A Tale of Two EDs: Endothelial Dysfunction and Erectile Dysfunction

An integral part of proper erectile function is blood flow, and if you're experiencing any sort of erectile dysfunction (ED), a potential source of the problem could be farther north.

"Ultimately, erections are a product of the vascular system working, and ED can manifest itself as a result of other conditions affecting that blood flow, as the blood vessels in the penis are smaller," said Michael Eisenberg, M.D., director of Men's Health at Stanford University.

The scientific name for one of the overarching issues with vascular health is endothelial dysfunction, which refers to the inability of specific muscle cells lining the arteries to relax, preventing vessel dilation and, thus, controlling blood pressure.

Why it's different from other cardiovascular conditions

Blood vessels can become stiff due to ongoing cardiovascular problems, and it can take years before you see the damage manifest through endothelial dysfunction, according to T. Mike Hsieh, M.D., a professor of urology at the University of California at San Diego and director of the university's Men's Health Center. The dysfunctional action occurs when the blood vessels can't properly dilate and constrict, which is taxing on the heart and kidneys, among other organs.

How endothelial dysfunction occurs in the body

Diagnosing endothelial dysfunction starts with the basics.

"Primary care doctors initially look at a broad overview of a patient's health: blood pressure, cholesterol, many of those vascular markers," Eisenberg said.

Endothelial dysfunction doesn't happen overnight. In most men, this type of cardiovascular disease is the result of lifestyle choices: Years—potentially decades—of poor diet, little exercise and a lack of awareness, which Eisenberg attributes to irregular preventive checkups.

Men with diabetes and other preexisting cardiovascular conditions are at a higher risk of developing endothelial dysfunction and could encounter a higher and earlier risk of erectile dysfunction due to the blood flow issue.

In a 2003 study published in the journal European Urology, researchers looked at the medical and sexual history of 300 patients with acute chest pain and coronary artery disease. The prevalence of some level of erectile dysfunction was 49 percent, and 100 percent of the patients with both type 1 diabetes and ED developed sexual dysfunction before the onset of coronary artery disease.

Giddy urologist Dr. Edwin Morales explains in depth how certain medical conditions, including heart disease and diabetes, can affect blood flow and erectile function. Click here to watch the video.

In older men, decreased testosterone may play a role in the development of endothelial dysfunction. A 2007 study in the journal Hypertension Research indicated lower testosterone levels may contribute to endothelial dysfunction—and, thus, erectile dysfunction—as the hormone's ability to protect portions of the endothelium may decrease over time.

ED as a sign of ED

Eisenberg noted that when men show signs of erectile dysfunction—which can happen at any age—cardiovascular testing can illustrate the best next steps.

"The penis is a 'use it or lose it' organ," Eisenberg said. "The longer it's out of whack, the less proper function we can preserve."

Since the development of endothelial dysfunction is a slow process, making better lifestyle choices is arguably the single most important step a man can take to curb and limit both kinds of ED—and, potentially, more significant cardiovascular issues. Not only are you doing something good for your sexual health, but a quality diet and regular exercise can help ward off heart attack and stroke, and keep your blood sugar in check.