fbpx Heart Health and Sexual Health: A Q&A With the SMSNA
The logo for the Sexual Medicine Society of North America is against a pink background of faded hearts.

Heart Health and Sexual Health: A Q&A With the SMSNA

The president of the Sexual Medicine Society of North America wants to raise awareness.
Written by

Lauren Dodd

One of the first signs of a future heart attack in men can often be spotted years before a cardiac event. And it has a lot to do with their penis. Wait, what?

Yep, as the obesity and diabetes epidemics continue to worsen, young adult men need to know erectile dysfunction (ED) is often the most common harbinger of heart problems to come.

About 20.1 million adults older than age 20 have coronary artery disease, the most common type of heart disease. It killed 382,820 people in 2020, according to the Centers for Disease Control and Prevention (CDC).

February is Heart Health Awareness Month, and to raise awareness about the sexual health side of the equation, Giddy spoke with the president of the Sexual Medicine Society of North America (SMSNA), Mohit Khera, M.D., a Houston urologist, about the strong link between your heart and your private parts.

Editor's note: This article has been edited for clarity.

How are sexual health and heart health related? And how important is it for patients to understand that relationship?

Khera: Erectile dysfunction [ED] and cardiovascular disease share the same risk factors; for example, hypertension, diabetes, obesity, hyperlipidemia. The same risk factors for ED are the very same risk factors for cardiovascular disease. So it's not surprising that many men who have ED also have cardiovascular disease and vice versa. In fact, and this is the take-home message, numerous studies have shown that if a man develops erectile dysfunction today, they're more likely to have a heart attack or stroke in the near future. One of the earlier studies came out in 2005 by Ian Thompson, where it showed that if a man gets erectile dysfunction, it said that 15 percent of them had a heart attack or cardiovascular event within seven years, [and] that when men presented for a heart attack in the emergency room, many of them had ED that had started roughly three years earlier. So we believe that ED is one of the first signs of cardiovascular disease or having a cardiac event.

What are the theories as to why they're so closely connected?

Now it gets more interesting. How do you explain this? There are several theories. I'll give you two of many. One is the thought that these risk factors cause something called endothelial dysfunction. The endothelium is the lining of the blood vessels. When they get injured, it gets very difficult for them to contract and relax, and you start developing a plaque. When you get a plaque on the endothelium, that can result in decreased blood flow to the organ, meaning the heart or the penis. So the common link between ED and cardiovascular disease, as many people believe, is the endothelial dysfunction that occurs.

The second theory is called the arterial diameter theory, which states: We know that the smallest arteries are the penile arteries, which are 1 to 2 millimeters. The coronary arteries are 3 to 4 millimeters. The carotid artery is roughly 5 to 6 or 7 millimeters. So you're more likely to have a blockage in the small arteries first, before you see a blockage in the coronary arteries. So there's an order that occurs here. That's maybe another reason.

These are just theories, because there are some flaws in both theories. But irrespective of which theory you believe in, we know that ED is the first sign of cardiovascular disease. That's a really important point.

It sounds like cardiologists and urologists have more in common than people might think.

If you think endothelial dysfunction is the common link between ED and cardiovascular disease, then the cardiologists have already shown how to improve endothelial dysfunction and reverse cardiovascular disease. And they've done it with numerous things. Diet and exercise can improve endothelial dysfunction and cardiovascular disease; weight loss can help as well. Well, in urology, we have shown as well that actually improving endothelial dysfunction can also improve erectile dysfunction.

Some of the best studies were by Dr. Esposito, where she showed that diet and exercise alone not only improved endothelial dysfunction, but it also improved erectile dysfunction. Not only does it work for cardiologists, but we also can reverse ED simply by reversing endothelial dysfunction.

How can younger people best protect their heart and sexual health before it's too late?

If a young man presents with ED, many times it's usually psychogenic, meaning there's usually a psychological cause. However, if a young man presents with ED and has cardiovascular risk factors—let's say he's obese, let's say he has diabetes or hyperlipidemia, or if he has two or more risk factors—that patient should have a cardiac evaluation because they may have cardiovascular disease. If they come in to me and they are obese and a smoker, that patient should get evaluated for cardiovascular disease. You can find it in those patients, and that is really important because it could potentially save your life.

What are the common misconceptions you hear from patients about ED?

I think many people who see young men who have ED assume that it's psychological in nature. But what they have to realize is that it could have an organic cause and it could be the first signs of cardiovascular disease in that young man. So don't just assume it's just psychological in nature. There could be an underlying cause. And it could be the first sign of cardiovascular disease.

What are your diet and exercise suggestions for folks suffering from ED?

If someone comes into my office for ED, the first step is lifestyle modification. The following is what we suggest: diet and exercise. I typically recommend a Mediterranean diet. It has been shown to actually improve sexual function. Exercise. The recommendation from the American Heart Association is at least two and a half hours a week of cardiovascular exercise. That's very important. Not only exercise, but also sleep is very important. Patients who are fatigued are more likely to have ED. Remember the four pillars are diet, exercise, sleep and stress reduction. Each one of these can do it.

There are also modifiable risks. You can stop smoking, which is important; you can lose weight, also important; and you can improve your insulin resistance and diabetes. Diet, exercise, sleep and stress reduction are all very important.

As the obesity epidemic gets worse, are you seeing younger patients enter your office more often?

Yes, that is true. The diabetes and obesity rates in the United States have significantly skyrocketed. Both of these have significantly led to increases in ED rates.

Is sex good for heart health? Is it seen as a heart-healthy cardiac exercise activity?

I think it's hard to define a directional relationship. We do know healthier people tend to have more sex. So that's interesting. It does require some cardiac reserve. I'd definitely say that those patients who are healthier do tend to engage in more frequent sexual activity.