No doubt about it, erectile dysfunction is a common problem in men, especially those older than 45 years. For all the advertising regarding Viagra, Cialis, and similar drugs, there is no mention that it may indicate serious vascular disease. This symptom requires consideration of more serious problems.
When faced with this problem, I always like to do a workup to determine the cause. In many patients, drugs such as beta blockers, diuretics, and antidepressants may interfere with sexual function. One must be sure the erectile dysfunction is not due to vascular endothelial disease, especially of small vessels (arteriosclerosis). Erection depends on the integrity of the vascular system, especially the small vessels.
Research upholds this association and men with E.D. should be considered to have a 10-year cardiovascular event risk equal to men with Coronary Artery Disease or Diabetes or greater than 2% per year according to Framingham Chart of risk. I like to do a workup of cardiovascular risk factors in all patients. There are 17 distinct risk factors for myocardial infarction.
Sometimes in the younger patients, low testosterone, high estrogen and low DHEA can cause ED without strong evidence of CV disease. In younger patients who have sexual dysfunction, I also like to investigate whether having metal intoxication is playing a role.
After treatment of the endothelial dysfunction (arteriosclerosis) if present, a cost-effective and non-toxic treatment for E.D. is Pycnogenol (French maritime pine bark extract) and the amino acid arginine. The combination affects endothelial dysfunction and underlying disease of many E.D. cases. It causes an increase in Nitrous Oxide also, which increases blood flow by vasodilatation. Good blood flow is needed to develop and maintain an erection.