Penile Predictions: Erectile dysfunction and heart disease

Erectile dysfunction can mean more than awkward pillow talk. It could signal trouble in another critical organ.

By Gordon Young

Bob Dole got almost as much attention for his Viagra commercials as he did for his 1996 presidential bid. The senator from Kansas may have lost the election, but he managed to get people talking about sexual dysfunction, a subject that rarely — if ever — surfaced in polite conversation.

Avoiding the subject, however, didn't make the problem go away. Nearly a third of men aged 18 to 59 and more than 40 percent of women report some form of sexual dysfunction, according to a medical study published last year in the Journal of the American Medical Association.

Dole's high-profile television ads and the explosive sales of Viagra have focused the national spotlight on erectile dysfunction (ED).

While ED is often associated with aging, recent studies indicate that in many cases ED may result from a sedentary lifestyle rather than simply growing older. More importantly, research also suggests that sexual dysfunction could be a warning sign of more serious problems such as cardiovascular disease.

According to LeRoy Nyberg, director of urology programs at the National Institute of Diabetes and Digestive Kidney Disease (NIDDK), it's just "common sense" that physically active men tend to function better sexually.

"I frequently see men who can't climb a flight of stairs," Nyberg says. "Their heart and lungs can't carry them anywhere, but they expect their penis to."

This common sense is backed up with scientific research. The results of the Massachusetts Male Aging Study, the largest random sample research ever conducted on ED, point to a direct correlation between ED and physical activity. Active men had the lowest risk of impotence; inactive men had the highest risk.

The good news is ED sufferers may be able to exercise their way back into the bedroom.

"The only behavior we found that can reduce the problem of erectile dysfunction is regular physical activity," John McKinlay told The Washington Post earlier this year. McKinlay, an epidemiologist at the New England Research Institutes, co-authored several reports on the Massachusetts Male Aging Study.

Research at the University of California, San Diego echoed these findings. Middle-aged men who began a consistent exercise program reported increased sexual activity and orgasms, as well as more consistent functioning during sex. Study author James White reported that the "degree of sexual enhancement correlated with the individual's fitness gain."

Research from the Harvard School of Public Health tells a similar story. Eric B. Rimm and other researchers analyzed 2,000 men aged 51 to 87 and found that "physical activity was strongly associated with better erectile functioning." In fact, Rimm discovered that a man's chance of ED corresponded to increases in his waist size.

Bernie Zilbergeld, a psychologist and sex therapist in Oakland, California, sees patients "all the time" whose unhealthy lifestyles are contributing to sexual dysfunction.

"Sex is hardly an Olympic event, but it does require energy and a certain degree of flexibility," says Zilbergeld, the author of The New Male Sexuality: The Truth About Men, Sex, and Pleasure. "Some guys are so out of shape it takes too much effort to get off the couch, let alone have sex."

Zilbergeld remembers one patient, a man in his early fifties, who was so overweight "he was ashamed to look at himself in the mirror" and had trouble "walking from his car to my office." The patient had ED and had stopped trying to have sex with his wife altogether.

After six months of counseling, along with a diet and exercise program, the patient was able to shed about 50 pounds.

"They started to reestablish intimacy by cuddling in bed and, Lo and behold, one thing led to another," Zilbergeld says. "He discovered he had missed his wife sexually."

While the prospect of improving sexual performance might seem like reason enough to talk to your doctor about ED, seeking help could end up saving your life. Beyond causing bedroom blues, impotence can also be a warning sign of life-threatening heart and vascular problems.

Atherosclerosis, the process that leads to heart attacks and strokes, may cause ED by causing decreased flow to the small blood vessels of the penis. This is likely to happen before the condition is present in the larger arteries such as the heart, brain and kidneys, so ED can serve as a warning for more serious problems.

And the numbers are striking. In a study presented this year to the American Heart Association by the Minneapolis Heart Institute Foundation (MHIF), 40 percent of 50 men with ED suffered from major blockages in heart arteries associated with chest pain and heightened risk for heart attack.

Tom Lue, a professor of Urology at the University of California, San Francisco, says patients with both impotency and heart problems are "quite common," pointing out that 50 to 70 percent of men with a history of heart attacks also suffer from ED.

Lue recalls one patient in his early forties who suddenly developed impotency for the first time in his life. Lue discovered that the vessels in his penis were narrowed and constricting blood flow. He urged the patient to see a cardiologist immediately, but the patient maintained he was healthy and only needed help with impotency.

"He didn't go to the cardiologist, and four months later he was in the intensive care unit after having a heart attack," Lue says. "The penis is like a window to the rest of the body. Whatever is happening there could be happening elsewhere."

This doesn't mean that everyone with ED suffers from some form of atherosclerosis, but men who are sexually active and experience a consistent change in erectile function may be exhibiting early signs of the condition. Likewise, training like a triathlete will not automatically eliminate impotence, which can be caused by psychological factors, hypertension, diabetes and drug interactions. But physical activity may be an alternative to expensive drugs like Viagra.

"The whole body is a system," Nyberg says. "Obviously, a problem in one area could be linked to other areas. You can't simply focus on the penis."

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