Erectile dysfunction is often the first sign of underlying heart and vascular problems

Erectile dysfunction can significantly impair quality of life. Not just the man's, but his partner's as well. There is strong association of ED with depression and anxiety. Depression and ED create a downward spiral by making each other worse.

Many men avoid seeking treatment for this condition.


Two major studies noted prevalence of erectile dysfunction anywhere between 30-52% between men aged 40-79 years.

Higher prevalence of erectile dysfunction was noted in United States and Eastern and Southeastern Asian countries than in Europe or South America. Cause of this is unclear at this time.


In full disclosure, despite 1 in 4 men below 40 seeking medical help for ED, there are very few studies in this age group. This could be partly due to suggestion that higher prevalence of psychogenic and (therefore) temporary causes of ED in this age group, but hardly an excuse to overlook.


You may be wondering, what causes erectile dysfunction. It is quite complicated there is often more than one reason.


It can be psychogenic ( ie from stress, depression, anxiety or relationship issues) or due to a physical cause ( called organic ED).


Organic ED can be neurologic ( from nerve damage), vascular( heart, blood vessels and metabolism mediated) or caused by pelvic injuries/surgeries. Hormonal causes have been implicated in ED as well, but is somewhat controversial.


By far the commonest cause of organic ED is heart and vascular mediated.


In fact, 3 major analyses found ED to be a harbinger of heart disease and predictor of future silent cardiac events.


Alcohol and smoking habits have consistently shown to affect erectile function. Significant dose/ response relationship exists between smoking and ED, ie longer and more one smokes, more likely they are to have ED, and could be reversed ( fully or partially) upon smoking cessation. Alcohol abuse has similar effect, although alcohol in moderation may not be as harmful.


There is data suggesting Western diet is worse compared to Mediterranean diet. Moderate and more frequent physical activities reduce risk of ED.


Obesity, especially central obesity, is a major and independent risk factor of ED.

Diabetes( even prediabetes) can impair sexual health.


The odds of ED increases 3 fold with high blood pressure, 2.57 fold with diabetes, 1.8 fold with high/abnormal cholesterol, 1.4 fold with smoking.

It is important to note that it's not high blood pressure that causes ED, but changes in blood vessels mediated by high blood pressure.


Fortunately there are multiple safe treatment options for ED now a days.

However, lifestyle changes and risk factor modification must precede or accompany any such treatment to address the root cause of the problem.


Here are our recommendations:


  1. ED, specifically in relatively younger men (over 40 but below 55), needs thorough cardiac evaluation, as this is often the first sign of heart problems. This is especially important when one doesn't have underlying medical problems like high blood pressure, diabetes or heart disease. This is as important as symptomatic relief of ED.

  2. It is important to institute life style changes ASAP alongside treatment to address root cause of the problem. This includes at least 30 minutes of moderate physical activities most days a week, weight loss if obese, switching from Western Diet to Mediterranean diet.

  3. Smoking cessation and alcohol moderation is a must.

  4. Depression, anxiety, if any, should be addressed as well.



Information derived from : "Erectile dysfunction by Faysal Yafi et al , Nature Reviews Dis Primers".










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