Erectile dysfunction is not about sex in the bedroom. In many men, it is the first sign that something is wrong with their heart.
In the United States, an estimated 30 million men have ED. It’s more likely to occur as you get older, and is found in around 15 percent of men in their 40s and 50s, and in almost half of men in their 60s.
When a man has difficulty getting or keeping an erection, his body is giving him a warning sign that his heart is not in good health, before the heart attack ever occurs.
It happens because blood arteries in the penis are much smaller than arteries that feed the heart. Your heart has coronary arteries that are 3-4 mm wide, while penile arteries are just 1 to 2 millimeters. They get blocked up quicker as they are smaller. Plaque starts to build up, and blood supply gets cut off 3-5 years before a major cardiovascular event, such as a heart attack or stroke.
What is Erectile Dysfunction?
Erectile Dysfunction is an inability to get or keep an erection to make sex enjoyable. The important word here is consistent inability. Stress, fatigue, or drinking alcohol from time to time can cause some problems with getting and keeping an erection, but this is not a medical issue.
Erectile dysfunction is a pattern that occurs regularly over weeks or months and reflects a deep physiological problem.
Erectile dysfunction is a vascular and neurologic phenomenon with identifiable causes, treatable with effective therapies.
To get an erection, the inner lining of your blood vessels (the endothelium) needs to produce nitric oxide. Nitric oxide causes the smooth muscle in the arteries to relax, which causes blood to flow rapidly into the artery. Your blood vessels have stopped making nitric oxide, so they don’t expand as they should. This same process is responsible for heart disease.
Causes of Erectile Dysfunction
There are numerous causes of ED, and we group them into those that impair blood flow and arterial health. The following are some of the other causes of erectile dysfunction:
1. Vascular Causes
Vascular disease refers to a disease of the blood vessels and is the most frequent physical cause of erectile dysfunction.
The arteries of the penis are small. But the coronary arteries of the heart are larger. Once endothelial dysfunction starts, it first affects the smaller penile arteries.
The smaller size of penile arteries compared with coronary arteries may explain why the same level of endothelial dysfunction can cause a reduction of blood flow in erectile tissues compared with that in coronary circulation.
That is why many men feel that erectile dysfunction often occurs years before heart disease. The blood vessels of the penis are just more susceptible to early vascular damage than the larger coronary blood vessels.
2. Hormonal Causes
Low Testosterone can lead to a low libido and affect erectile function.
Also:
- Thyroid dysfunction, both hypo and hyperthyroidism, affects sexual function.
- High prolactin levels can suppress testosterone and cause erectile dysfunction.
- Hormone imbalance due to diabetes can also cause erectile dysfunction.
3. Autonomic Nervous System Imbalance
Erections are provoked and sustained by nerve signals in the autonomic nervous system. The nerves can be damaged by diabetes, multiple sclerosis, spinal cord injury, Parkinson’s disease, and pelvic surgery. These directly affect erectile function.
In addition to these factors, here are some other conditions that can contribute to ED:
- Atherosclerosis
- High blood pressure
- Metabolic syndrome
- Parkinson’s or MS.
- Obstructive Sleep Apnea
- Peyronie’s disease (scars in the penis)
- Low testosterone
- Stroke
Also, Injuries to your penis, pelvic floor, or spinal cord can also cause severe erectile dysfunction.
4. Medications
There are various commonly used medications that list erectile dysfunction as a potential side effect. These include:
- Beta-blockers
- Blood pressure medications
- Some antidepressants, such as SSRIs and SNRIs
- H2 blockers like cimetidine
- Some antipsychotic medications
- Parkinson’s disease drugs
- Prostate cancer drugs
- Antiarrhythmics
- Sedatives
- Chemotherapy drugs
- Muscle relaxers
5. Psychological Causes
Physical causes are more common in older males, whereas psychological causes are more common in younger males and frequently occur in both males and females. Some common psychological causes of erectile dysfunction include:
- Anxiety
- depression
- Relationship stress,
- Performance anxiety
- Low self-esteem
6. Lifestyle Factors
Some other lifestyle factors that may contribute to erectile dysfunction are:
- Smoking
- Using drugs, including cocaine or marijuana,
- Obesity
- Excessive alcohol
- Sedentary lifestyle
- Poor sleep
Erectile Dysfunction and Heart Disease
There is a connection between erectile dysfunction and heart disease. Both rely on your healthy blood vessels. In addition, they have similar risk factors. Erectile dysfunction and heart disease can start with damage to the inner lining of blood vessels (endothelium).
When the lining is not working as it should, it lessens blood flow throughout your body. This is referred to as endothelial dysfunction. Endothelial dysfunction causes poor blood supply to the heart. And it reduces blood flow to the penis.
Erectile dysfunction can be an early warning sign of cardiovascular events and may be a useful tool to select men at high risk for major cardiovascular disease. Studies also showed a higher risk of cardiovascular diseases, coronary heart disease, cardiovascular-related mortality, myocardial infarction, and stroke in patients with erectile dysfunction.
Erectile dysfunction and heart disease share common risk factors, such as:
- Hypertension
- Type 2 diabetes
- High cholesterol
- Smoking
- Obesity
- Sedentary lifestyle
- Metabolic syndrome
If you experience erectile dysfunction, especially if you are under 60 years of age and there is no clear cause such as trauma or stress, you should have a cardiovascular assessment.
Does Lisinopril Cause Erectile Dysfunction?
Many men suspect their prescriptions are to blame when sexual issues arise. A very common question is: Does lisinopril cause erectile dysfunction?
Lisinopril is an ACE inhibitor drug that is used to treat high blood pressure. The medical fact is that lisinopril is actually one of the most erectile-dysfunction-friendly blood pressure drugs available. It is effective because it prevents angiotensin II from narrowing blood vessels. By blocking it, lisinopril helps keep your arteries open, which should theoretically help blood flow.
Lisinopril causes erectile dysfunction in less than 1 percent of men. For most men with high blood pressure, lisinopril may actually help with erectile dysfunction.
If you are taking lisinopril and you have ED, the drug is unlikely to be responsible for that symptom. The actual cause is the underlying high blood pressure that initially caused the damage to the arteries. Around 35% or more of men who suffer from high blood pressure also experience erectile dysfunction. If you are taking lisinopril for blood pressure, you are more likely to keep blood vessels healthy and blood flowing to the penis.
Note that some other blood pressure medications, specifically beta-blockers and diuretics, are well-known to frequently cause sexual side effects.
Medications that do cause erectile dysfunction:
- The beta-blockers, especially the older ones such as metoprolol and atenolol
- Thiazide diuretics such as hydrochlorothiazide or chlorthalidone
- Spironolactone with anti-androgenic effects
If you are taking one of these and experiencing erectile dysfunction, speak with your provider for an alternative medication.
Erectile Dysfunction Symptoms
Not all erectile problems are worth checking with your doctor. However, these patterns do.
Seek evaluation if:
- Erectile dysfunction is for four or more weeks
- You are under the age of 50, and you are developing ED for the first time and have no clear psychological cause for the development.
- Erections have progressively gotten less firm over months or years
- You have any heart disease risk factors, including high blood pressure, diabetes, high cholesterol, smoking, or a family history of heart disease
- Experiencing erectile dysfunction, as well as chest tightness, shortness of breath, or fatigue with exercise
Root Cause Treatment for Erectile Dysfunction
First-line treatment for erectile dysfunction needs to target endothelial repair and calm the arterial inflammation.
1. Restore Your Nitric Oxide Naturally
Don’t use a pill to open your vessels. There are supplements available, such as L-Citrulline or L-Arginine, that can help increase nitric oxide production in the body. Exercise and exposure to sunlight are also natural triggers for nitric oxide production when you breathe through your nose.
2. Reverse Insulin Resistance
If your blood sugar is damaging your blood vessels, the first step is to get control of your blood sugar. Drink water and avoid processed carbohydrates and added sugars. Try to eat foods rich in protein and good fats that will help maintain lower insulin levels and help heal your blood vessels.
3. Optimize Your Testosterone
Low testosterone means that your blood vessels are becoming less flexible. Getting your levels to an optimal range improves your erectile function and protects your heart.
4. Get Advanced Cardiovascular Testing
Plaque is not apparent in a standard lipid panel. You’ll need an advanced NMR LipoProfile to see particle size, a Coronary Artery Calcium (CAC) scan to determine whether or not plaque has already developed in your heart, and markers such as ApoB and Lp(a).
5. Lose excess weight
Obesity is a modifiable risk factor for erectile dysfunction. Losing weight can have beneficial effects on testosterone, inflammation, vascular function, and erectile function directly.
6. Stop smoking
Smoking is one of the most powerful factors that cause endothelial dysfunction. Quitting smoking at any age will have a positive impact on your vascular health and erectile function.
Bottom Line
Erectile dysfunction is a highly accurate, early warning sign of heart disease. Taking an erectile dysfunction medication without assessing your heart and blood vessel health is a huge opportunity that you are missing to save your life.
At Kairos Integrative Care, Lola, one of our integrative nurse practitioners, will find out the exact causes of erectile dysfunction and develop a personalized, root-cause plan for you to restore vascular health and regain your confidence.
We serve patients in Houston, Sugar Land, and nearby zip codes 77046 & 77478 and accept most major insurance plans, including Aetna, Cigna, BCBS, UnitedHealthcare, Tricare, and more.
New patients are always welcome, and if visiting the clinic isn’t possible, telemedicine appointments are available across Texas.
Book your appointment today.
