What Doctors Want ED Patients to Ask About Their Heart
It's difficult to make generalized statements about sexual health because so many sexual functions interact with physical and mental health in different ways for different patients. This is especially true for erectile dysfunction (ED), as the causal and correlative elements of this condition can be elusive and difficult to summarize.
However, there's one question having to do with ED that men shouldn't really need to ask anymore: Could my ED be indicative of other health problems such as heart disease?
The answer is, unequivocally, yes. ED can indicate or be a precursor of heart disease and other illnesses. In no way should the physiological inability to get or maintain an erection be regarded as a trivial matter.
"Potentially, men that have erectile dysfunction, if one may not know that they have heart disease, these are men that maybe need to be evaluated a little bit more carefully," said Ron Blankstein, M.D., a cardiologist at Brigham and Women's Hospital and a professor at Harvard Medical School in Boston. "Just like men that have any other risk factor—if somebody has high blood pressure, high cholesterol or is a smoker—those are all risk factors meaning that person is more likely to have heart disease. Well, the same thing is true for erectile dysfunction. If a man has erectile dysfunction, they have a higher risk of having heart disease."
Knowing this much is a start, but so is knowing what kinds of questions you should ask your doctor when ED becomes an issue, and when you should pursue screening for other conditions. It helps to know how to broach these subjects.
Each scenario is different, but there are a few critical questions you might want to bring up with your doctor right away, whether the doctor happens to be thinking primarily about your heart or your penis.
Ask: Should I be taking _____?
Certain medicines and recreational substances don't mix well. Before you independently start treating your erectile dysfunction or your heart condition, it behooves you to consult a physician.
Remember, ED and heart disease never exist in a vacuum; they exist inside your body, which is home to other functions and processes at all times, thus the room for error with using an uninformed prescription strategy is vast.
Plenty of medicines can treat ED or heart disease, or even both at once. But medications for either condition might not be right depending on lifestyle choices. For example, ED or heart patients who have drug or alcohol problems may need to resolve those issues before certain medicines can be safe or effective.
Most doctors are generally grateful when patients take a proactive approach to reviewing medications with their medical team members. ED can be rooted in biological causes, psychological causes or both, so it's important for your prescribing physician to be aware of your recreational and medical substance use.
Men often go to their doctor because they have ED questions, but there may be unknown factors to examine inside your body. Fortunately, the medical world has developed countless ways to observe what's going on behind the scenes of our bodily functions.
Ask: How can I find out more?
Blankstein also has expertise in cardiovascular imaging methods, which he said create a whole array of innovative and important tools at the disposal of doctors and their patients. Stress tests and other imaging resources can be instrumental in the detection and diagnosis of dangerous heart disease.
"It's a way for us to detect disease earlier and treat patients earlier," he said. "Sometimes, patients that we think are low risk may have a significant amount of underlying plaque burden and essentially they are high risk; and sometimes it's vice versa, and patients who may have risk factors, they actually don't have any disease. So imaging, for us, is a way to get a more personalized assessment of the amount of someone's risk and the amount of plaque they have."
A personalized assessment is essential because what is revealed on the surface is not necessarily indicative of what's going on inside a person's heart, respiratory or sexual systems.
"We do imaging in patients that don't have symptoms that want to know their risk of a future heart attack, and then there are patients who do have symptoms who present," Blankstein said.
Ask: Who should I be talking to?
Doctors sometimes have to urge patients to take their concerns to the appropriate specialist, said Hossein Sadeghi-Nejad, M.D., a professor of surgery and urology at Rutgers New Jersey Medical School and the chief of urology at the New Jersey Veterans Affairs Hospitals.
"If a 40-year-old, otherwise healthy man comes to me with erectile dysfunction, and through my history-taking and evaluation I have determined that this is not in this guy's head—he really has a physiological problem—I may do some objective testing at a penile ultrasound test, which shows me the blood flow," he said. "If that blood flow to the penis or arterial blood flow is abnormal, I go out of my way to convince that patient that, look, I genuinely recommend that you should see a cardiologist so that he could do a baseline test."
Ask: Can you help me understand the link?
The link between ED and heart disease gets trotted out so often that it's easy to become numb to the meaning when you don't have a medical education of any kind. This shouldn't preclude you from being interested in understanding why doctors emphasize the connection.
When considering heart disease, sometimes you actually should be thinking with your penis first.
"The blood flow to the penis, the arterial flow to the penis, is actually a finer vascular bed than the main cardiac vessels, right? So if you have atherosclerosis, if you have cholesterol problems, if you have problems with blood flow, it is more likely to manifest in your penis first than in your heart," said Sadeghi-Nejad, a specialist in male infertility and erectile issues whose expertise from surgical, technological and general urological perspectives gives him a unique knowledge of what the penis can reveal about patients.
It may seem counterintuitive, but the very real potential consequences of ignoring ED as a risk factor for cardiovascular disease should not be laughed off.
Ask: Basically anything
"I can't tell you how many times a patient comes back and says, 'Doc, you know, I'm very lucky. I saw this cardiologist and they did the workup. I do, in fact, have this problem or that problem. They put me on medications,'" Sadeghi-Nejad said. "In rare cases, I've had patients actually, believe it or not, who ended up getting catheterized, getting angio, and they found they had serious cardiac disease that they were unaware of."
Most doctors in any area of specialization don't want patients to be intimidated by these anecdotes. It's better for everyone to recognize the essential nature of asking questions and generally be involved and educated about their own health factors, choices and potential outcomes.
When you're talking to your doctor about erectile dysfunction, heart disease or anything else, the policy of "There are no stupid questions" is a good one to adopt. Your doctor may be a wealth of knowledge on sexual or cardiovascular functions, but they know only so much about you and your history with the symptoms, or lack thereof, associated with your concerns.