Erectile Dysfunction May Be Warning Sign

Jan. 20, 2004 -- Problems in the bedroom may actually be the first sign of problems in blood vessels in other parts of the body for men who suffer from erectile dysfunction.

A new study shows that erectile dysfunction (ED) or difficulty maintaining or achieving an erect penis sufficient for sexual intercourse may be a warning sign of blood vessel disease in other parts of the body in men without risk factors for heart disease.

"If a patient does have erectile dysfunction, then we can speculate that he probably has some early disease in other blood vessels in other parts of his body," says researcher Alan Bank, MD, of the St. Paul Heart Clinic in St. Paul, Minn., in a news release. "We don't know if these men are going to go on to develop heart attacks and strokes, but the next step is to look at men like this, and follow them out over time, and see if they are at risk for having other major vascular events."

ED and Blood Vessel Disease

Researchers say erectile dysfunction affects about 52% of men between ages 40 and 70 years, and the majority of cases are caused by conditions that affect blood flow to the penis, such as atherosclerosis and diabetes.

In this study, published in the Jan. 21 issue of the Journal of the American College of Cardiology, researchers compared 30 healthy men in their mid-40s, with no major symptoms of heart disease but suffered from erectile dysfunction with 27 age-matched men without ED.

Aside from the erectile dysfunction, the study showed that the two groups of men appeared similar. But the men with ED had abnormal findings on tests of blood vessel relaxation response. The men with ED also had lower responses to tests of how well the blood vessels relax in response to stimulation with nitrates which cause vessels to widen and fill with blood.

Bank says those findings indicate that the defect in men with erectile dysfunction appears to be in the muscle that surrounds the blood vessels rather than with the inner lining of the vessels. During an erection the muscles inside the penis relax causing arteries to fill with blood, swell, and lengthen.

"Not only is there a defect in the penile smooth muscle, there is also a defect in the smooth muscle in an artery in a different part of the body, the brachial artery in the arm. So we think there is a systemic or generalized defect in the ability of the smooth muscle to relax in response to nitrates," says Bank.

A New Reason to Ask About ED

Researchers say the study shows that doctors should ask their patients about erectile dysfunction because it may be an early sign of blood vessel disease in men without other known risk factors. They say more study will be needed to determine if men with ED but no other risk factors are actually more likely to develop heart disease.

In an editorial that accompanies the study, Melvin D. Cheitlin, MD, of the University of California San Francisco, agreed that physicians should evaluate erectile dysfunction patients for the presence of vascular disease.

"The important message here is that many patients with erectile dysfunction have a vascular mechanism similar to that seen in atherosclerosis and that its presence should alert the clinician to the possible presence or future development of vascular disease. To paraphrase Richardson and Vinik: 'A flagging penis should raise the red flag of warning to evaluate the patient for arterial disease elsewhere,'" writes Cheitlin.