Erectile dysfunction: a medical problem not to be ignored

Erectile dysfunction is among the most common and least discussed of men's health problems. Around 40 % of men aged 40 have some form of erectile dysfunction, a proportion that increases with age (Journal of Urology, 2022). Yet many never discuss it with their doctor, either out of shame, because they see it as an inevitable consequence of aging, or because they are unaware that it may be a harbinger of a serious underlying medical condition.

Erectile dysfunction isn't just a performance problem. It's often a cardiovascular signal.

Erectile dysfunction as a cardiovascular signal

Erection depends on adequate blood flow to the penile arteries. These arteries are small-calibre and among the first to be affected by atherosclerosis, the hardening and progressive obstruction of the arteries caused by cholesterol plaques. Vascular erectile dysfunction often precedes cardiovascular events such as angina or heart attack by three to five years.

That's why a man consulting us for erectile dysfunction should systematically benefit from a cardiovascular assessment: blood pressure, lipid profile, blood sugar and, depending on the profile, an electrocardiogram or an exercise stress test. Erectile dysfunction is an independent cardiovascular risk marker recognized by leading cardiology societies.

Other common causes

Diabetes is one of the most common causes of erectile dysfunction, both through its effect on blood vessels and nerves. High blood pressure, obesity, a sedentary lifestyle, smoking and excessive alcohol consumption all contribute to erectile dysfunction through vascular or neurological mechanisms.

Certain medications can cause erectile dysfunction as a side effect, including some antihypertensives, antidepressants, antiandrogens and ulcer medications. The doctor can assess whether a therapeutic adjustment is possible without compromising treatment of the underlying condition.

Psychological factors, such as performance anxiety, depression, relational stress or a history of trauma, play a role in a significant proportion of cases, particularly in younger men. These dimensions merit assessment and, if appropriate, psychological support.

Treatment options

Phosphodiesterase type 5 inhibitors, of which sildenafil (Viagra) is the best-known example, are the first-line drug treatment. They act by facilitating vasodilation in erectile tissue during sexual stimulation. They are effective in around 70 % men, and are well tolerated. They do not create a spontaneous erection and require sexual stimulation to work.

Lifestyle modifications have a real impact on erectile function. A study published in the Journal of Sexual Medicine showed that in obese men with moderate erectile dysfunction, significant weight loss and increased physical activity were enough to restore normal erectile function in a third of participants. Treating the underlying causes, whether diabetes, hypertension or smoking, improves erectile function in many cases.

Frequently asked questions about erectile dysfunction

Is erectile dysfunction normal with age?
It becomes more frequent with age, but it's not inevitable. Many men maintain satisfactory erectile function well into old age, especially those who maintain a healthy lifestyle. Persistent difficulties merit medical evaluation.

Are erectile dysfunction drugs harmful to the heart?
For men without severe cardiovascular problems, they are generally safe. They are contraindicated in association with nitrate derivatives used for angina pectoris, due to the risk of severe hypotension. This is one of the reasons why a medical consultation is necessary prior to their use.

Do I need a prescription for erectile dysfunction medication in Quebec?
Yes, these medications are available on prescription. A consultation can also help identify and treat the underlying causes, which is more beneficial than treating the symptom alone.

When to consult a healthcare professional

If you've had persistent erectile difficulties for more than a few weeks, have cardiovascular risk factors or a history of diabetes, or would like to explore treatment options, a medical consultation is essential.

A doctor can assess potential causes, prescribe a cardiovascular check-up if necessary, and discuss treatment options tailored to your situation. A face-to-face or online teleconsultation at one of our Omicron Clinic in Quebec allows you to access it in complete confidentiality.

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