Causes of erectile dysfunction - Vascular disease

Vascular disease

Since erections depend on the blood vessels that serve the penis, it's not surprising that vascular disease is the leading cause of erectile dysfunction. The most common type of vascular disease is atherosclerosis, which occurs when fatty deposits build up on artery walls, narrowing and clogging them. Most people think of atherosclerosis as occurring mainly in the heart's arteries. But in fact, it can occur in arteries throughout the body -- including those in the penis. High blood pressure, high cholesterol, diabetes, and smoking all lead to atherosclerosis.

Another vascular problem that can cause erectile dysfunction is a venous leak, in which blood seeps out of the penis during an erection instead of remaining trapped inside. In this case, a man may be able to get an erection, but he cannot sustain it. Doctors aren't sure what causes venous leakage.
An abdominal aortic aneurysm, or a ballooning of the aorta, is another vascular problem associated with erectile dysfunction. The aorta, which delivers blood from the heart to the abdomen, is the body's main artery. An aneurysm forms when a blood vessel, weakened by a disease like atherosclerosis or hypertension, balloons outward under the pressure of blood flowing through it. The nerves and arteries leading to the penis lie next to the aorta. As the abdominal aorta expands, it can squeeze and damage these nerves and blood vessels, causing erectile dysfunction.

Hypertension, drugs, and erections

Men with erectile dysfunction are about 38% more likely to have high blood pressure than those without erectile dysfunction, according to a 2005 study that examined the medical records of more than 1.9 million men. This finding supports observations that erectile dysfunction often occurs in men who smoke or are overweight -- both common risk factors for high blood pressure. In fact, erectile dysfunction might serve as a warning sign that a man has high blood pressure or heart disease.
Complicating matters is the fact that some drugs used to treat high blood pressure -- especially beta blockers -- can cause erectile dysfunction. But the effect may be at least partly psychological, rather than physical: When erectile dysfunction occurs after a man starts taking a new medication, it's possible that fears about his health, rather than the medication itself, are triggering the problem. In addition, being aware of possible side effects may make a person more likely to recognize them as abnormal. One study looked at men newly diagnosed with heart disease but without erectile dysfunction who started treatment with the beta blocker atenolol (Tenormin). Among those who were told about the drug's sexual side effects, almost a third reported erectile dysfunction. In contrast, of those who were not told the drug's name or its side effects, only 3% said they experienced erectile dysfunction.
Although all blood pressure medications can cause erectile dysfunction, the problem seems to be greater with diuretics and beta blockers than with ACE inhibitors (see Table 1 for common examples). If you experience erectile dysfunction shortly after starting treatment with any of these drugs, it may make sense to ask your doctor if you can try a different one.