Few men recognise the link between cardiovascular health and impotence: about a third of men with erectile dysfunction, or ED, will also have heart disease. Photo: Shutterstock
Erectile dysfunction (ED) could be a sign your heart health is not good, and can precede the onset of a significant cardiovascular event by three to five years
A loss of early morning erections is another sign all may not be well with a man’s heart, a recent study suggests
A man’s erections, or lack of them, can say a lot about his overall heart health.
Having trouble getting or keeping an erection firm enough for satisfactory sex is not a topic men like to talk about, but erectile dysfunction, or ED, is surprisingly common: more than half of men aged 40 to 70 experience some degree of impotence.
One of the major ways in which heart health is related to erections is in the state of our arteries, says Dr Boon Lim, a consultant cardiologist at Imperial College London in the UK.
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Healthy arteries enable a healthy flow of blood, which a man needs to achieve and sustain an erection.
But the build-up of cholesterol inside artery walls, leading to an inflammatory condition called atherosclerosis, leads to a narrowing of the arteries.
“If the heart’s arteries are narrowed, causing an increased risk of angina or heart attacks, then it is highly likely that the same process causing atherosclerosis within the heart’s arteries is happening in other areas of the body,” Lim says.
This includes arteries in the brain, arms, legs, pelvis, kidneys – and penis.
If blood circulation to the penis is hampered by narrowed arteries then it may be difficult to get an erection, because for one to happen, arteries must dilate and increase blood flow to the penis, Lim says.
A number of diseases may cause ED but atherosclerosis is a common cause, says Dr Andrew Yip, a Hong Kong-based urologist.
If arteries to the penis are narrowed then it’s very likely vessels to the heart are also blocked, Yip says. That’s why ED is a predictor for heart disease and about a third of men with ED will also have heart disease, he adds.
ED is often the first sign of a change in cardiovascular health and can precede the onset of a significant cardiovascular event, such as a heart attack, by three to five years – so there is a window of warning to address heart problems.
The severity of erectile dysfunction can even predict the severity of subsequent heart attack, and the degree of heart blockage.
Few men recognise the relationship between heart disease and erectile dysfunction, though. Many assume it is a result of ageing, which isn’t true, Yip says. A man might experience fewer erections with age, but if they stop altogether, that’s a red flag.
Healthy men experience as many as five erections a night during deep REM sleep, each lasting up to half an hour. And they frequently wake with an erection.
When men start to notice they no longer do, it might be time to think about their heart health, says Dr Leen Antonio, an endocrinologist at University Hospitals Leuven in Belgium.
A recent study Antonio led on sexual symptoms as predictors of mortality found that loss of early morning erections is another sign all may not be well with a man’s heart.
Men who regularly woke up erect were 22 per cent less likely to have a heart attack or stroke in the next three to five years, the study found.
The autonomic nervous system is another link between general cardiovascular health and erections, Lim says.
This part of our primitive nervous system controls all the automatic functions in a body that are subconscious. It is a kind of master regulator for processes such as maintaining adequate blood pressure, skin and temperature regulation, and digestion processes.
The autonomic nervous system is also involved in controlling erections and ejaculation. It can be negatively affected by a number of diseases, conditions and even lifestyle choices, including Parkinson’s, cancer, autoimmune diseases, diabetes and alcohol abuse. It can also be affected by atherosclerosis.
“Poor autonomic control, arising from whatever process, is likely to affect the heart negatively, but also may impact the ability to maintain, or initiate, an erection,” says Lim, who is also the author of the 2021 book Keeping your Heart Healthy.
When should men worry? And can better heart health improve erections?
Lim says preventing atherosclerosis, promoting a healthy autonomic system and improving overall heart health requires making holistic lifestyle choices.
These include having a healthy diet and a regular exercise programme, coupled with adequate rest and sleep, and not to be overcome with stress.
The reason most men have no idea of the connection between their heart health and the ability to have an erection “is that there is often a stigma with respect to inability to initiate or maintain an erection”, Lim says. A man does not like to admit to anyone, not even a doctor, that he cannot have sex.
There are many psychological components to having an erection, Lim adds. But if there are no psychological issues, do not suffer in silence. An erection problem should prompt a doctor’s visit for a check-up of your overall cardiovascular status.