Q WHY DOES MY GP SAY MY HUSBAND’S PROBLEM GETTING AN ERECTION IS CAUSED BY HIS HEART?

A

Erectile dysfunction (ED), caused by disruption of various vascular, neuronal, hormonal and metabolic factors, may predict future coronary artery disease (CAD), so newly presenting ED patients should have cardiac assessment. Men with ED worry that exertion/ excitement during intercourse may precipitate angina and heart attacks, but with advice and counselling, most men with CAD can have sex safely and use ED therapies. High-risk conditions, including unstable heart disease, recent myocardial infarction, or unstable arrhythmias, need specialist advice. Heart treatments, such as nitrates, are often not advised as a course of treatment with oral ED treatments (PDE5Is), but these can be substituted with an alternative under the advice of a cardiologist. Conversely, men with known CAD should be asked about erectile problems. With over-the-counter ED medication, pharmacists can now assess individual risk and signpost them to the appropriate investigations.