The relationship between sexual and cardiovascular wellbeing is strong. One of the most common sexual disorders in men is erectile dysfunction, a multifactorial condition that can also be a symptom of heart disease. We talk about this topic with Dr. Alessandro Pizzocaro, andrologist of the Operating Unit of Endocrinology, and Dr. Maddalena Lettino specialist at the Cardiovascular Department of Humanitas.


Erectile Deficit

Erectile dysfunction is a condition characterized by the inability to achieve or maintain an erection to end a sexual intercourse. In the subject with erectile deficit, impulses start from the nervous system that induce relaxation of the muscles of the corpora cavernosa of the penis and also the increase of the blood flow in these districts.

One of the unalterable risk factors for erectile dysfunction is age. In fact, its incidence is beginning to increase after the age of 40. As the Italian Society of Urology points out, 65% of 70 year-old men are affected by sexual potency disorders. However, this condition is also related to the state of health of men. Erectile deficiency, in fact, can be caused by neurological, psychological, hormonal and even vascular problems. Diabetes mellitus, testosterone deficiency up to psychological disorders such as anxiety and depression are all related to erectile deficiency. Therefore, a multifactorial disorder is defined and thus to define the treatment of the dysfunction it is necessary to identify the underlying cause.

“Erectile dysfunction is not an “illness” but a symptom – explained Dr. Lettino. It shares all the risk factors with cardiovascular disease such as hypertension, dyslipidemia, diabetes, sedentariness, smoking and incorrect nutrition that leads to weight gain. Therefore, the first therapy is prevention, acting on lifestyle from a young age in order to avoid not only cardiovascular diseases but also erectile dysfunction”.


Heart and erectile dysfunction

Erectile deficiency is also related to metabolic syndrome, a group of conditions and diseases that can increase individual cardiovascular risk: increased blood sugar levels, hypertension, abdominal obesity, an increase in triglycerides and a reduction in “good” HDL cholesterol.

Numerous researches, among which a recently published study in Vascular Medicine has remembered how important it is to pay attention to the erectile dysfunction as factor of risk for cardiovascular health. This is because both cardiovascular disease and erectile dysfunction share the same risk factors that negatively affect the functioning of blood vessels in all body districts and therefore also those of the genital area.

“In the presence of the risk factors previously indicated, erectile dysfunction may be an indicator of vascular-metabolic disease – continued Dr. Lettino. Therefore, early diagnosis and correct treatment, educational and behavioral in addition to pharmacological, not only allow improving sexual function but can save lives in the future avoiding the risk of vascular events.

The researchers’ hypothesis is that dysfunction assessment could be a tool for risk stratification especially among young people. They therefore conducted a meta-analysis of 28 studies that examined the relationship between this condition and subclinical cardiovascular disease. They reported, in conclusion, a significant association between erectile deficit and impaired endothelial function. This is a marker of the ability of blood vessels to relax as well as an early sign of the development of vascular disease. Dysfunction was also associated with an increase in the mean intimal thickness of the carotid artery, an early marker of atherosclerosis.

Could erectile dysfunction be considered as a predictive factor in the development of subclinical and therefore silent cardiovascular disease, particularly in the 40s and 50s? “As previously said, erectile dysfunction is nota disorder solely of vascular nature and therefore it should be investigated in a complete way and on all possible causal fronts. If other pathologies are excluded and the vascular hypothesis should become prevalent, it is good to also think about the hypothesis of a multi-location vascular pathology and therefore evaluate cardiac involvement”, answers Dr. Lettino.

“Obviously, erectile dysfunction of vascular origin (as well as subclinical heart disease) is rarer in young people. After the age of 40, the above applies. It goes without saying that, in cases suggestive of vascular dysfunction, intervening preventively at this stage is much more useful in terms of the development of coronary artery disease. However, since sexual function does not depend only on “organic” factors, in addition to effective drug therapy to solve the sexual symptom, sometimes it is appropriate to resort to psychological support of “couple” therapy, also investigating the female sexuality. In fact, the involvement of both partners allows us to achieve a more effective and lasting result”, concludes the specialist.