Erectile Dysfunction: A Silent Epidemic and Indicator of Serious Health Issues

Erectile dysfunction (the problem of the penis not becoming or staying erect for long enough) can be called a silent epidemic. According to various surveys, more than half of men over 40 are affected by this problem in some form. But very few of them are willing to talk openly about it with their life partners or family members.

Even if this topic is sometimes discussed, it is often taken as a subject of jokes and banter, not as an early sign of an impending serious illness. But many recent studies have shown that a man's sexual organ (penis) can be an important indicator of his overall health. Erectile dysfunction can be an early warning of many serious diseases, including diabetes, heart attack, stroke, and dementia.

According to Emanuele Jannini, a sexual health expert at the University of Rome Tor Vergata in Italy, it is like a 'canary in a coal mine' (an indicator that signals danger). Jannini, who is also the editor of an academic book that reviewed past research, says, "If erectile dysfunction can be tested well, many serious risks that may appear in men's health can be identified in time." But because many men hesitate to talk about their sexual health, they are missing such an important opportunity to identify serious risks in time.

It is important to understand why you should be aware of this very common problem and how it warns doctors.

• Blood flow problem

Like most health problems, the actual prevalence of erectile dysfunction depends on how it is defined and measured. Therefore, various studies have reported its rate in adult men worldwide to be between 3 percent and 76.5 percent, which is a very large difference.

However, one of the largest studies, involving about 1,200 men with detailed questionnaires, showed that 39 percent of men aged 40 regularly experience some level of erectile problem. By the age of 70, this rate reaches up to 67 percent.

According to research, men with erectile dysfunction are 59 percent more likely to have coronary heart disease and 34 percent more likely to have a stroke. In many ways, erectile dysfunction is a plumbing problem.

There are two sponge-like structures inside the penis called 'corpora cavernosa', which remain flaccid in a normal state. When a man becomes sexually aroused, the brain sends signals to relax the muscles around the arteries of the penis. Then, a large amount of blood flows into these two structures.

As the blood fills, these structures expand and the veins carrying blood out of the penis are compressed. Thus, the blood gets trapped inside the penis.

Like an air-filled balloon, the penis expands and becomes hard. Therefore, any reason that prevents sufficient blood from reaching the penis weakens a man's ability to achieve or maintain an erection.

In many cases, the cause is also psychological. Hormones like 'adrenaline' and 'cortisol' released during stress narrow the blood vessels, preventing the corpora cavernosa from becoming sufficiently rigid.

High stress can also affect the production of 'testosterone' hormone. This reduces sexual desire and arousal. Hypogonadism and other glandular diseases may also play a role in reduced testosterone production.

Not only that, stress distracts people, making it difficult to concentrate on sexual activity.

According to Jannini, from a human evolutionary perspective, there was a good reason behind this. If stress stops sexual arousal, the body can conserve its energy for survival. He says, "If the environment is risky, it is not appropriate to reproduce in such a situation."

But in the modern world, much of the stress we experience is not life-threatening. Therefore, this protective mechanism of the body can be activated more often than necessary.

• Connection with heart and brain

In many cases, erectile dysfunction also indicates a broader health problem. For example, it can be caused by atherosclerosis (the condition where fat deposits in arteries make them hard and narrow). This significantly increases the risk of heart disease.

Since the arteries of the penis are among the smallest blood vessels in the body, problems in them can appear first. Therefore, erectile dysfunction can often be an early warning of serious heart disease that may appear in the future.

A recent study analyzing data from 154,794 men showed that men with erectile dysfunction are 59 percent more likely to have coronary heart disease and 34 percent more likely to have a stroke.

Michael Carroll, a reproductive science expert at Manchester Metropolitan University in the UK, says, "A good indicator of whether blood vessel health is good or not is having a good erection."

Some preliminary research suggests that poor penile health may also indicate a weakening of brain function. A study in Taiwan found that men with erectile dysfunction were 68 percent more likely to develop dementia within a seven-year period.

Like the penis, our brain also relies on good blood circulation. Only when sufficient blood reaches the brain can it receive the necessary energy and remove toxins.

• Connection with diabetes

Monitoring for erectile dysfunction can be particularly important for individuals at risk of diabetes. Diabetes damages the circulatory and nervous systems through various processes.

For example, persistently high blood sugar levels cause excess glucose to bind to proteins in the blood vessel walls. This process is called glycation. As a result, blood vessels lose their elasticity.

Like atherosclerosis, this reduces blood flow to essential organs in the body. Since the blood vessels of the penis are very sensitive, their effects may be seen there first.

Bogdan Vlacho, a researcher at the Sant Pau Research Institute in Barcelona, Spain, says, "The relationship between diabetes and erectile dysfunction is very strong. Men with type-2 diabetes are about three times more likely to develop erectile dysfunction than men without diabetes."

In a recently published research review, Vlacho noted that individuals with diabetes and erectile dysfunction are much more likely to develop peripheral neuropathy (nerve damage in the hands and feet).

These individuals also have a high risk of retinopathy (damage to the retina of the eye), which can eventually lead to blindness. Also, due to delayed wound healing, in some cases, amputation of hands or feet may be necessary.

Despite this, regular screening for erectile dysfunction in diabetic patients is not common practice. Santiago Martinez, an endocrinologist at the University of Barcelona, Spain, says, "Studies have shown that many healthcare professionals do not even discuss this issue with patients."

• Potential treatment

A survey by the Urology Foundation in the UK showed that more than half of men with erectile dysfunction were unwilling to consult a doctor due to shame and anxiety. Not only that, 20 percent of participants said they would rather go a month without drinking beer than see a healthcare professional about their problem.

But according to Michael Carroll, all men experiencing erectile dysfunction should seek medical help. He says that treatment can reduce stress and dissatisfaction related to sexual life. Not only that, it also provides an opportunity for important discussions with doctors about overall physical health, which can sometimes be life-saving.

He says, "Addressing the problem early is the most important thing."

After all, erectile dysfunction is not an incurable disease. Medications like Viagra (sildenafil) dilate the blood vessels of the penis and increase blood flow. Some empirical evidence suggests that patients using such medications to improve sexual life have also shown better cardiovascular health. While there are indications that the risk of heart attack or heart failure may be reduced, clinical trials have not yet definitively confirmed this.

Notably, Viagra was initially developed for the cardiovascular treatment of patients with high blood pressure. Later, researchers discovered its now-familiar 'side effect'.

Another study analyzing data from over 885,000 patients showed that individuals using such medications may have their risk of developing Alzheimer's disease reduced by almost half.

At the very least, if you inform your doctor about your erectile problem, they can test for risk factors for heart disease such as high blood pressure and atherosclerosis. They can also provide necessary advice on the effects of obesity or other lifestyle factors on the heart and circulatory system.

In some cases, simple measures like improving diet and regular exercise can also bring significant improvements. For diabetic patients, controlling blood sugar levels well is extremely important.

However, according to Santiago Martinez and Bogdan Vlacho, research is still in its early stages as to whether these treatments reduce the risk of other complications along with erectile dysfunction.

In addition, it is not easy to determine the actual cause of erectile dysfunction. This is because it can also be caused by excessive addiction to pornography, mental health problems, or psychological factors related to sexual desire.

Carroll says, "If a person has diabetes or heart disease, it is relatively easy to link and treat it. But if psychological or behavioral problems are mixed with lifestyle factors such as excessive alcohol consumption, smoking, excessive use of pornography, treatment can be very difficult. Many such men do not want to openly discuss their habits."

• The bone we lost

While all these studies offer important messages for current healthcare, Emanuele Jannini is also pondering another interesting question from an evolutionary perspective. That is—how did the penis become such a good indicator of overall health?

Humans are a species in which penile erection depends entirely on blood flow. But many other primates, including our closest relatives, chimpanzees, have a small bone called a 'baculum'.

During sexual arousal, this bone protrudes and supports the penis, making their sexual capacity not directly dependent on overall health like humans. So why did humans lose that bone during evolution, and instead develop the potential for problems in sexual activity? This question has long puzzled evolutionary biologists.

But Jannini's hypothesis is different. According to him, one possible reason for men losing the penile bone during human evolution may have been to make it easier for women to identify the healthiest and best genetically endowed partners.

He says, "It seems very strange that we lost such an important bone for reproduction, after which our sexual response became very unpredictable. But this is precisely why the penis has become an excellent biological marker for chronic diseases."

(David Robson is a distinguished science writer. His latest book, 'The Laws of Connection: Thirteen Social Strategies That Will Transform Your Life', was published in 2024 by Canongate (UK) and Pegasus Books (USA & Canada). This article is a translation from BBC.)