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Erectile dysfunction may be more than just a problem in bed

Erection problems are common but they can be embarrassing for men to discuss with partners and doctors. The sales of erection drugs on the internet or billboard advertising are boosted by keeping erectile…

Discussions of erectile function can be challenging but it’s important for more than your sex life. Tom Small/Flickr

Erection problems are common but they can be embarrassing for men to discuss with partners and doctors.

The sales of erection drugs on the internet or billboard advertising are boosted by keeping erectile problems in the dark. They reinforce the idea that it’s an embarrassing problem that can be fixed without seeking help from doctors.

But this means men are missing out on an opportunity to improve their health.

Many men will be surprised to learn that erectile dysfunction affects about one in five men over the age of 40 and two in three men over 70. There’s also increasing research evidence linking erectile dysfunction with other general health problems, such as diabetes and heart disease.

And it’s becoming clearer that erectile dysfunction can be an early warning sign of chronic health conditions, but many men and some doctors still don’t appreciate this.

Erectile dysfunction and diabetes

The greater risk of erectile problems in men with diabetes has been known for some time with studies estimating that up to four in five men with diabetes will have erectile dysfunction at some time in their lives. This is twice the rate in men without diabetes.

Diabetes can cause reduced blood flow to the penis or affect the function of penile blood vessels, making it more difficult to get an erection. It can also damage the nerves in the penis (and elsewhere in the body).

Diabetes is often associated with high blood pressure, high cholesterol and obesity – each of these is an independent risk factor for erectile dysfunction. Less commonly, the lower levels of testosterone in men with diabetes may contribute to erectile dysfunction.

Just as in men without diabetes, psychological issues including “performance anxiety” can also cause erectile dysfunction or make the situation worse once a man starts to experience erectile problems.

In some cases, men presenting with erectile dysfunction may have undiagnosed diabetes (or hypertension or high cholesterol). A blood glucose test from a doctor, and if levels are high, diabetes treatment, can help both the erectile problems and other health problems caused by diabetes.

Erectile dysfunction and cardiovascular disease

Erectile dysfunction is increasingly being recognised as an early warning sign of future cardiovascular disease, particularly coronary heart disease.

Erectile dysfunction can be an early warning sign of chronic health conditions. Len Matthews/Flickr, CC BY-NC-SA

An Australian study has shown about twice the risk of a later cardiovascular event (such as heart attack or stroke) in men aged 20 years or older with erectile dysfunction, compared to similarly aged men in the general population.

Men with diabetes and erectile dysfunction also have a higher risk of a subsequent cardiovascular event, than other men with diabetes.

The risk of a cardiovascular event after developing erectile dysfunction is similar to that of being a smoker or having a family history of coronary heart disease.

One study has shown that within a year of the first significant episode of erectile dysfunction in men aged 55 years or over, one in 50 had a major stroke or heart attack. And within five years, it was greater than one in ten men.

It seems that erectile dysfunction in younger men is an even stronger predictor of later cardiovascular disease than in older men.

The link between erectile dysfunction and cardiovascular disease is thought to be due to a common underlying vascular problem. As blood vessels in the penis are smaller, they may be affected earlier than other parts of the body, such as the heart.

In this instance, the penis acts as a window to the health of the circulatory system.

Getting checked out

The best way to get help for erectile problems is to see a doctor to discuss the problem.

Undergoing a general health check including measurement of cardiovascular disease risk factors including diabetes, hypertension, high lipid levels, smoking, obesity and low level of physical activity will help.

As will a discussion of psychosocial issues that might be contributing to the problem and the importance of restoring sexual function. In some cases, a testosterone measurement may be done.

Discussions of sexual issues and erectile function can be challenging for both doctors and men. But understanding more about erectile dysfunction, and its links with other health problems can be a motivating factor for men to take steps to improve their erectile function and general health.

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22 Comments sorted by

  1. Margaret Kalms

    Artist photographer

    This article is really sad. I know sex means a lot to men, yet it baffles me why so many men do not get sexual problems attended to. If there is something wrong with their cars, most men immediately go to the mechanic and fix the problem. So why don't you men attend to something that is so important to your sense of adulthood? As a woman, such neglect can seem very selfish. Your sexual problems affect us women who are in a relationship with you. If you say "Nothing is wrong." when we ask, then it is easy to think that your erection or other sexual problems are because you do not fancy us any more. So you loose your woman as well.
    A trip to the Dr could make all the difference. Please, men, get your health, even your sexual health checked regularly.

    1. bill parker


      In reply to Margaret Kalms

      I would concur with this. And I would also like to add that a very common condition in older men is Benign Prostatic Hyperplasia (BPH). This is a benign englargement of the prostate which can be managed by surgery and by the use of drugs such as Duodart and Avodart.

      At the very least getting a PSA test done regularly ( a one off is not adequate) is sensible. Then if the PSA is above normal range then something can be done; a biopsy perhaps.

    2. Michael Shand

      Software Tester

      In reply to Margaret Kalms

      Speaking for myself, sex isn't that important, much overhyped by almost everybody.

      The experience of a great meal is on par with great sex for me, free falling during a sky dive is actually more thrilling.

      You do feel this preasure if you are a man that if you don't act like a midless tool when it comes to sex then you are somehow less of a man - it's the inverse of women who are not ashamed of enjoying sex being thought of as less valuable as a women, obviously not to the same extent but overall people overhype it

    3. Jon Cassar


      In reply to Margaret Kalms

      As one of those 'ageing men' for whom sex is still important, I found that popping the odd Cialis worked wonders for me. The effect lasts for several days so it's not a case of having to jump straight onto the little lady. Spontaneity can still be maintained.
      At first the price in Australia staggered me - $180 for 8 tablets! But I started experimenting with the far cheaper overseas product which only costs $70 for 40 tabs.
      I don't need them all the time, just occasionally when I flag a bit.
      However, the pills don't work like an aphrodisiac, a man has to still feel sexual towards his partner.
      Well recommended. Don't be shy guys, some of my mates went for them once I opened up to them.

    4. Allan Gardiner


      In reply to Margaret Kalms

      Margaret, any woman suddenly discovering that she now has a male partner with erectile disfunction, and then throws all caution to the w_ind'elicately thinking that she'd be much better off being known as a *loose* woman, always puns..err..runs the risk of forever losing her fine upstanding man altogeth_er'ethismic, because it could cause him to want to start hanging loose himself a_s'well.

    5. Chris O'Neill

      Retired Way Before 70

      In reply to bill parker

      Ironically, getting PSA tests done is the last thing you want to do if you want to avoid erectile disfunction.

  2. Chris O'Neill

    Retired Way Before 70

    "They reinforce the idea that it’s an embarrassing problem that can be fixed without seeking help from doctors."

    Or maybe they don't expect doctors to think that erectile disfunction is a problem. After all, doctors are still one of the leading causes of erectile disfunction from overtreatment for prostate cancer: Prostatectomies items no. 37210 and 37211:

  3. Matty Silver
    Matty Silver is a Friend of The Conversation.

    Sex Therapist / Sex Commentator at Self Em

    Dear Doug,

    Excellent article, but I just like to add some of my experiences.

    As a sex therapist I see many young men with erectile dysfunction who have acquired performance anxiety. They may have had a bad experience once which was very upsetting and afterwards they experience great fear every time they engage in sexual intercourse, especially if it is with a new partner. They terrify themselves with thoughts of: 'will I get hard enough', 'will I keep it up', 'how long will I last' and 'will…

    Read more
    1. Michael Field

      logged in via email

      In reply to Matty Silver

      I wonder if doctors understand what a sex therapist does. I know I don't, so thank you for your comment. I assumed it was something to do with spicing up your sexual experience, but you are talking about dealing with a serious problem. Maybe most doctors are as ill informed as me.

  4. Sue Ieraci

    Public hospital clinician

    Thanks for the article.

    Another good reason to take erectile dysfunction off the billboards and back into general medical practice, where all the related vascular risk factors can be addressed.

  5. Neville Mattick
    Neville Mattick is a Friend of The Conversation.

    Grazier: ALP Member at A 4th Generation Grazing Station

    Thank you for the information in this submission.

    I believe that there is also a link between Sexual function and Prostate Health and that it is important for our bodies to do as designed; that is to move and work regularly.

  6. Ken Taylor

    Research Scientist at CSIRO

    I'm wondering how it is "that erectile dysfunction affects .. two in three men over 70" i.e 66% yet three in five i.e. 60% without diabetes don't "have erectile dysfunction at some time in their lives."

    Do a lot of men over 70 have diabetes or could it be that "erectile dysfunction" makes it more likely a man will live longer?

  7. Tim Allman

    Medical Software Developer

    I would have liked to have seen a definition of ED in the article. It's not at all clear what is normal and what is not.

    1. Jon Cassar


      In reply to Matty Silver

      All is not lost, guys. With Cialis and Viagra, you can still saddle up and head up to the hills. Nowadays you don't have to sing Willie Nelson's 'pecker song' -

      I have outlived my pecker.
      My nookie days are over,
      My pilot light is out.
      What used to be my sex appeal,
      Is now my water spout.
      Time was when, on its own accord,
      From my trousers it would spring.
      But now I've got a full time job,
      To find the fuckin' thing.
      It used to be embarrassing,
      The way it would behave.
      For every single morning,
      It would stand and watch me shave.
      Now as old age approaches,
      It sure gives me the blues.
      To see it hang its little head,
      And watch me tie my shoes!!

  8. Tom Hennessy


    "Successful treatment of erectile dysfunction and infertility by venesection in a patient with primary haemochromatosis"

    1. Tom Hennessy


      In reply to Tom Hennessy

      Porphyria, diagnosed by porphyrins, the backbone of a red blood cell, liberated when a red blood cell is destroyed, hemolysis, is induced by iron overload alone.
      "Experimental porphyria can be induced by iron overload alone"
      Porphyria is rescued in many cases by vitamin E.
      "Vitamin E In Porphyria"
      Vitamin E deficiency has been shown to increase hemolysis.
      "hemolysis, was used to indicate vitamin E deficiency"
      So, is it the iron causing the hemolysis, also explaining the erectile dysfunction found in those with hemochromatosis, successfully treated by venesection?
      "Successful treatment of erectile dysfunction and infertility by venesection in a patient with primary haemochromatosis"

    2. Tom Hennessy


      In reply to Tom Hennessy

      "An excess of iron, by destroying vitamin E and oxidizing the unsaturated fats in red blood cells, can contribute to hemolytic anemia, in which red cells are so fragile that they break down too fast."

  9. Siddharth Saini

    logged in via Facebook

    Erectile dysfunction can torment a man till the deepest reach of his mind. And if this happens at an age, as young as 20 years, everything seems topsy turvy. And from then on, many other things start to mess up. An Australian study recently suggested that men in the age frame of 20-30 with Erectile dysfunction are more likely to face a heart attack or heart stroke later in life, compared to men in the same age frame without erectile dysfunction. It is always the prevention that is to be taken care of and there will be no room left for cure to occur ... This can be done by learning all about Erectile dysfunction.