As a urologist specializing in men’s sexual health, I often find myself discussing the cardiovascular system. Why? Because there’s a strong connection between a man’s heart health and his sexual function. In this post, we’ll explore the intricate relationship between cardiovascular health and sexual performance in men, particularly focusing on erectile function.
The Heart-Penis Connection
At first glance, the heart and penis might seem to have little in common. However, they’re more closely linked than you might think. Both organs rely heavily on blood flow to function properly. The same factors that can damage the blood vessels in your heart can harm the blood vessels carrying blood to the penis.
How Erections Work
To understand the connection, let’s first review how normal erections occur. When a man becomes sexually aroused, his brain sends signals to the pelvic nerves which innervate the penis. These nerves trigger the relaxation of smooth muscles in the penile arteries and tissues. As these muscles relax, blood flow increases, filling the spongy erectile tissue in the penis and causing it to become erect.
Any condition that affects the nerves or arteries in the penis can lead to erectile dysfunction (ED).
Cardiovascular Disease and Erectile Dysfunction
Cardiovascular disease (CVD) can impact erectile function in several ways:
- Atherosclerosis: This condition, characterized by the buildup of plaque in the arterial wall, can restrict blood flow in the coronary arteries, aorta and penile blood vessels. The penile arteries are smaller than coronary arteries, so they may show signs of atherosclerosis earlier.
- Endothelial dysfunction: The endothelium, which lines blood vessels, plays a crucial role in regulating blood flow. Dysfunction of the endothelium is often an early sign of cardiovascular disease and can also contribute to ED.
- Hypertension: High blood pressure can damage blood vessels, increase the risk of heart attack and stroke AND reduce blood flow to the penis. Cardiologists call hypertension the “silent killer” because it usually has no symptoms. We, urologists, call hypertension the “silent erection killer”.
- Diabetes and insulin resistance: This condition often coexists with cardiovascular disease and wreaks absolute havoc on the nerves and arteries in the penis. .
Shared Risk Factors
Most risk factors for cardiovascular disease are also risk factors for ED:
- Smoking
- Obesity
- Sedentary lifestyle
- High cholesterol
- Hypertension
- Diabetes mellitus
- Excessive alcohol consumption
This overlap further underscores the connection between cardiovascular and sexual health. ED and CVD have the exact same risk factors. ED often precedes CVD by several years. Furthermore, other vascular pathology may also be present such as kidney disease in men with ED.
ED as an Early Warning Sign of Impending Doom
ED can often be an early warning sign of underlying cardiovascular issues. In fact, ED symptoms typically occur 3-5 years before the onset of cardiac symptoms. This is because the arteries in the penis are smaller than those in the heart, so they may show signs of disease much earlier. Let me be clear, ED is a giant risk factor for CVD.
In our experience, we often see new ED patients who were given a prescription for Viagra by their primary care physician or an online health care “provider”. These patients often see us because they want more answers, not just a prescription. As urologists, we work up these patients extensively.
Our work-up will include a careful assessment of CVD risk factors and a thorough cardiac and vascular exam. Our diagnostic testing is comprehensive and will include assessment of kidney function, lipid profile, insulin sensitivity and markers of cardiovascular disease such as high sensitivity CRP and homocysteine levels. Advanced cardio-lipid testing may also be performed. Based on this comprehensive assessment of CV risk we may order cardiac testing such as a stress test, cardiac sonography and coronary artery calcium scores. We also have a low threshold for getting our patients seen by experts in cardiovascular medicine and intervention.
In these men, we often find significant cardiovascular risk factors that are not being adequately mitigated. It is not that rare for us to find significant cardiovascular disease when we do diagnostic testing such as coronary artery calcium scores. Many of these men require cardiac intervention, not a Viagra prescription.
Men with ED must take it seriously, hard stop. ED always requires a medical evaluation, preferably by a urologist. Even if Viagra works like a charm, there may be impending doom around the corner if CVD is not ruled out. One of our sayings at Obsidian Men’s Health is that “there is no sex in the graveyard.”
Improving Cardiovascular Health to Boost Sexual Function
The good news is that many of the steps you can take to improve your cardiovascular health can also enhance your sexual function:
- Regular exercise: Physical activity improves blood flow, helps maintain a healthy weight, and can boost testosterone levels.
- Healthy diet: A diet rich in fruits, vegetables, whole grains, and lean proteins can improve both heart health and sexual function. The Mediterranean diet, in particular, has been associated with a lower risk of ED and CVD.
- Quit smoking: Smoking damages blood vessels and can impair erectile function. Quitting can lead to significant improvements in both cardiovascular and sexual health.
- Maintain a healthy weight: Obesity is linked to both cardiovascular disease and ED. Losing excess weight can improve erectile function.
- Manage stress: Chronic stress can contribute to both heart disease and sexual dysfunction. Implement stress-reduction techniques like meditation or yoga.
- Limit alcohol intake: There is no amount of alcohol that is healthy, period. Alcohol reduction or cessation can improve vascular health tremendously.
- Sleep: Sleep is a performance enhancing drug. If you are not sleeping enough or the quality of your sleep is impaired seek medical attention.
- High quality medical care: Seeing an internist who is proactive about health and longevity is vital. Yearly assessment of blood pressure, lipids and insulin sensitivity are key to good cardiovascular health.
Medical Treatments
If lifestyle changes aren’t sufficient, several medical treatments can address both cardiovascular health and erectile function:
- Medications: Many drugs used to treat cardiovascular disease, such as statins, may also improve erectile function. Conversely, ED medications like PDE5 inhibitors (e.g., sildenafil, tadalafil) can also have cardiovascular benefits. Medications are sometimes essential when it comes to mitigating the risk factors of CVD and ED. If these risk factors are not controlled ED will certainly worsen over time and become resistant to therapy.
- Testosterone replacement therapy: In men with low testosterone levels, replacement therapy may improve both cardiovascular risk factors and sexual function.
- Revascularization procedures: In some cases, procedures to improve blood flow to the heart may also benefit erectile function.
When to Seek Help
We can sum this up with one word, ALWAYS. Erectile dysfunction is a medical problem until proven otherwise. Since the risk factors for ED are the same for CVD, men should ALWAYS seek help immediately.
Remember, addressing ED isn’t just about improving your sex life – it could be crucial for your overall health, life or death.
Conclusion
The link between cardiovascular health and sexual function in men is clear and significant. By taking steps to improve your heart health, you’re likely to see benefits in your sexual performance as well. Conversely, if you’re experiencing erectile difficulties, it’s important to consider the possibility of underlying cardiovascular issues.
As a urologist, I can’t stress enough the importance of a holistic approach to men’s health. Your sexual health isn’t isolated from the rest of your body – it’s intimately connected, particularly to your cardiovascular system. By maintaining good heart health, you’re not just protecting your life, you’re also preserving your quality of life, including your sexual function.
Remember, there’s no need to suffer in silence. If you’re concerned about your sexual or cardiovascular health, don’t hesitate to seek professional help. With proper care and attention, you can maintain both a healthy heart and a satisfying sex life well into your later years. No man is too old to have a sex life and no man with ED is too young to have a heart attack.
