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what is erectile dysfunction?

by Janet Casperson, BS, MSN, ANP-C

Erectile dysfunction (penis dysfunction) is defined as the inability to maintain an erection sufficient for penetration.

Erectile dysfunction (ED or penis dysfunction) is directly related to penis health but also serves as an early warning sign of cardiovascular disease and other serious illnesses. Penile dysfunction is an indicator of way more than erection problems.



Sexual intimacy in America changed dramatically in March 1998, with Pfizer’s introduction of Viagra®. Since then we have worked to deepen our fundamental understanding of sexual function and its effects on the quality of life for men, women and relationships and on the total human body.

Causes of erectile dysfunction: cardiovascular disease

Exciting changes have occurred within the last couple of years as clinicians have discovered that cardiovascular disease can be predicted by the presence of erectile dysfunction. It is well known that the purpose of the heart is to pump blood. The heart pumps blood to all the vital organs and when it comes to sexual intimacy for men, the penis is the most vital organ. Men's sexual health often hints at men's total health.

Our purpose is to emphasize and distill the vast amount of scientific research which details the profound effects that cardiovascular disease, diabetes; cholesterol and hypertension have on sexual dysfunction in both sexes and, in particular, erectile dysfunction into a user friendly format for the couple who suffer from sexual dysfunction.

Erection problems can warn about existing heart disease

American men have an approximately 50% chance of dying of cardiovascular disease; half of those men will die suddenly without any prior warning. Until recently, we didn’t know the signs or symptoms that were predictive of silent heart disease. But today, because of the work of dedicated researchers, we know that men who cannot maintain an erection sufficient for penetration may have significant underlying cardiovascular disease. Research studies consistently indicate that the inability to maintain an erection is the earliest symptom of silent heart disease. Therefore, the loss of erections is a harbinger of subsequent cardiovascular disease and demands a comprehensive cardiovascular workup. 

Within our clinical practice it is no longer acceptable or appropriate to hand out samples of medications like Viagra®, Levitra® or Cialis® without a thorough questioning regarding cardiovascular risks factors and, when appropriate, a cardiovascular evaluation. Diagnostic test abnormalities such as elevated cholesterol can point to certain changes that can affect erectile function on a long-term basis.

Metabolic Syndrome and Erectile Dysfunction

Metabolic syndrome (also known as Syndrome X, Insulin Resistance Syndrome, Central Obesity and the Deadly Quartet) is a relatively new diagnostic complex that we are just beginning to understand. Estimates suggest that approximately 25% of the adult United States’ population has metabolic syndrome; many people who are affected don’t even know it. This syndrome includes “central” obesity  (in men, a waist circumference greater than 40 inches, in women, a waist circumference greater than 34 inches), an elevation of the triglycerides, decreased HDL cholesterol (the “good” or “healthy” cholesterol), blood pressure greater than 135/85 and elevated fasting blood glucose. Men with metabolic syndrome are at much greater risk for erectile dysfunction and cardiovascular disease secondary to the presence of this syndrome. It has been said that these men are a “ticking time bomb” for microvascular complications, cardiovascular disease and erectile dysfunction.

Not since the approval of birth control pills, which sparked the first sexual revolution of the 1960’s, has a single pill made such an impact on society as Viagra did. We have entered into the second sexual revolution. We intend to discuss the vast array of scientific research concerning the effects of cardiovascular disease and its effect on erectile dysfunction, review the many risk factors associated with two diseases, discuss the appropriate diagnostic evaluation, review erectile dysfunction treatment options and give a glimpse of our predictions for what the future has to offer so our patients can go into this new sexual revolution armed with the necessary facts and tools.


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August 2006
Posted August 2008
Updated October 2011


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