Erectile dysfunction is not an easy topic to discuss, but it is one that affects many men. It is defined as the inability to attain or to maintain an erection sufficient enough to allow for a satisfactory sexual performance. It is important to point out that this does not just refer to the ability to engage in sexual intercourse, but also the ability to engage in sexual activity on one’s own through masturbation or to engage in other kinds of sexual activity with a partner.
One of the more challenging issues involved with understanding ED is the fact that erection, ejaculation, and orgasm are all separate on a neurological level. Because of this, some men may still be able to achieve an orgasm despite facing significant erectile problems, such as those that can be caused by diabetes, or alterations to the ejaculatory process that may be caused by a radical prostatectomy.
There are many causes of functional erectile difficulties. These may include an inadequate amount of blood inflow, as well as issues such as disruptions to the neurological process that causes erection or a venous leak. The pathophysiology behind the issue can include causes such as a low level of sexual interest or poor central arousal, as well as medications that may affect one’s sexual abilities. Other various kinds of generalized medical conditions may also be the cause of ED.
Other metabolic and endothelial risk factors can be contributors to ED. These may include cardiovascular diseases, as well as lifestyle issue such as obesity, smoking, a lack of exercise or physical activity, and metabolic syndrome. Most men, particularly younger men, may find that they can reduce their risk of developing ED by modifying their lifestyle, such as by increasing their amount of exercise or by giving up smoking.
Another contributing factor when it comes to ED can be the potential damage caused by issues such as hypertension, hyperlipidemia, smoking, and other problems to the source of eNO in the body, these two main sources being the penile nerve endings and healthy endothelial lining. Men who have any of these conditions may therefore be at higher risk for ED than others.
Additionally, there are various causes for neurological ED. Among them are neurological conditions that include traumatic brain injury, Parkinson Disease, and MS. Additionally, men who have undergone any kind of abdominal, pelvic, bladder, or prostate surgery that could interfere with peripheral nerve innervation may find that they are at higher risk. Any kind of radical prostatectomy, including those performed through open, laparascopic, or robotic procedures, can often result in ED regardless of whether nerve-sparing operative techniques were used. This is because of both nerve and hemodynamic damage.
Incompetence of the veno-occlusive mechanism is another factor that can lead to poor erectile function. Causes for this kind of issue can include aging as well as issues such as Peyronies disease and low testosterone in addition to factors such as surgical or congenital issues that may have been caused by a deeper venous leak. Additional lower urinary tract symptoms (LUTS) may also be considered an independent risk factor for ED. There may also be shared pathophysiological mechanisms between them.
Finally, one factor that is important to point out is that men who have been diagnosed with diabetes may have ED that is secondary to neuropathy, vascular factors that include both small vessel and large vessel disease, as well as various structural and functional abnormalities within the corpus cavernosum. Additionally, glycemic control can have an effect on the quality of a man’s erections if he has diabetes. Other factors in ED may include hypogonadism and hypothyroidism.
How ED can be used as an Indicator of Vascular Health
Numerous studies have been done that confirm the ability of ED to help indicate cardiovascular disease. When physicians identify ED as a presenting symptom, they can help to improve his health prior to his first cardiovascular event, which in severe cases could be something as serious as a sudden cardiac death.
It is such a good indicator is because the penile arteries are much smaller than the coronary arteries, carotid arteries, and femoral arteries, at about 1 to 2 mm in diameter compared to 3 to 4 mm in diameter, 5 to 7 mm in diameter, and 6 to 8 mm in diameter respectively. That means that the same amount of plaque buildup in the penile arteries can have a much more substantial effect on blood flow. This means that ED symptoms can present themselves long before a myocardial infarction or a stroke.
In fact, a study performed in 2006 found that ED symptoms could present as early as 3 years sooner on average than other symptoms of coronary artery disease that can occur. The study also found that all of those patients within the study who had both type 1 diabetes and ED developed sexual dysfunction before the onset of CAD.
In general, findings indicated that incidences of erectile dysfunction had at least an equal or potentially even greater effect on other cardiovascular events that subsequently followed, including stroke, transient ischemic attack, congestive heart failure, and cardiac arrhythmia as factors such as a history of MI or smoking.
Another study that examined the relation of ED to vascular diseases found that moderate to severe ED could be associated with a 65% relative risk increase of coronary heart disease and a 43% increased relative risk of stroke within 10 years of its onset.
While these findings are relevant to all men who suffer from ED, it is a particularly important finding for younger men who may still be suffering from asymptomatic vascular disease. This makes ED a crucial marker in identifying the potential for disease and for prompting lifestyle changes as well as preventative intervention.