we often see patients with these conditions also experiencing ED,” he says.

“Likewise, diabetes affects small arteries and can cause vision loss (arteries in the retina), kidney disease (arteries in the kidneys), neuropathy (arteries to peripheral nerves) and ED (arteries to the penis).”

Dr. Eisenberg points out that when speaking with couples, he often discovers that ED has had a profound impact on the health of their relationship. “Many men shy away from intimacy because they don’t have confidence in their erections, and this can strain the relationship in even the strongest couples. Intimacy is such a key component in a healthy, loving relationship, there’s no reason for it to be adversely affected by something as treatable as ED.”

He says that the best treatment ends up being the one that works best for each individual patient. And, if possible, men should consider seeing a sexual medicine specialist who can offer all the treatment options, and together, you decide which would be ideal.

“Oral medications such as Viagra, Cialis or Levitra are the most common initial treatment because they’re effective in a large number of men with relatively mild side effect profiles. However, some patients have ED and these medications will not be effective, such as those with diabetes; they should be referred to a specialist for further treatment.” Additionally, depending on the patient, there are surgical options available for treatment of ED.

Dr. Eisenberg emphasizes that while ED is more prevalent as men age, it’s not necessarily part of normal aging. “This is a myth and discourages many men from being treated who would otherwise continue to have a normal, healthy sex life. I treat men into their 90s for ED.”

He adds, “If there’s ever a 100-year-old referred to me who is healthy enough for sex, I’ll treat him as well.”