Warnings from Impotence

The same lifestyle factors and diseases that cause impotence also cause heart attacks (International Journal of Impotence Research, 2016;28:14–19). This study found that many impotent men have no idea they are at high risk for a heart attack and cannot even name any of the six factors that put them at high risk for both impotence and heart attacks:

• smoking

• overweight

• diabetes

• high cholesterol

• high blood pressure

• lack of exercise

The same factors that damage the arteries leading to the genitals also damage the arteries leading to the heart (Int J Clin Pract, 2010;64:848–857). All men who become impotent should look for a cause, and the most likely cause will be arteriosclerosis that puts them at high risk for suffering a heart attack. Of men who show up in a doctor's office for the treatment of impotence, more than 25 percent have already been diagnosed with heart disease, 23 percent are diabetic, 34 percent are on drugs to treat high blood pressure, and almost 20 percent are on statins to lower high cholesterol (International Journal of Impotence Research, 2008;20:S15–S20). The same lifestyle changes that help to prevent a heart attack also help to prevent and treat impotence (J Sex Med, Jan 2009;6(1):243-50).

Mechanism of an Erection The arteries that carry blood to the penis are normally closed and allow only a slight trickle of blood to flow. When a man become excited, the muscles that surround the penile arteries relax to allow more than six times as much blood to fill the penis. The pressure from this increased amount of blood closes off the veins that carry blood from the penis, so that more blood comes into the penis and less blood comes out, which causes the erection.

Arteriosclerosis means that plaques are laid down on the inner linings of arteries to obstruct the flow of blood. Anything that obstructs the flow of blood into the penis can make a man impotent. The same plaque formation that can obstruct the arteries leading to the heart can obstruct the flow of blood to the penis.

Do Not Just Take Viagra or Testosterone If you suffer from impotence, get a medical evaluation to find the cause. Impotent men suffer a very high rate of heart disease, even if they have not had that diagnosis (J Am Coll Cardiol, 2005; 46: 1503–1506). The rate of impotence in diabetic men is very high primarily because of the disease's very high rate of arteriosclerosis (The Journal of Sexual Medicine, 2013;9(8):2093–2103). Taking Viagra may help you achieve an erection, but it does nothing to prevent a heart attack.

When low testosterone is the cause of impotence, it almost always also causes lack of desire, so if you have desire you are unlikely to lack testosterone. A man does require a certain amount of testosterone to have desire and erections, but once a man has enough testosterone, more does not make him more sexual or achieve stiffer erections (Fertil Steril, 1993;59:1118–1123). Arteriosclerosis can damage the testicles to cause low testosterone. Just taking testosterone pills or injections rarely cures impotence.

My Recommendations Your doctor's evaluation for impotence should include a workup for heart disease and its causes (tests for diabetes, cholesterol, blood pressure and so forth), a check to see if you are taking any medication that can make you impotent, and an evaluation for the many other conditions that cause impotence. The treatment should always include correcting lifestyle factors that cause both impotence and arteriosclerosis, including overweight, tobacco use, alcohol intake, substance abuse, sleep disorders, poor diet and lack of exercise. 

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