Cardiovascular Issues in the Treatment of Erectile Dysfunction

The cardiovascular response to sexual activity worries a lot of men and women, particularly if a coronary or vascular event has already occurred. The fear of inducing another cardiac episode is fuelled by many myths including the assumption that sex is an extreme stress to the heart, driven to some extent by media/internet distortion. Adding the anxiety that treating ED may increase cardiac risk, and we have a recipe for relationship stress or breakdown and couple frustration. Many agree with the concept that ED is “a man’s problem but a couple’s concern” because it invariably is, though at times is not managed as such. Though this chapter addresses an organic condition, it is important not to compartmentalize ED too rigidly – men with organic ED may, and often do, have psychological problems as well, and men with a predominantly psychological etiology may also have organic issues.

Introduction

The link between erectile dysfunction (ED) and cardiovascular disease (CVD), specifically coronary artery disease (CAD), is now well established. We recognize that ED may be a marker for silent CAD as the common denominator in the majority of men over 30 years of age is endothelial dysfunction. In addition, up to 75% of men with CAD have some degree of ED, often presenting before the coronary event. The Second Princeton Consensus Conference, which focused on sexual dysfunction and cardiovascular risk, concluded that ED is a warning sign of vascular disease with the practical recommendation that a man with ED and no cardiac symptoms is a cardiac or vascular patient until proven otherwise. From these observations came the idea that ED in the absence of CAD symptoms offered an opportunity to reduce the risk of a coronary or vascular event by addressing the recognized CAD risk factors shared by ED and CAD. This proposal was strengthened by a series of publications pointing to an average time window of 3 years between ED and a CAD event.

The cardiovascular response to sexual activity worries a lot of men and women, particularly if a coronary or vascular event has already occurred. The fear of inducing another cardiac episode is fuelled by many myths including the assumption that sex is an extreme stress to the heart, driven to some extent by media/internet distortion. Adding the anxiety that treating ED may increase cardiac risk, and we have a recipe for relationship stress or breakdown and couple frustration. I have always liked the concept that ED is “a man’s problem but a couple’s concern” because it invariably is, though at times is not managed as such.

Therefore the cardiovascular issues that need to be addressed are:

  • Is sex safe statistically, but more importantly for the individual being counseled?
  • Can ED be safely treated in cardiac patients?
  • Can ED be a means of preventing subsequent CVD?

Though this chapter addresses an organic condition, it is important not to compartmentalize ED too rigidly – men with organic ED may, and often do, have psychological problems as well, and men with a predominantly psychological etiology may also have organic issues.

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