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Erectile dysfunction (ED), referred to as impotence, is the inability to get or keep an erection firm enough to have sexual intercourse. ED is a common condition. Study from National Health and Morbidity Survey 2019 shows that among sexually active Malaysian men aged 18 and above, 78.7% of them probably has ED.9 However, frequent ED can be a sign of health problems that need treatment. It can also affect one’s quality of life such as productivity, relationship with partners and family as well as mental health.
Image adapted from source: Intermountain Healthcare
ED is more common in men with diabetes than in those free from it, with estimates ranging from two three-fold.1 Studies suggest that prevalence of ED in men with diabetes ranges from 35–75% versus 26% in the general population. The onset of ED also occurs 10–15 years earlier in men with diabetes than it does in counterparts without diabetes. Diabetes messes with the production of nitric oxide, damages the blood supply to the penis and the nerves that control an erection.
When a man becomes sexually aroused, a chemical called nitric oxide is released into the bloodstream. Nitric oxide signals the arteries and the muscles in the penis to relax, which allows more blood to flow into the penis and results in an erection.2
Dyslipidemia is one of the main risk factors for cardiovascular disease and also for vasculogenic ED.
Increased plasma levels of low-density lipoprotein (LDL) and cholesterol will cause inadequate circulation of blood throughout the system including the penis and genital area.3 ,4
High cholesterol also affects testosterone production. Testosterone is a hormone responsible for the secondary sex characteristics of men. It is also responsible for sending messages of sexual stimulation throughout the body.3
In a study done in 2003, it was noted that men with a body mass index (BMI) >28.7 kg/m2 had higher risk for ED than men with a normal BMI of <25 kg/m2.5 Obesity itself is actually not the direct cause of ED.
However, obesity plays an imperative role in the incidence of cardiovascular risk factors, such as diabetes, hypertension or hypercholesterolaemia. Therefore, obesity is said to predispose a patient to vascular and metabolic impairments, which in turn leads to ED.11
Image adapted from source: Apex Health Centre
Studies have found an established correlation between cardiovascular diseases and erectile dysfunction, with one of the main common mechanisms being endothelial dysfunction. In general, men with ED are more likely to have cardiovascular disease and to have an increased risk of coronary heart disease (CHD) or stroke compared with the normal population.6 ,8
ED can also act as a signal of increased cardiovascular disease risk. Abnormal cholesterol profiles were discovered in 60% of men complaining of ED without a history of cardiac disease. Among apparently healthy men with ED, more than 60% had hyperlipidemia and 90% of the men with hyperlipidemia had evidence of penile artery disease using Doppler ultrasound evaluation.7
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Shiri A, Ansari M & Hassani KF. Int. J. Impot. Res. 2006; 18: 348-353.
Medical News Today. Does diabetes cause erectile dysfunction? Available at https://www.medicalnewstoday.com/articles/317012. Accessed on 19 October 2020.
Boston Medical Group. ERECTILE DYSFUNCTION: EFFECTS OF HIGH CHOLESTEROL IN MEN. Available at https://www.bostonmedicalgroup.com/erectile-dysfunction-effects-of-high-cholesterol-in-men#:~:text=The%20side%20effects%20of%20high,chemicals%20to%20create%20an%20erection Accessed on 19 October 2020.
Kim SC. Asian J. Androl. 200; 2(3): 161-166.
Constance G, Bacon ScD, Murray A, et al. Ann. Intern. Med. 2003; 139: 161-168.
Ponholzer A, Temml C, Obermayr R, et al. Eur. Urol. 2005; 48(3): 512-518.
Sadovsky R. Curr. Sex. Health Rep. 2004; 1: 129-136.
Feldman, HA, Goldstein, I, Dimitrios G, et al. J. Urol. 1994; 151(1): 54-61.
Institute for Public Health (IPH), National Institutes of Health, Ministry of Health Malaysia. 2020. National Health and Morbidity Survey (NHMS) 2019: Vol. I: NCDs – Non-Communicable Diseases: Risk Factors and other Health Problems
Yafi, Faysal A et al. “Erectile dysfunction.” Nature reviews. Disease primers vol. 2 16003. 4 Feb. 2016 11. Abdalla Ibrahim et al. European Cardiology Review 2018;13(2):98–103.
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