Welcome to Mayo Clinic's podcast. This month's topic is atherosclerosis and how it can lead to erectile dysfunction. I'm your host, Rich Dietman.

As we get older, our blood vessels may become narrowed and less elastic, a condition known as atherosclerosis. In today's podcast we're going to talk about how atherosclerosis in men can cause erectile dysfunction, or ED, as it's sometimes called. Here to help us understand this problem is Mayo Clinic cardiologist, Dr. Brooks Edwards. Dr. Edwards, thanks for being with us today.

Dr. Edwards: Thank you, Rich.

Rich Dietman: Atherosclerosis and erectile dysfunction, now that might surprise some men. How are the two related?

Dr. Edwards: Well, the function to have a normal erection, one requires increased blood flow to the penis. The blood supply to the penis is therefore critical, and if there's diseases that limit blood flow — for example, atherosclerosis, where there's a buildup of plaque in arteries — that may limit the ability of the penis to have a normal erection.

Rich Dietman: How do doctors diagnose or determine whether a man's ED is due to atherosclerosis?

Dr. Edwards: The causes of erectile dysfunction are many, and oftentimes men present with multiple factors that can lead to erectile dysfunction. For example, many of the patients have atherosclerosis; they also have a history of high blood pressure, or hypertension, and may have diabetes. All these factors may combine to lead to ED.

Rich Dietman: If a man has ED, and it's caused by atherosclerosis, does that mean that he could have heart disease or other complications?

Dr. Edwards: Well, atherosclerosis is a generalized disorder of the arterial system of the body, so it may affect the arteries in the leg, it may affect the arteries in the penis, or the arteries in the heart. By knowing that a man has atherosclerosis, it's a marker and it's a risk factor for having heart disease, but there certainly isn't a one-to-one correlation and there may be men who have atherosclerosis affecting some arteries without affecting the heart arteries.

Rich Dietman: Can erectile dysfunction caused by atherosclerosis happen at any age, or is it generally something that occurs in older men?

Dr. Edwards: Erectile dysfunction tends to be an age-related phenomenon. If you look at men under 40, about 5 percent will have some history of ED. As they age, that number may go up to 20 percent or even more.

Rich Dietman: OK, if erectile dysfunction is caused by atherosclerosis, can it be treated?

Dr. Edwards: Erectile dysfunction can be treated, and there are many strategies for treatment. Oftentimes the goal of treatment is to improve blood flow to the penis, not to treat the atherosclerosis per say, and there are drugs and devices that can help do that. At the same time, I think we should put in a word for prevention, and by looking at risk factors for ED, those are many of the risk factors for heart disease. Things like hyperlipidemia, or high cholesterol, high blood pressure, diabetes and smoking, all of those factors lead to atherosclerosis, lead to heart disease, and by focusing on prevention, lifestyle changes, controlling lipids, controlling blood pressure, hopefully we can not only prevent ED but we can prevent even more catastrophic disorders.

Rich Dietman: Getting back to some of the treatments, aside from the lifestyle changes, what are some of those treatments and how well do they work?

Dr. Edwards: When we look at the treatment for erectile dysfunction, the first decision to make is, is there a physiologic or anatomic basis for the erectile dysfunction, or is there a psychological problem that's limiting functional erections? If there's a psychological problem, that leads to one form of therapy. If there's a physiologic problem, the kind of problems that we see with atherosclerosis, then we look at strategies to improve blood flow to the penis, both the arterial inflow to the penis, and both retain the blood for an adequate erection in the penis during intercourse. To do that, there are a number of oral agents now available. We call them phosphodiesterase inhibitors, and they're widely available and actually quite effective. If you look at the oral agents as a group, about 80 percent of men without diabetes will have a nice response, an adequate response, to oral therapy, and among the diabetic patients, and again, they have ED as a multifactorial problem, they have atherosclerosis and they oftentimes have neuropathy and a nerve problem leading to ED. Those patients have a response rate of about 60 percent.

Rich Dietman: There are a lot of ads for herbal supplements and other products that claim to treat ED. Are any of these options to treat ED that's caused specifically by atherosclerosis?

Dr. Edwards: The herbal supplements really are not effective therapies for atherosclerosis-induced ED or physiologic bases of ED. The one place where some herbal supplements may work are in patients who have psychological problems leading to ED, and the herbal supplement in that case would simply be a placebo. But in that setting, some patients may report benefit.

Rich Dietman: So, getting back to treatment, it sounds like, regardless of whether ED is caused by atherosclerosis or not, that the treatments for ED tend to focus on that problem and they aren't tailored so much to treating the atherosclerosis to somehow or another relieve the ED.

Dr. Edwards: Right, by the time atherosclerosis has caused erectile dysfunction, it's unlikely that we can reverse the atherosclerosis, so we're looking for other strategies to improve erectile function. The other point to be made is that there are many strategies, ranging from simple things like the prescription medications we talked about to other vacuum devices and even surgical implants, and I encourage patients to talk to their doctors about their issues and if they have erectile dysfunction, oftentimes men are reluctant to bring it up. It's important to bring it up, it's an important part of their life and there are good strategies now and even better strategies evolving to restore normal erectile function to men, and so it's not something that should be ignored or neglected.

Rich Dietman: Thanks very much, Dr. Edwards. We've been talking with Mayo Clinic cardiologist, Dr. Brooks Edwards. You've been listening to Mayo Clinic's podcast. I'm Rich Dietman.