Vol 7, No 4 (2022)
Review paper
Published online: 2022-11-18

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Cardiovascular physiology and erectile dysfunction

Leyla Ozturk Sonmez1
Disaster Emerg Med J 2022;7(4):255-260.


Erectile dysfunction (ED) is defined as the inability to initiate or maintain an erection that is not satisfactory or sufficient for sexual activity.

Erectile dysfunction affects the patient in many ways, especially the physical and psychosocial condition, and has extremely negative effects on the quality of life of the patient and his partner. There is increasing evi­dence that erectile dysfunction occurs in the early stages of coronary artery and peripheral vascular disease. This makes us think that ED is not only a condition that affects the quality of life but also a potential warning sign for cardiovascular diseases. Therefore, it is important to know the relationship between cardiovascular system physiology and erectile dysfunction. In this review, the relationship between cardiovascular system physiology and erectile dysfunction was evaluated in light of the literature.

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  1. Hackett G, Kell P, Ralph D, et al. British Society for Sexual Medicine. British Society for Sexual Medicine guidelines on the management of erectile dysfunction. J Sex Med. 2008; 5(8): 1841–1865.
  2. Selvin E, Burnett A, Platz E. Prevalence and Risk Factors for Erectile Dysfunction in the US. The American Journal of Medicine. 2007; 120(2): 151–157.
  3. Corona G, Monami M, Boddi V, et al. Is obesity a further cardiovascular risk factor in patients with erectile dysfunction? J Sex Med. 2010; 7(7): 2538–2546.
  4. Perek B, Casadei V, Puślecki M, et al. Clinical presentation, surgical management, and outcomes of patients treated for aortic stenosis and coronary artery disease. Does age matter? Kardiologia Polska. 2018; 76(3): 655–661.
  5. Ellsworth P, Kirshenbaum EM. Current concepts in the evaluation and management of erectile dysfunction. Urol Nurs. 2008; 28(5): 357–369.
  6. Sánchez A, Contreras C, Martínez P, et al. Endothelin A (ETA) Receptors Are Involved in Augmented Adrenergic Vasoconstriction and Blunted Nitric Oxide-Mediated Relaxation of Penile Arteries from Insulin-Resistant Obese Zucker Rats. The Journal of Sexual Medicine. 2014; 11(6): 1463–1474.
  7. Ryu JiK, Cho KSu, Kim SuJ, et al. Korean Society for Sexual Medicine and Andrology (KSSMA) Guideline on Erectile Dysfunction. World J Mens Health. 2013; 31(2): 83–102.
  8. New Cardiovascular Risk Factors; Resting Heart Rate, Hs-CRP, Fibrinogen and PMNL. Annals of Clinical and Analytical Medicine. 2012; 03(01).
  9. KOSTIS J, JACKSON G, ROSEN R, et al. Sexual Dysfunction and Cardiac Risk: The Second Princeton Consensus Conference. The American Journal of Cardiology. 2005.
  10. Raheem OA, Su JJ, Wilson JR, et al. The Association of Erectile Dysfunction and Cardiovascular Disease: A Systematic Critical Review. Am J Mens Health. 2017; 11(3): 552–563.
  11. Jin L. Angiotensin II Signaling and Its Implication in Erectile Dysfunction. The Journal of Sexual Medicine. 2009; 6: 302–310.
  12. Becker AJ, Uckert S, Stief CG, et al. Plasma levels of angiotensin II during different penile conditions in the cavernous and systemic blood of healthy men and patients with erectile dysfunction. Urology. 2001; 58(5): 805–810.
  13. Yang R, Yang B, Wen Y, et al. Losartan, an Angiotensin type I receptor, restores erectile function by downregulation of cavernous renin-angiotensin system in streptozocin-induced diabetic rats. J Sex Med. 2009; 6(3): 696–707.
  14. Comiter CV, Sullivan MP, Yalla SV, et al. Effect of angiotensin II on corpus cavernosum smooth muscle in relation to nitric oxide environment: in vitro studies in canines. Int J Impot Res. 1997; 9(3): 135–140.
  15. Ertemi H, Mumtaz FH, Howie AJ, et al. Effect of angiotensin II and its receptor antagonists on human corpus cavernous contractility and oxidative stress: modulation of nitric oxide mediated relaxation. J Urol. 2011; 185(6): 2414–2420.
  16. Granchi S, Vannelli GB, Vignozzi L, et al. Expression and regulation of endothelin-1 and its receptors in human penile smooth muscle cells. Mol Hum Reprod. 2002; 8(12): 1053–1064.
  17. Wingard CJ, Husain S, Williams J, et al. RhoA-Rho kinase mediates synergistic ET-1 and phenylephrine contraction of rat corpus cavernosum. Am J Physiol Regul Integr Comp Physiol. 2003; 285(5): R1145–R1152.
  18. Packer MA, Scarlett JL, Martin SW, et al. Induction of the mitochondrial permeability transition by peroxynitrite. Biochem Soc Trans. 1997; 25(3): 909–914.
  19. Khan MA, Thompson CS, Mumtaz FH, et al. The effect of superoxide dismutase on nitric oxide-mediated and electrical field-stimulated diabetic rabbit cavernosal smooth muscle relaxation. BJU Int. 2001; 87(1): 98–103.
  20. Yang G, Wu L, Jiang Bo, et al. H2S as a physiologic vasorelaxant: hypertension in mice with deletion of cystathionine gamma-lyase. Science. 2008; 322(5901): 587–590.
  21. d'Emmanuele di Villa Bianca R, Sorrentino R, Maffia P, et al. Hydrogen sulfide as a mediator of human corpus cavernosum smooth-muscle relaxation. Proc Natl Acad Sci U S A. 2009; 106(11): 4513–4518.
  22. Gratzke C, Angulo J, Chitaley K, et al. Anatomy, physiology, and pathophysiology of erectile dysfunction. J Sex Med. 2010; 7(1 Pt 2): 445–475.
  23. Chew KK, Finn J, Stuckey B, et al. Erectile dysfunction as a predictor for subsequent atherosclerotic cardiovascular events: findings from a linked-data study. J Sex Med. 2010; 7(1 Pt 1): 192–202.
  24. Yusuf S, Hawken S, Ôunpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet. 2004; 364(9438): 937–952.
  25. Chang ST, Chu CM, Hsu JT, et al. Scrutiny of cardiovascular risk factors by assessing arterial stiffness in erectile dysfunction patients. World Journal of Urology. 2009; 28(5): 625–630.
  26. Janiszewski PM, Janssen I, Ross R. Abdominal obesity and physical inactivity are associated with erectile dysfunction independent of body mass index. J Sex Med. 2009; 6(7): 1990–1998.
  27. Zhang QL, Brenner H, Koenig W, et al. Prognostic value of chronic kidney disease in patients with coronary heart disease: role of estimating equations. Atherosclerosis. 2010; 211(1): 342–347.
  28. Jose P, Skali H, Anavekar N, et al. Increase in creatinine and cardiovascular risk in patients with systolic dysfunction after myocardial infarction. J Am Soc Nephrol. 2006; 17(10): 2886–2891.
  29. Lee M. Focus on phosphodiesterase inhibitors for the treatment of erectile dysfunction in older men. Clin Ther. 2011; 33(11): 1590–1608.
  30. Vlachopoulos C, Jackson G, Stefanadis C, et al. Erectile dysfunction in the cardiovascular patient. Eur Heart J. 2013; 34(27): 2034–2046.
  31. Plasma MDA Levels, GSH-Px Activities and Nitrite/Nitrate Levels in Patients with Familial Mediterranean Fever. Annals of Clinical and Analytical Medicine. 2010; 01(01).
  32. Kloner RA, Henderson L. Sexual function in patients with chronic angina pectoris. Am J Cardiol. 2013; 111(11): 1671–1676.

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