Diabetes, heart attack, dementia, addictions. PEnnis can function as an indicator of general health. Experts believe that evolution brought this “curse” to men to help women identify healthy partners.
One could describe the erectile dysfunction like a silent epidemic. According to several studies, it affects more than half of men over 40 years old. Still, few are willing to talk about the subject with the people they love.
When the topic comes up in conversation, it is often treated as a joke rather than an early sign of health problems. But a growing number of studies suggest that the penis can act as an indicator of general health.
Erectile dysfunction, in particular, can be one of the first signs of serious illnesses, such as diabetes, heart attack, stroke and dementia.
According to sexologist Emmanuele Jannini, from the University of Rome Tor Vergata, in Italy, erectile dysfunction is often one of the first signs that something is not right with your health.
Jannini recently organized an academic book that brings together scientific evidence on the topic. For the expert, more careful investigation of erectile dysfunction could help doctors identify serious health problems before they worsen.
But the reluctance of many men to talk about their sexual health means these opportunities for early diagnosis are missed.
Here’s what you need to know about this extremely common problem and why it should serve as a warning to doctors.
Circulation problems
As with many medical conditions, the exact prevalence of erectile dysfunction depends on how it is defined and measured. Therefore, studies present very different estimates: the global prevalence among adult men varies between 3% and 76.5%.
One of the largest and most detailed studies on the subject evaluated around 1200 men using extensive questionnaires. The study found that 39% of 40-year-old men regularly experienced some degree of sexual impotence. At age 70, this proportion reached 67%.
In many ways, erectile dysfunction is a blood circulation problem.
The penis is made up of two spongy structures called corpora cavernosa, which normally remain flaccid. During sexual arousal, the brain sends signals that increase blood flow to this region. As the corpora cavernosa fills, they compress the veins responsible for draining blood, causing it to remain in the organ and produce an erection.
Like a balloon when inflated, the penis increases in volume and becomes rigid. Any factor that reduces blood flow to the organ can make it difficult to obtain or maintain an erection.
The problem often has a psychological origin.. The stress response, which involves hormones such as adrenaline and cortisol, can cause blood vessels to constrict, preventing the corpora cavernosa from hardening. High levels of stress can also interfere with testosterone production, reducing libido and sexual arousal.
It is important to emphasize that people with hormonal conditions, such as hypogonadismthey also produce less testosterone, which may contribute to the problem.
Furthermore, stress is often accompanied by mental distraction, which can make it difficult to concentrate during sexual activity. From an evolutionary point of view, this probably had a function: if stress interrupts sexual arousal, the organism preserves energy to deal with dangerous situations. “If the environment poses risks, it is important not to reproduce it”, explains Jannini.
But in the modern world, there are many sources of stress that do not pose a threat to survival. As a consequence, this protection mechanism may be triggered more frequently than necessary.
Heart and brain problems
In many cases, erectile dysfunction can also reflect broader health problems. One of the causes is the atherosclerosisa condition in which blood vessels harden and narrow, increasing the risk of cardiovascular disease.
As the arteries in the penis are among the smallest in the body, they tend to be one of the first to present problems. Therefore, erectile dysfunction can serve as an early sign of heart disease.
A recent analysis of data from 154,794 people concluded that men with erectile dysfunction had 59% more likely to develop coronary artery disease and 34% more likely to suffer a stroke.
“Having a good erection is a good indicator of the health of your blood vessels,” says Michael Carroll, an expert in reproductive science at Manchester Metropolitan University, in the United Kingdom. Carroll is the author of the book Your Nuts: The Science of How They Work and What It Means For Your Fertility, scheduled for release this year.
There is also evidence that penile health problems may serve as an early sign of cognitive decline. A study carried out in Taiwan concluded that men diagnosed with erectile dysfunction had 68% more likely to develop dementia over seven years of follow-up. Just like the penis, the brain depends on good blood flow to receive nutrients and eliminate toxic substances.
The relationship with diabetes
Monitoring erectile dysfunction may be especially important in people at risk of developing diabetes, a disease that affects the circulatory and nervous systems through different mechanisms. Spikes in blood glucose, common when the disease is not well controlled, can cause excess sugar to bind to proteins in the walls of blood vessels. This process, known as glycation, reduces the elasticity of vessels and makes blood circulation difficult.
As with atherosclerosis, the reduction in blood flow first affects the most delicate vessels in the body, including those in the penis.
“The relationship between diabetes and erectile dysfunction is very strong”says Bogdan Vlacho, investigator of the Sant Pau Research Institute, in Barcelona, Spain. “Men with type 2 diabetes are about three times more likely to develop erectile dysfunction than those who do not have diabetes.”
In a recent review of the scientific evidence, Vlacho also concluded that people with diabetes and erectile dysfunction have a significantly higher risk of developing “peripheral neuropathy” — nerve damage in the hands and feet — than diabetes patients without erectile dysfunction. They are also more subject to retinopathywhich can lead to blindness, and wound healing difficultieswhich in some cases can result in amputations.
Despite this, routine investigation of erectile dysfunction in diabetic patients is not yet part of usual clinical practice.
“There is evidence that health professionals do not talk to patients about this subject”says Santiago Martinez, an endocrinologist at the University of Barcelona, in Spain, and co-author of the study review.
Treatments
Research carried out by The Urology Foundation, in the United Kingdom, concluded that more than half of men with erectile dysfunction avoided seeking medical help out of shame or anxiety related to the problem. Around 20% said they would rather go a month without drinking beer than consult a health professional.
But, according to Carroll, from Manchester Metropolitan University, all men experiencing erectile dysfunction should seek medical advice. In addition to alleviating a major source of suffering and stress, this can open up a valuable conversation about the patient’s overall health — a conversation that, in some cases, can save lives. “It is essential to treat the problem early,” says Carroll.
After all, erectile dysfunction It is not an untreatable condition. Medicines like Viagrawhose active ingredient is sildenafilpromote the dilation of blood vessels in the penis. There are also observational reports that suggest that patients who use these drugs to improve their sex lives have better cardiovascular outcomes, including a lower risk of heart failure, although this has not yet been proven in clinical trials.
Keep in mind that Viagra was originally developed as a cardiovascular treatment for patients with high blood pressure, before researchers realized its better-known effect.
Some studies also suggest that these medications may reduce the risk of dementia. Research that analyzed more than 885,000 patients concluded that the use of these medications was associated with a halving of the risk of developing Alzheimer’s disease.
Even if no specific treatment is indicated, reporting erectile dysfunction to your doctor allows you to investigate common risk factors for cardiovascular diseases, such as hypertension and atherosclerosis, in addition to identifying problems such as obesity, which may be harming vascular health.
Furthermore, talking to a doctor about erectile dysfunction allows you to investigate common risk factors for heart disease, such as hypertension and atherosclerosis, as well as identify problems such as obesity, which may be harming cardiovascular health.
In some cases, simple measures, such as changes in diet and physical exercise, can help. For people with diabetes, controlling blood glucose levels is essential.
Still, Martinez and Vlacho point out that research into the effects of these treatments on erectile dysfunction and preventing other complications is still in its early stages.
At the same time, identifying the causes of erectile dysfunction may require further investigation, as the problem may also be related to habits such as compulsive pornography consumption and mental health issues associated with sexual desire.
“When a man has diabetes or a cardiovascular disease, it is generally easier to establish the relationship and recommend treatment,” says Carroll. “But when lifestyle factors, such as alcohol consumption and smoking, come into play, combined with psychological or behavioral aspects, such as excessive pornography use, the situation can be more difficult to address. Often, these men don’t want to talk about their habits.”
The lost bone
In addition to the importance of these discoveries for current medicine, Jannini reflected on the possible evolutionary implications of the fact that the penis functions as such a sensitive indicator of the body’s general health.
In this respect, human beings are relatively unusual. Our ability to achieve a firm erection depends on blood flow. Most other primates, including our closest relatives the chimpanzees, have a retractable bone called a staffor penile bone. During sexual arousal, this bone helps support the erection and keep the organ rigid. Therefore, the sexual life of these animals is not as directly linked to the general state of health as it is in humans.
Because then men will have evolved in such a way as to lose their staff and thus become more susceptible to erectile dysfunction? This is a question that has intrigued evolutionary biologists for decades. Jannini suspects that the loss of the penile bone may have helped ancient women of the human species identify healthier partners with greater reproductive potential.
“It is very strange that we have lost the most important bone for reproduction, because our sexual response is extremely unpredictable,” says Jannini. “But this also makes it the perfect biomarker for chronic disease.”
