2. Why erectile dysfunction
• This topic is often laughed at, but can be symptom
of current/future problems
• This topic is often uncomfortable for both the
practioner and the patient due to stigma
• This topic is often ignored by students
3. What is erectile dysfunction
• According to Stacy Elliot, MD, erectile dysfunction is
defined as “the persistent inability to attain and
maintain an erection sufficient to permit satisfactory
sexual performance”
• Sexual performance:
• Intercourse
• Masturbation
• Same gender sexual activity
• or other stimulatory methods
Elliott, S. L. (2011). Hot topics in erectile dysfunction. BC Medical Journal, 480-486.
4. What is an erection and what causes erectile
dysfunction?
• When a male is sexually stimulated/aroused, blood will
engorge the penis allowing sexual activities to
commence.
• Erectile difficulties are often the result of inadequate
blood inflow due to:
• cardiovascular disease
• obesity related, smoking, hypercholesterolemia
• Diabetes
• metabolic syndrome
• disrupted neurological signals
• SSRIs used to treat depression
• venous leaks
Elliott, S. L. (2011). Hot topics in erectile dysfunction. BC Medical Journal, 480-486.
5. Pathway to an erection
• an erection is dependent on the nitric oxide-cyclic
guanosine monophosphate pathway
• at penile nerve endings and healthy endothelial lining
• these areas can be damaged
by hypertension,
hyperlipidemia, and smoking
http://www.nature.com/ijir/journal/v20/n4/fig_tab/ijir20084f1.html
Elliott, S. L. (2011). Hot topics in erectile dysfunction. BC Medical
Journal, 480-486.
6. Cardiovascular disease
• Cardiovascular disease can affect the ability to
maintain an erection
• Erectile dysfunction can be used as a marker for
physicians to discuss cardiovascular disease and
prevent fatal heart attacks
• Potentially the most efficient predictor of silent
coronary artery disease in diabetic population**
** Corona, G., Monami, M., Boddi, V., Cameron-Smith, M., Lotti, F., De Vita, G., & …Maggi,
Elliott, S. L. (2011). Hot topics in erectile
M. (2010). Male Sexuality and Cardiovascualr Risk. A Cohort Study in Patients with Erectile
dysfunction. BC Medical Journal, 480-486.
Dysfunction. Journal of Sexual Medicine, 7(5), 1918-1927. Doi.
10.1111/j.17436109.2010.01744.x
7. Cardiovascular (cont.)
• Cohort study on patients with erectile dysfunction
• 13 item structured interview of 1,697 patients
followed for an average of 4 years
• 159 patients suffered a major cardiovascular event
• 15 were fatal
• 85 were ischemic heart disease
• 41 of these were acute myocardial infarction
• 40 cerebral (stroke or transient ischemic attack)
• 14 peripheral artery disease
Corona, G., Monami, M., Boddi, V., Cameron-Smith, M., Lotti, F., De Vita, G., & …Maggi, M.
(2010). Male Sexuality and Cardiovascualr Risk. A Cohort Study in Patients with Erectile
Dysfunction. Journal of Sexual Medicine, 7(5), 1918-1927. Doi.
10.1111/j.17436109.2010.01744.x
8. Cardiovascular (cont.)
• That erectile dysfunction shows early coronary
artery disease due to smaller arteries when
compared to coronary arteries.
• Individuals with severe erectile dysfunction has an
80% increased risk for cardiovascular disease
• Erectile dysfunction can be used as indicator of
future cardiovascular disease
Corona, G., Monami, M., Boddi, V., Cameron-Smith, M., Lotti, F., De Vita, G., & …Maggi, M.
(2010). Male Sexuality and Cardiovascualr Risk. A Cohort Study in Patients with Erectile
Dysfunction. Journal of Sexual Medicine, 7(5), 1918-1927. Doi.
10.1111/j.17436109.2010.01744.x
9. Diabetes and Erectile dysfunction
• Erectile dysfunction is a common side effect of
diabetes and 36% of men with diabetes will
experience some for of erectile dysfunction
• Erectile function is dependent on the patients age,
need for insulin, glucose control, and how long the
patient has been diagnosed with diabetes
• Men who are diabetic should be routinely asked
about erectile dysfunction and that blood glucose
monitoring is not enough to determine if a patient is
likely to experience erectile dysfunction
Tyagi, S., & Roy, R. K. (2010). Effective therapy for the managment of erectile
dysfunction in men with diabetes mellitus: a review. International Journal of Pharma and Bio Sciences, 1(2), 1-12.
10. Other causes of erectile dysfunction
• Erectile dysfunction can be linked to metabolic
disease and lowered testosterone
• Caused by the natural decline in testosterone in the
aging male, which in turn, also plays a part in the
build up of central fat deposits leading to
metabolic syndrome
• Visceral adipose tissue is an endocrine organ and is
directly related to cardiac risk.** **Traish, A. M., Feeley, R., & Guay, A. (2009).
Mechanisms of obesity and related
pathologies: Androgen deficiency and
Yassin, A. A., Akhras, F., El-Sakka, A. I., & Saad, F. (2010). Cardiovascular diseases
endothelial dysfunction may be the link between
and erectile dysfunction: the two faces of the coin of androgen deficiency. Andrologia, 1-8.
obesity and erectile dysfunction. FEBS Journal,
(276), 5755-5767.
11. Other causes of erectile dysfunction
• Obesity also leads to increased insulin, glucose, C-
peptide levels, and reduced plasma testosterone
• Erectile dysfunction is much more common in men
with a BMI greater than or equal to 25 (59.3% in a
study of 158 men)
**Traish, A. M., Feeley, R., & Guay, A. (2009).
Mechanisms of obesity and related
pathologies: Androgen deficiency and
endothelial dysfunction may be the link between
obesity and erectile dysfunction. FEBS Journal,
(276), 5755-5767.
12. Psychology and Erectile Dysfunction
• Sexual dysfunction can lead to:
• incompetence schema
• erection concern thoughts
• lack of erotic thoughts
• sadness
• continued erectile dysfunction all due to the
fact that many men believe they must have
continual successful sexual performance that
pleases sex partners 100% of the time
Nobre, P. (2010). Psychological determinants of erectile dysfunction: testing a cognitive-
emotional model.International Society for Sexual Medicine, (7), 1429-1437.
13. So in other words
My erection is a I’m older,
not dead
good indicator of
my health!
