Why your GP cares about erectile dysfunction

There is a reason a careful consultation about erectile dysfunction spends so much time on your heart. The association between ED and cardiovascular disease is one of the better-established findings in men's health, and it runs in a useful direction: the ED usually comes first.

The size of the vessels explains it

Penile arteries are roughly 1 to 2 mm across. Coronary arteries are 3 to 4 mm. When atherosclerotic plaque builds up at a similar rate throughout the arterial tree, it produces a noticeable narrowing in the smaller vessel considerably earlier. The symptom you notice in the bedroom is the same disease process that eventually shows up in the chest.

Studies following men with ED and no known heart disease have consistently found a raised rate of cardiac events over the following years, with the interval typically falling between three and five years.

What to ask for

• Blood pressure, measured properly rather than once in a rush
• A lipid profile
• HbA1c, to check for diabetes or pre-diabetes
• A QRISK score, which combines these into a ten-year cardiovascular risk
• Morning testosterone, if desire has dropped as well

The symptoms that mean stop

Sex is moderate physical exertion, comparable to climbing two flights of stairs. If you get chest pain, unusual breathlessness or palpitations during sex or exercise, that needs assessing before any treatment for ED is started. A consultation that does not ask you about this is not doing its job.

The same applies if you have had a heart attack, stroke or significant arrhythmia in the last six months, or if a doctor has told you to avoid strenuous activity. In those situations the right answer is a face-to-face assessment, not an online prescription.

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