If you’re having trouble getting or keeping an erection, you may find it frustrating or embarrassing to discuss with your doctor. However, erectile dysfunction (ED) can sometimes be an early sign of heart disease, especially in people over 40. Talking about it with your doctor could help identify underlying heart issues.

Read on to discover more about the causes of ED and how it may be related to heart disease. You’ll also learn about ways you can improve your sexual health and your heart health. Note that some ED drugs should not be taken if you have heart disease, so be sure your health care providers are aware of all the medications you take.

What Is Erectile Dysfunction?

ED refers to trouble getting an erection or maintaining it for sexual activity. Getting an erection is a complex process, and having occasional difficulty is normal. But if you regularly experience ED and don’t have nocturnal erections (spontaneous erections during sleep), it may be a sign of another health condition, such as heart disease.

There are many causes of ED. For example, it can be the result of nerve damage. Conditions that can damage nerves include stroke, multiple sclerosis, and diabetes. Surgery or radiation therapy can also damage the nerves and lead to ED.

Some cases are caused by changes in hormones. People with low testosterone or thyroid problems may have ED.

Getting an erection is also closely linked to your emotions and psychological state. People who are under a lot of stress or experience depression or anxiety may have ED. This is known as psychogenic ED, and it’s the most common type among people younger than 40. People with psychogenic ED can achieve erections while sleeping.

Although many factors affect the ability to get an erection, a common cause of ED among older people is vascular disease (a problem with blood vessels). According to researchers, a relatively high number of ED cases in older people are caused by vascular disease.

What Is Vascular Disease?

Your circulatory system is made up of your heart and blood vessels. Your heart’s job is to pump blood to the rest of your body through your blood vessels. This is important for delivering oxygen and nutrients to your tissues and getting rid of carbon dioxide and other waste products.

However, sometimes the blood vessels stop working properly and become narrow — this is called vascular disease. There are different types of vascular disease, but many prevent blood from flowing through the body as it should.

Both your heart and your penis need good blood flow to work properly. To get an erection, your penis has to fill with blood. But if blood flow is interrupted, it can lead to ED.

Your heart also requires regular blood flow to work normally, or coronary artery disease (sometimes called heart disease) can result. Without proper blood flow, the heart doesn’t get enough oxygen, and the muscle can be damaged and die. This is called a myocardial infarction, or a heart attack.

Atherosclerosis and endothelial dysfunction are two types of vascular disease with similar risk factors that can contribute to ED.

Atherosclerosis

Scientists originally believed that a vascular disease called atherosclerosis caused ED. Atherosclerosis refers to a buildup of fat and cholesterol that forms plaques in blood vessels, which then narrow and make it harder for blood to flow through.

Atherosclerosis can happen in most of the body’s blood vessels. Narrowing of the blood vessels leading to the penis can limit blood flow and make it difficult to get an erection.

When plaques form in the heart’s blood vessels, the condition is called coronary artery disease. Reduced blood flow can lead to many heart problems, including chest pain, heart attack, and even heart failure.

Endothelial Dysfunction

Although atherosclerosis can contribute to ED, scientists now believe that a condition called endothelial dysfunction plays a larger role. The inside of a blood vessel is made up of cells called endothelial cells. In a healthy blood vessel, endothelial cells tell the blood vessel when to contract (narrow) and when to relax. Blood vessel relaxation and contraction control your blood pressure.

When endothelial cells don’t work like they should, this is called endothelial dysfunction. If a person has endothelial dysfunction, their blood vessels stay contracted and don’t relax. So even though nothing, such as a plaque, is blocking them, the blood vessels are narrower than they should be. Endothelial dysfunction can increase the risk of many cardiovascular diseases, including high blood pressure, heart attack, and heart failure.

Does Having Erectile Dysfunction Mean You Have Heart Disease?

Having vascular disease puts people at high risk of both ED and heart disease. According to a 2021 study in the Journal of Clinical Medicine, over half of men with heart disease also have ED. Also, scientists have found that having ED increases the risk of different types of heart disease, including heart attack and stroke. People with ED are also more likely to have a family history of heart disease.

ED usually starts two to five years before other heart diseases are diagnosed. Almost two-thirds of people with coronary artery disease had ED before they were diagnosed with heart disease. Scientists believe that ED develops before heart disease because the blood vessels in the penis are smaller, so they’re the first to be affected by vascular disease. As time goes on and vascular disease gets worse, it can affect larger blood vessels and lead to heart disease.

Because of this time delay, ED is often considered an early warning sign of heart disease if other risk factors are present. Doctors can use ED as a sign of vascular dysfunction. Early detection and treatment of heart disease can help prevent more serious health problems.

Having ED doesn’t necessarily mean that you have or will develop heart disease. ED has many causes, including changes in hormones or stress in your life. Medications can also cause problems with erections. Your doctor can help figure out the cause of your ED.

How Can You Improve Both Erectile Dysfunction and Heart Health?

The good news is that you can improve both your heart health and ED. Because the two conditions share many risk factors, making heart-healthy lifestyle changes can also improve your sex life.

As part of your treatment, your doctor may advise eating a healthy diet with lots of fruits and vegetables. You can improve your overall health by getting regular exercise and maintaining a healthy weight. Your doctor may also recommend that you stop smoking and limit alcohol. Remember, improving your heart health will also help improve your sexual health.

Your health care team will also look at your medications. Your doctor may be able to recommend other treatments that are less likely to cause ED.

Your doctor may also prescribe medications to treat your ED, such as sildenafil (Viagra). Some of these drugs can be dangerous if you have heart disease, so be sure to check with your doctor before taking any medications for ED.

If you’re experiencing ED, talk with your primary care doctor. If you have a history of heart disease or your doctor is concerned about your cardiovascular risk, they may refer you to a cardiologist (heart specialist). Your health care team can help you manage ED and heart disease and help you find ways to improve your sexual health.

Talk With Others Who Understand

MyHeartDiseaseTeam is the social network for people with heart disease and their loved ones. On MyHeartDiseaseTeam, more than 61,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Are you experiencing erectile dysfunction? Do you have more questions about how ED is related to heart disease? Share your experiences and questions in the comments below, or start a conversation by posting on your Activities page.