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Sexual function and cardiovascular disease: what the general cardiologist needs to know
  1. Stella Roushias1,
  2. Nicholas Ossei-Gerning2,3
  1. 1 Urology Department, Cardiff and Vale University Health Board, Cardiff, UK
  2. 2 Cardiology Department, University Hospital of Wales, Cardiff, UK
  3. 3 University of Wales Trinity Saint David, Swansea, Wales
  1. Correspondence to Professor Nicholas Ossei-Gerning, Cardiology Department, University Hospital of Wales, Cardiff, CF144XW, UK; Nick.Ossei-Gerning{at}wales.nhs.uk

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Learning objectives

  • Pathophysiology of erectile dysfunction (ED).

  • Endothelial dysfunction: the common origin of ED and cardiovascular disease (CVD).

  • ED as a predictor of CVD.

  • Recommended evaluation of sexual dysfunction for cardiologists.

  • Management of ED in CVD.

  • Effects of CVD treatments on erectile function.

  • Female sexual dysfunction and CVD.

Introduction

Erectile dysfunction (ED) is defined as the persistent inability to attain and/or maintain an erection sufficient for sexual performance.1 ED and female sexual dysfunction (FSD) are common and distressing disorders. A UK-based population (n=1768, mean age 50) demonstrated 34% of men and 41% women reported current sexual problems.2 This figure was even higher in the Massachusetts Male Aging Study (MMAS) at 52% of 40–70 year olds.3 All identified strong age-related and concomitant cardiovascular disease (CVD) comorbidity correlation with ED.

ED often coexists with CVD and shares common risk factors, for example, age, smoking, obesity, hypertension, dyslipidaemia, diabetes and metabolic syndrome.4–6 Pertinently, endothelial dysfunction is the underlying pathophysiology of both ED and CVD7; unsurprisingly, ED has proven to be an independent risk factor for CVD.8 9 The time lag of 2–5 years9 10 between ED and coronary artery disease (CAD) presentation offers a window of opportunity for investigation and intervention. In established CVD, ED is a predictor of mortality and CVD events. This relationship appears stronger for younger and intermediate CVD risk men, for whom further risk stratification would be beneficial to management.9 A definitive pathophysiological link between FSD and CVD is less clear.

The management of CVD with lifestyle changes and routine medications may improve ED, which in turn can positively affect quality of life (QoL).11 Conversely, cardiologists must also consider CVD medications may have detrimental effects on erectile function and consequently on psychological well-being.

Here we examine the relationship between ED, FSD and CVD, assessing the implications …

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