Drugs & Aging

, Volume 22, Issue 10, pp 823–844 | Cite as

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

  • Stephen L. Archer
  • Ferrante S. Gragasin
  • Linda Webster
  • Derek Bochinski
  • Evangelos D. Michelakis
Therapy In Practice


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.



Drs Michelakis and Archer are supported by the Canada Foundation for Innovation, the Alberta Heart and Stroke Foundation, the Canadian Institutes for Health Research (CIHR), and ABACUS (the Alberta Cardiovascular and Stroke Research Centre). Dr Archer is a Canada Research Chair in Oxygen Sensing and Translational Cardiovascular Research and is supported by NIH-RO1-HL071115. Dr Michelakis is a Canada Research Chair in Pulmonary Hypertension and a Scholar of the Alberta Heritage Foundation for Medical Research (AHFMR).

The authors have no conflicts of interest that are directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Stephen L. Archer
    • 1
  • Ferrante S. Gragasin
    • 2
  • Linda Webster
    • 2
  • Derek Bochinski
    • 3
  • Evangelos D. Michelakis
    • 2
  1. 1.Department of Medicine (Cardiology), Department of Physiology and the Vascular Biology GroupUniversity of AlbertaEdmontonCanada
  2. 2.Department of Medicine (Cardiology) and the Vascular Biology GroupUniversity of AlbertaEdmontonCanada
  3. 3.Department of Surgery, Division of UrologyUniversity of AlbertaEdmontonCanada

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