Living With Heart Conditions and ED

Men with a heart condition often experience impotence or erectile dysfunction (ED). If you've ever experienced difficulty in achieving or maintaining an erection during sex or noticed a drop in libido, you've encountered symptoms of ED.

For any man, a recurrence of ED is worrisome, but the added fear of whether your heart is healthy enough for sex can lead to depression and anxiety. These psychological symptoms reduce feelings of sexual excitement, worsen erectile dysfunction and may lead to a higher risk of heart disease. Diseases such as diabetes, prescription medications, physical injuries, mental health disorders, lifestyle choices and other risk factors contribute to erectile dysfunction.

A 2010 meta-analysis of seven studies on ED and cardiovascular risk published in the Journal of Sexual Medicine indicated an association between erectile dysfunction and an increased risk of heart disease. This does not necessarily mean if you have ED, you also have an underlying heart problem. However, it does mean you should get screened for heart disease before starting any ED treatment or medication.

In a 2018 study published in the American Heart Association's Circulation journal, researchers suggested ED is a powerful predictor of the risk of cardiovascular disease. About 1,900 men ages 60 to 78 were found to be twice as likely to have a cardiac event if they reported having erectile dysfunction.

An overview of heart health and ED

Erections are a result of nerve impulses stimulated by sexual arousal, which increases blood flow to sponge-like tissues along the shaft of the penis. The sudden flow of blood to these tissues causes an erection by enlarging, straightening and hardening the penis. The brain, hormones and emotions all play a role in sexual arousal, but blood flow from a healthy heart and arteries is vital.

A healthy, pumping heart allows for blood to flow to all parts of your body. If your heart or arteries are damaged, the flow may be slowed or blocked, and you could be diagnosed with cardiovascular disease. Left untreated, cardiovascular disease can lead to a heart attack, chest pain (angina) or stroke. It can also be a cause of erectile dysfunction.

Men with cardiovascular disease may worry about having a heart attack during sex because physical activity will increase their heart rate. However, that risk is slim as long as the man does not experience chest pain, shortness of breath, nausea or indigestion, or an irregular heartbeat.

If you have no apparent cause or underlying problem for your ED, you should see your doctor and get screened for cardiovascular disease.

Daily effects of ED

Living with ED is difficult, with complications and negative impacts on your daily life, the most obvious being an unsatisfactory sex life. Other problems involve fertility, identity and masculinity.

Erectile dysfunction can impede your ability to ejaculate, making infertility a possible side effect. If you and your partner are attempting to get pregnant and find your ED is getting in the way, don't despair—other options are available. Talk to your doctor about in vitro fertilization (IVF) and other fertility treatments that can allow you to sidestep your sexual dysfunction and grow your family.

Many men with ED suffer a negative outlook toward their identity and masculinity. History and culture have always heavily conflated healthy erections with masculinity, so it can be difficult to be faced with the inability to get an erection. It's important to recognize that your identity as a man has nothing to do with your erections. Find solace in like-minded support groups, whether online or in person. If you need additional help, seek a therapist who can help you talk through those emotions and find healthy ways to resolve them.

A decline in pleasure from your sex life can lead to relationship problems, frustration, stress, anxiety, anger, embarrassment, low self-esteem and more. All these emotions play a role in how you function in your daily life, impacting your partner, your relationships with others and even your work life.

Although some people are embarrassed to discuss problems they may be having in the bedroom, don't hesitate. Go to the doctor if you have any symptoms of ED—they could reflect difficulties with heart health.

Sex and relationships with ED

Relationships with your sexual partner(s) can suffer because of ED, especially if you are too embarrassed or worried to talk about it. You may table the discussions without identifying the medical reasons and assume it's related to aging, stress or other factors.

If you're in a relationship and you're avoiding sex, your partner may worry that you're having an affair, you don't find them attractive anymore, you're watching too much pornography or you have an illness you're keeping secret.

From your partner's perspective, the list of possible reasons why you can't get an erection and why your sexual relationship has changed is as big as their imagination. It's imperative to talk openly and honestly about your health with your partner. Communication is key. Bring your partner to your next appointment and allow them to ask questions about your heart disease and its effects on your sexual function. Supply your partner with educational materials and literature so they can understand exactly what you're going through.

If you're undergoing treatment for erectile dysfunction and want to maintain intimacy with your partner, there are nonpenetrative sexual options. Kissing, cuddling and oral sex are all valid ways to keep you and your partner satisfied. Sometimes, eliminating the anxiety around penetrative performance can help alleviate the tension and allow for intimacy to continue.

Intimacy can be much more than just sexual satisfaction. Keeping the connection with your partner is paramount. If you and your partner need a little help, consider seeing a couples counselor. A professional can help identify the emotional or mental reasons affecting your ED, and give you a healthy, nonjudgmental space in which to work out any resentment or communication issues you and your partner are facing.

How to manage ED

Treatment for ED depends on a person's underlying cause, which may include:

• Diseases such as high blood pressure or cholesterol, diabetes, sleep disorders, Parkinson's disease, multiple sclerosis, metabolic syndrome, clogged blood vessels, Peyronie's disease (when scar tissue develops inside the penis), treatments for prostate cancer, or surgeries or injuries that affect the spinal cord or pelvic area
• Prescription and over-the-counter drugs, such as antihistamines, antidepressants, pain medication, or drugs for high blood pressure or prostate conditions
• Psychological or emotional issues, such as anxiety, depression or stress
• Other health-related risk factors and lifestyle choices, such as obesity, smoking, alcoholism or drug use, and inactivity

In each case, you'll need to follow your physician's orders. Once the underlying issue(s) is under control, more focus can be directed toward relieving the symptoms of erectile dysfunction.

Talk to your doctor

Talk to your primary care physician and/or a urologist about your ED. Any potentially serious underlying medical conditions, especially heart disease, will need attention.

Once your doctor has eliminated any potential underlying causes, you may be referred to a urologist. Urologists are doctors who specialize in diseases of the male reproductive system and the urinary tract. The urologist may perform additional testing to determine whether you have erectile dysfunction. The tests include:

• Blood tests can reveal low testosterone levels and thyroid issues, as well as diabetes and heart disease.
• Urine testscan show if you have diabetes or other diseases.
• Ultrasoundscan expose the blood vessels in the penis so a urologist can see if there's a blood flow problem.
• Injection testemploys medication injected into the penis to cause an erection. Your doctor can then evaluate the firmness and duration of your erection.
• Nocturnal penile tumescence (NPT) testis done via a portable, battery-operated device you wear on your thigh. The doctor can tell from this device what sort of nocturnal erections you're having. The device stores data the doctor can access later.

After testing, your doctor may be able to suggest several ED treatment options for your consideration, such as:

• Testosterone replacement therapy (TRT)
• Talk therapy to address issues such as stress, anxiety, post-traumatic stress disorder (PTSD) and depression
• Medications such as sildenafil (Viagra), vardenafil (Levitra), avanafil (Stendra) or tadalafil (Cialis)
• Mechanical aids such as vacuum devices and penile constriction rings
• Wearable devices such as Eddie by Giddy®
• Penile injection therapy
• Sex therapy
• Surgical options such as a penile implant
• Exercises such as yoga, aerobics or Kegel exercises to strengthen the pelvic floor

For the majority of men, ED is a treatable condition. Any treatment option you choose is likely to improve your physical, mental and sexual health, and your daily life. Additionally, treating ED in relation to possible heart problems is a way to prevent a more dangerous disease down the line.