Revised: November 26, 2013
Accepted: December 13, 2013
Published online: March 24, 2014
Erectile dysfunction is a prevalent complaint among men. The majority of patients suffering erectile dysfunction exhibit various risk factors of vascular diseases. Erectile dysfunction used to be recognised as one of the consequences of vascular diseases in patients suffering heart attack or myocardial infarction. During the last decade, however, the role of endothelial dysfunction in the occurrence of erectile dysfunction has been signified, and it has been suggested that erectile dysfunction may not be simply a consequence of vascular diseases but an indicator of future vascular problems. Erectile dysfunction has been known as “the tip of iceberg” of a generalised vascular dysfunction, which typically happens before serious vascular problems. Considerable evidence shows a link between erectile dysfunction and vascular disorders. Several theories have been considered for the association between erectile dysfunction and vascular diseases. One of them is the “artery size” theory focusing on the differences between the diameter of the penile artery and other arteries. Another theory is based on “endothelial dysfunction”, which highlights inappropriate vasoconstriction as a cause of erectile dysfunction and vascular diseases. “Age” has also been reported to have pivotal role in the development of vascular dysfunction resulting in erectile dysfunction and ultimately vascular diseases. Another theory explaining the pathophysiology of erectile dysfunction and its relationship with vascular diseases focuses on the formation of atherosclerosis plaques. This article endeavours to review the current literature and discuss why a multidisciplinary approach is needed while assessing erectile dysfunction.
Core tip: Erectile dysfunction (ED) per se is not a life-threatening problem but it is a harbinger of more serious vascular impairments. Indeed, a strong correlation has been documented between the severity of ED and the severity of vascular diseases, myocardial infarction and stroke. The vascular symptoms are demonstrated 2-3 years on average after exhibition of the first symptoms of erectile dysfunction. This gap provides enough time to intervene and prevent subsequent vascular problems. Notwithstanding, the predictability of subsequent vascular disease may be missed as these patients are not simultaneously evaluated by an urologist and a cardiologist.