Aetiology and Management of Male Erectile Dysfunction and Female Sexual Dysfunction in Patients with Cardiovascular Disease

Abstract

The historical basis for understanding erectile function as a neurovascular phenomenon and the advance from fanciful to effective treatment of erectile dysfunction (ED) are reviewed, with emphasis on patients with cardiovascular disease (CVD). ED occurs in 60% of CVD patients by 40 years of age. Male ED and female sexual dysfunction (FSD) diminish quality of life and often warn of occult CVD. ED is often unrecognised but is readily diagnosed during a 5-minute interview using a truncated International Index of Erectile Function questionnaire. Erection of the penis and clitoral engorgement result from local, arousal-induced release of neuronal and endothelial-derived nitric oxide (NO). Arterial vasodilatation and relaxation of cavernosal smooth muscle cells cause arterial blood to flood trabecular spaces, compressing venous drainage, resulting in tumescence. Cyclic guanosine monophosphate (cGMP)-induced activation of protein kinase G mediates the effects of NO by enhancing calcium sequestration and activating large-conductance, calcium-sensitive K+ channels. Future treatment strategies will likely enhance these pathways. Phosphodiesterase-5 inhibitors (sildenafil, tadalafil and vardenafil) increase cGMP levels in erectile tissue. These agents are effective in 80% of CVD patients with ED and can be used safely, even in the presence of stable coronary disease or congestive heart failure, provided nitrates are avoided and patients do not have hypotension, severe aortic stenosis or evocable myocardial ischaemia. Second-line therapies (vacuum constrictor device and transurethral or intracavernosal prostaglandin E1) can also be used in CVD patients. Treatment of FSD and its relationship to CVD are less well established, but similarities to ED exist. ED can be prevented by reduction of CVD risk factors, exercise, weight loss and abstinence from smoking.

Safety and efficacy of a Labisia pumila var alata water extract on sexual well being and lipid profile of pre- and postmenopausal women: A randomized double-blind pilot study

“…The link between cardiovascular disease (CVD) and sexual dysfunction in males is well-established; mild or moderate erectile dysfunction is much more common in patients with CVD (Archer et al, 2005). In contrast, sexual dysfunction in women with CVD has received limited attention (Steinke, 2010).…”

“…Research has shown that the mechanism of clitoral engorgement is very similar to penile erection, and thus may also be adversely affected by CVD (Steinke, 2010). Neuropathy or vascular disease resulting from CVD risk factors such as hypertension, smoking, diabetes or hyperlipidemia are known organic causes to female sexual dysfunction (Archer et al, 2005).…”

“…Neuroendocrinal effects of declining estrogen levels, including mood swings, hot flushes, irritability, memory lapses and insomnia also adversely affect sexual response (Buster, 2013). As well, there are some evidence to suggest a link between sexual dysfunction and cardiovascular disease (Archer et al, 2005;Steinke, 2010).…”

Sexual Counseling for Individuals With Cardiovascular Disease and Their Partners

“…2 There is a strong association between sexual disorders and comorbid conditions, especially ED, CVD, and depression. [90][91][92] Depression may be an important contributing cause of ED, including decreased libido, difficulty with arousal and orgasm, and dyspareunia. 3,93,94 Changes in sexual activity after a cardiac event may impair the patient's quality of life, negatively affect psychological health, and strain marital or other important intimate relationships, which in turn may lead to depression and anxiety.…”

Comparison of the Effects of Elaeagnus angustifolia Flower Capsule and Sildenafil Citrate Tablet on Anxiety Resulting From Sexual Dysfunction in Women Referring to the Selected Clinics of Shiraz University of Medical Sciences

“…32 Nevertheless, some researchers believe that the complete role of this mechanism in vaginal congestion as a response to sexual arousal is still unknown. 33 In general, various plants, including ginseng, yohimbine, rose flower extract, and E angustifolia flower, have been used in traditional medicine to treat sexual dysfunction. Since Elaeagnus angustifolia flower exists in Iranian traditional medicine and no studies have been conducted in this regard, the researchers of the present study decided to use this plant for treatment of sexual dysfunction.…”