About erectile dysfunction

Though erectile dysfunction is distressing, it isn’t life threatening. But heart disease can be. Erectile dysfunction — trouble keeping an erection sufficient for sex — can be an early warning sign of heart disease. Understanding the connections between erectile dysfunction and heart health can help you recognize signs and symptoms of heart disease early on. Likewise, if you have heart disease, getting the right treatment can help you maintain or improve erectile function. Factors linked to heart disease that can cause erectile dysfunction include:

  • Atherosclerosis. This damaging process reduces blood flow to your heart and contributes to coronary artery disease. It can also affect the blood vessels to the penis, causing erectile dysfunction. Conversely, if you’re having trouble with erections, it could be a sign that your heart is also at risk.
  • Medications. Some prescriptions that men take to protect their hearts can cause erectile dysfunction. Additionally, medications that are often prescribed for erectile dysfunction may not be safe when combined with certain heart medications.
  • Depression and anxiety. Researchers have found a connection between depression, heart disease and erectile dysfunction. Feeling anxious can also lead to erectile dysfunction. If you have heart disease, you may worry that having sex could trigger a heart attack.

Atherosclerosis, a buildup of plaques in arteries, can prevent enough blood flow from reaching your heart, legs and brain — and your penis. If atherosclerosis has made your arteries in one part of your body narrow and stiff, arteries elsewhere in your body are probably also affected. When atherosclerosis affects blood flow to your penis, the blood can’t sufficiently fill the penis to allow a suitable erection.

The same factors that raise your risk of atherosclerosis in the arteries in your penis also increase your chances of heart disease. Because the arteries supplying your penis are smaller than the ones to your heart, symptoms may first show up as erectile dysfunction. If you haven’t been diagnosed with heart problems, consider erectile dysfunction a wake-up call. It could be a warning sign that the blood vessels feeding your heart might also be in trouble.

A number of risk factors can contribute to both heart disease and erectile dysfunction. They include:

  • Diabetes. Men who have diabetes have more problems getting an erection than do men who don’t have diabetes. The problem is partially due to the diabetes-related damage to blood vessels that supply the penis.
  • Obesity. Overweight men are more likely to have heart disease and erectile dysfunction.
  • High cholesterol. A high level of low-density lipoprotein (LDL, or “bad”) cholesterol contributes to atherosclerosis in blood vessels, raising the risk of erectile dysfunction.
  • Smoking. Smoking cigarettes raises your risk of developing atherosclerosis. Not only does smoking increase your chances of heart disease, but it can make you nearly twice as likely to develop erectile dysfunction.
  • High blood pressure. Over time, high blood pressure damages the lining of your arteries and accelerates the process of atherosclerosis — which can lead to heart disease and erectile dysfunction.

Some medications that treat heart disease can make you more likely to develop erectile dysfunction. These include:

  • High blood pressure medications such as clonidine (Catapres), and beta blockers such as metoprolol (Lopressor)
  • Diuretics such as spironolactone (Aldactone), used for high blood pressure as well as heart failure

Although you can’t stop taking your medications, there may be other drug options that are less likely to cause erectile dysfunction. Discuss your symptoms and potential options with your doctor.

Medications prescribed for treatment of erectile dysfunction may cause significant side effects when mixed with certain heart drugs called nitrates.

Nitrates are often prescribed to reduce chest pain, dilate the blood vessels and lower blood pressure. Because erectile dysfunction medications, such as sildenafil (Viagra), also reduce blood pressure, combining these two types of medication can cause a dangerous drop in blood pressure.

Do not take sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) if you use nitrate medications (NitroBid, Nitro-Dur, Imdur, others) for chest pain.

If you have coronary artery disease or have had a heart attack in recent months, check with your doctor before you begin taking any of these drugs for erectile dysfunction.

Men who’ve had a heart attack or surgery to treat their heart disease are often anxious about resuming an active sex life. However, intercourse seldom causes heart attacks. Sexual activity with your usual partner in a familiar setting doesn’t lead to a particularly high blood pressure level or heart rate. Even if you’re at high risk of having a heart attack, weekly sexual activity only slightly raises the risk. Talk to your doctor about when you can resume sexual activity after you’ve had heart problems or surgery.

There’s mounting evidence that depression is associated with an increased chance of having heart problems — and erectile dysfunction. Work with your doctor to make sure you’re getting the right treatment if you’re feeling down. Treatment can help alleviate erectile dysfunction and may prevent heart problems.

Depression is treated with counseling and medications. Although treating depression can help with erectile dysfunction, some antidepressants have sexual side effects. If you do have bothersome sexual side effects, you may need to try another antidepressant. Your doctor can also decrease the dose or add another medication to offset the effects of the antidepressant on erectile dysfunction.

Seeing your doctor for erectile dysfunction may have a silver lining. It could be a tip-off that you have underlying health problems linked to heart disease that need to be checked out and treated. If your doctor thinks you may be at risk for heart disease, making simple lifestyle changes may be enough to help keep your heart healthy — and improve your ability to have an erection. If you have more serious signs and symptoms of heart disease, you may further tests or treatments.