It may seem odd at first and you would wonder what Cardiologists have to do with ED (Erectile Dysfunction). Although this may not seem ordinary from daily clinical routine, a thorough look and clinical inclination and interrogation among the patients who have heart diseases or chronic cardiovascular disorders are mostly suffering from erectile dysfunction. The mere association of vasculogenic erectile dysfunction and coronary disease is a well known phenomenon, a kind of phenomenon that represents scientific evidences that were not able to be translated in to clinical routine and practice. There are a lot of cardiologists who are hesitant to ask their patients about sexual problems and there are two reasons behind it.

• There are a lot of patients with ED and concomitant cardiac problems who are not being treated for ED because doctors think that it is considered as a high risk for a patient to be engaged in sexual activities as well as for using certain drugs like PDE-5 inhibitors.

• It can be that other cardiologists don’t make the effort or lacks the time to educate their patient about chronic cardiovascular disorders related to ED. They may even be not that aware of its relations and how it can affect patients.

Either way, lack of awareness had a significant impact on a patient’s sexual dysfunction in their life then can lead to even worse than the experience of myocardial infarction or any cardiovascular event. Since a patient does not know about its relation, they would not tend to share it and not even cardiologists ask about it. It would seem right to take this time and be aware.

In common knowledge it is said that sexual problems increases with ages as well as with the development of illness and specific chronic disease such as, kidney failure, diabetes and most of all, heart diseases. It is then in 1948 when a better sense of awareness contributed by Kinsey who released a movie entitled, Kinsey – let’s talk about sex, and in 1981 that was a Starr report that revealed people who are above 65 years of age are only once a week sex active and that women who are 61 to 91 only had an average of 1.4 per week sex active. In conclusion, sexual activity decreases as age increases. To take view of the baby boomer’s generation that are currently in their mid-forties that there will be an overwhelming number of people who will be suffering from sexual dysfunction in the years to come in connection with the reduced quality of life and depression. In other cases, it seems that sexual problems are still a taboo that led patients to never talk to their physicians about it. It is also unfortunate that there are a lot of physicians out there who are not well educated with sexual dysfunctions as well or lack the approach on how to address sexual dysfunction especially in other patients and patients with chronic cardiovascular disorder. It must be known that sexual problems can be caused by different conditions even more so with gender of whether the patient is a man or a woman.

• In males, it is common to hear sexual dysfunction, it is normally termed, that means they have difficulty in maintaining or gaining penile erection, in result they have the inability to successfully perform coitus. Anorgasmy or premature ejaculation can be other presentations of sexual dysfunction.

• In women, sexual dysfunction is more over represented by lack of vaginal lubrication, anorgasmy or painful intercourse or decrease in arousal caused by lack of libido can be their representation of sexual dysfunction problems. In the women’s aspect, little is known about women’s sexual dysfunction problems because it seems to not really show unlike in men, however researchers over the time has addressed these problems more intensively.

Generally, there are seven specific reasons or causes of sexual dysfunction that are particular in men. These are related to endocrine, vascular, hormonal, psychogenic/psychosocial and neurogenic causes, and including side effect caused by drugs as well as rare traumatic cases. But out of all these causes it is estimated that over 80% of all the cases are related to vascular conditions. That included inadequate blood supply and vascular disorders. And by gender there are over 52% of men that will probably have the sexual dysfunction problem by the age of 40 to 70, these numbers are likely to increase due to aging and prolonged survival of illness found in critical heart conditions. In effect, sexual dysfunction represents a major economical, medical and psychosocial problems. Specifically with the patients and the elderly having cardiac diseases, there are several cases of inadequate treatment for sexual problems which had been summarized as follows:

1) Fear. When one already experience a cardiac event such symptoms of hear failure or heart attack, having chest pains or has already went through the experience of cardiac catheterization or bypass surgery, many have instilled fear in them to resume sexual activity because they fear to have a heart attack again. This may be fierce for some but studies proved that there are only very low records of the real world incidence of having a heart attack or having a fatal arrhythmia. Based on a research in 1996 that of all heart attacks that happened during sexual intercourse and sudden death that occurs during sex is only around 1-3%.

2) Concomitant medication: Side effects on drugs that contribute to the development of erectile dysfunction or decrease in libido. It is always worth it to take effort in evaluating a certain drug to be used that may cause the side effects. This will allow you to take charge and exchange it for some other class drug having fewer side effects of sexual dysfunction.

3) Risk Factor. Associating risk factor with the possible occurrence of atherosclerosis, myocardial infarction and stroke are the possible link to the occurrence of erectile dysfunction. There’s smoking, diabetes, high cholesterol level, and high blood pressure are just some. The proper control of these risks is important in preventing a potentially life-threatening condition but also to improve sexual dysfunction.

4) Performance Capabilities. When one performs sexual intercourse, it is inevitable that hear rate and blood pressure rises on the average of 5 to 15 minutes and in total hemodynamic challenges for the heart only requires 3-5 minutes of its total cardiac output for male erection. The average sexual activity is compared to an activity of climbing t

5) Two flights of stairs. Most of the patients who has a preserved left ventricular function after myocardial infarction can go on with their sex activities, however 50% of these people have reported decrease in interest. Even if these men underwent a successful balloon angioplasty of bypass surgery of coronary disease, 36% percent of these men have reported decrease interest in sexual activity. For men that already experienced heart failure, 60% of them show no more interest in sex and 40% believe that they shouldn’t be as active so avoid potential damage to their heart.

6) Medication Interaction. Since PDE-5 inhibitors Viagra, Levitra, Cialis had been introduced with the matching promotion of celebrities such as Senator Bob Dole and Playboy founder and editor Hugh Heffner announcing the product’s success in sexual performance to maintain an active sex life, these drugs had been reported as to be life threatening for patients with heart problems. In publications and FDA reports, it became obvious that there are absolute contradiction of all PDE-5 inhibitors had the NO donating agents like nitrates. Nitrates are substances used for oral tablets, spray, sublingual tablets or capsules or as transcutaneous patches to over come chest pains. If you combine using PDE-5 and nitrate together, the outcome will be a drop in blood pressure that may be fatal for patients that has coronary artery disease. Patients coronary artery disease who are in a stable condition and are not using nitrates can possibly used PDE-5 inhibitors.

Making advances in knowing the connection of chronic cardiovascular diseases and sexual dysfunction problems can be beneficial and can lead to easier treatments.

Ongoing conference regarding the association of sexual dysfunction and heart disease have not been that rampant, so the encourage for this knowledge is extremely helpful. There’s this book entitled “Sex and the Heart” to tackle more on this topic as one output on how physicians and researchers address sexual dysfunction in patients that have cardiac problems.

Some topics in this book:

· Sexual dysfunction as an early symptom for future heart disease

· Sexual dysfunction and function in the elderly

· Future treatment options

· And more detailed understanding towards sexual dysfunction

This is not just for the patient to be aware of, but also the physicians and internists who are not familiar with the problems of ED and urologists who are not that aware of the cardiovascular problems and erectile dysfunction on their ongoing patient and future patients especially when matter can be fatal and they may be held liable for the outcome of being un aware.