Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection
satisfactory for sexual performance. Evidence is accumulating to consider ED as a
vascular disorder. Common risk factors for atherosclerosis are frequently found in
association with ED, and ED is frequently reported in vascular syndromes, such as
coronary artery disease (CAD), hypertension, cerebrovascular disease, peripheral arterial
disease, and diabetes mellitus. Finally, similar early impairment of endothelium-dependent
vasodilatation and late obstructive vascular changes has been reported in both ED
and other vascular syndromes. Recently, we proposed a pathophysiologic mechanism to
explain the link between ED and CAD called the artery size hypothesis. Given the systemic nature of atherosclerosis, all major vascular beds should be
affected to the same extent. However, symptoms rarely become evident at the same time.
This difference in rate of occurrence of different symptoms is proposed to be caused
by the different size of the arteries supplying different vascular beds that allow
a larger vessel to better tolerate the same amount of plaque compared with a smaller
one. According to this hypothesis, because penile arteries are smaller in diameter
than coronary arteries, patients with ED will seldom have concomitant symptoms of
CAD, whereas patients with CAD will frequently complain of ED. Available clinical
evidence appears to support this hypothesis.
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Publication history
Published online: November 08, 2005
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© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
