Losing an Erection is Not Lame

Everyone wants to win an election. Sometimes, when the incumbent loses, he may cry “Foul!”. Others may chide the electorate for being ungrateful. To the introspects, attempt to find out the reasons for the loss and then make appropriate adjustments, in the hope to win in the next round.

Yes, similar to losing the election, it may also be a big deal for a man who fails to obtain an erection. Some are terrified and have reckoned it to losing his manhood. On the other hand, its presence may be a subtle warning, providing him with an opportunity to take better care of his heart health. Erectile dysfunction is a taboo subject in conservative Asian societies. It may be embarrassing for a man to make it known that he is unable to achieve or maintain a penile erection that is adequate for satisfactory sexual performance.

Surprisingly, this is not an uncommon condition. Some researchers have estimated that as many as 2 out of 5 men over the age of 40 years suffer from erectile dysfunction, albeit to varying degrees. In Singapore, this figure was estimated to be astonishingly even higher, at about 50% for men over the age of 30 years. Following the local ethnic trend of heart attacks, the prevalence was highest among Indians, followed by Malays, and then Chinese.

Similar channels

Indeed, erectile dysfunction is known to occur more frequently among patients with heart disease. Men with erectile dysfunction are also associated with a higher subsequent risk of cardiovascular complications, even for those without pre-existing heart disease. Among the group of previously otherwise healthy individuals, erectile dysfunction may precede the occurrence of stroke or heart disorders by an average of 3 years! As such, failing an erection is a warning sign for coronary disease for men.

Of the various cardiovascular disorders, disease of blood vessels is the most prevalent. These are channels or conduits to carry blood to the various parts of the body. Being smaller in calibre, as compared to coronary or cerebral arteries, the blood flow may be restricted earlier in the penile blood vessels than in the other organs when narrowing starts to develop.

To achieve an erection, the arteries need to relax to allow a greater amount of blood to enter the organ. Outflow is simultaneously reduced to allow the accumulated blood to form the turgid tubular structure. This complex process, involving both the nervous and hormonal systems, also depends on the normal function of the lining of the artery,
otherwise known as the endothelium. When vascular health is poor, the ability of the endothelium to enlarge the blood vessel diminished correspondingly. As a result, the amount of blood flow is reduced and blood is unable to accumulate sufficiently to stiffen the organ.

This “small artery” hypothesis may account to the fact that erectile dysfunction may develop prior to the manifestation of heart disease or stroke. The degree of erectile dysfunction is associated with severity and extent of heart disease. Over a 6-year period, the overall chance of dying after suffering a heart attack or stroke is almost 50% higher for those with erectile dysfunction compared to those without.

Sharing Risks

Realising that they are diseases of the blood vessel, it is not surprising that the risk factors for developing heart disease and erectile dysfunction, such as increasing age, diabetes mellitus, hypertension, abnormal cholesterol level, obesity, smoking, alcohol consumption and sedentary lifestyle, are fairly similar. Since age is an important predictor for both conditions, this adverse relationship of other risk factors between erectile dysfunction and heart health are stronger for younger men. As discussed earlier, for those without heart disease or stroke, there is a window of opportunity 2 to 5 years for him to modify these risk factors aggressively to prevent one of these medical catastrophes.

Stand Up, Again

This disruption can be the body’s way of cautioning his heart health. Erectile dysfunction can become an issue in a relationship. Instead of showing displeasure, his vigilant partner can help to keep him healthy. She can persuade and encourage him to identify and treat the condition and the related risk factors accordingly. During a consultation, the doctor can evaluate for symptoms of heart disease and stroke, and look for the various disorders that are associated with erectile dysfunction and heart disease. Managing these conditions optimally will certainly improve both his physical and sexual well-being.

Since the diagnosis of erectile dysfunction suggests underlying or established cardiovascular disease, the risk associated with physical and sexual activity needs to be assessed as well. Overall, for individuals who engage in episodic physical activity, the rates of heart attack and sudden death are 3.5 and 5 times higher, respectively. Heart attack occurs almost 3 times higher for sexual activity. Therefore, by stratifying the likelihood for these adverse events, the physician can dispense appropriate advice. For those who are at high risk, further treatment may be required before resuming these activities.

Having sufficient physical activity, eating wisely, maintaining a healthy body weight, limiting the intake of alcohol and smoking cessation are the key elements in preventing cardiovascular disorders. Certainly, management of hypertension and diabetes mellitus should be optimised. Several of these recommendations for heart health are also effective in improving sexual function.

For those who are still unable to achieve or maintain erection, there are effective medicines to assist them. Except for nitrates (a type of medicine used to relax coronary arteries for patients with angina), the drugs that are used to treat erectile dysfunction can be used together with the other medications for glucose control, blood pressure and lipid-lowering. Therefore, these potentially life-saving therapeutic regimens should be continued as much as possible.

Regaining Control

But not all weak erection is due to physical illnesses. Performance anxiety, particularly for the young and the introverted, may be a cause for erectile dysfunction. Unlike those related to diseases, failure to achieve an adequate erection may be incidental and intermittent, such as when there is a conflict in the relationship. Alternatively, he may be suffering from a mood disorder or distraction from work and other situations. Other conditions such as pain, infection or premature ejaculation may also result in poor sexual performance. However, in other instances, for example, night or early morning erections are generally rigid in these men. Therefore, these circumstances are to be overcome to regain control.

In addition, several types of medicines, excessive alcohol consumption and smoking are known to cause erectile dysfunction. Antihistamines, which are frequently used for respiratory tract infection and allergies, blood pressure-lowering medicines and diuretics are some of the more common agents that are known to cause or aggravate the condition. When sexual performance is impaired only after a long period following their initiation, these medicines are less likely to be cause for erectile dysfunction. Disease progression is more likely to be the reason. Therefore, it is important to adhere to treatment regimens for heart disease, hypertension and diabetes which are vital, if not more crucial, in improving outcomes for this group of patients.

Act Now

When a man is unable to achieve an adequate erection, it is not the end of his world. A second chance is offered to those who are man enough to stand up for the challenge. Instead of being limp and flaccid, take action and raise up to take control by improving your health and quality of life.

Article is contributed by Dr Mak Koon Hou, Assistant Honorary Secretary of the Singapore Heart Foundation. He is also a cardiologist in private practice.