No reason to be ashamed: ‘Research into erectile dysfunction can save lives’

The curtains are drawn. Music comes from the speaker, barely louder than a whisper. A scented candle flickers in the corner, bathing the room in a golden glow. Nothing stands in the way of a romantic evening for two. Or?

The plans end quickly. He wants. He can not. Neither the romantic atmosphere nor his wife’s new lingerie can change that. The erection does not occur. Once more.

The story of a man sitting across from Nicolas Diehm in his consulting room could play out like this or something like that. “Please tell me the problem is not psychological,” he, like about a third of other patients, would like to hear from the doctor. And in fact, erectile dysfunction rarely has a psychological origin. In fact, it only affects about ten percent of cases, as several medical institutions claim.

Diehm knows this too, as an angiologist who deals with vascular diseases, especially those in the penis. At his erectile dysfunction center in Aarau, he and his team receive 10 to 15 patients every week who complain of erection problems. Many of them arrive late. The reason for this is often shame. The feeling that they are less of a ‘man’ without an erection or that there is something wrong with them.

This is despite the fact that a new survey among 1,074 men by the “Deutsche Ärzteblatt” shows that 27.5 percent have mild erection problems, 13.9 percent have weak to moderate erection problems, 4.4 percent moderate erection problems and 6 percent severe erection problems. The problem is not that rare and is still a taboo subject. “People talk about heart attacks, but not about erectile dysfunction,” says Diehm. Although the latter would be an important topic of discussion because: “Researching erectile dysfunction can save lives.” How is that possible?

There is often a combination of various organic risk factors, such as high blood pressure, obesity, possibly diabetes or a disorder of lipid metabolism. These organic causes can lead to narrowing of the blood vessels. Simply put, it looks a bit like a water pipe that has become calcified. According to Diehm, such narrowing of the blood vessels is responsible for almost half of erectile dysfunction.

An erection occurs when the arteries leading to the penis and the erectile tissue of the penis expand. In this way, blood flow can be increased and the penis becomes larger. However, if the arteries are calcified, sufficient blood can no longer reach the penis.

Erectile dysfunction is not a hopeless fate. Sometimes a change in lifestyle is enough, Diehm says. A 2019 study examined 200 men with erectile dysfunction. In 90 percent of cases the cause was a vascular problem. In addition, risk factors were recorded in all study participants: 42.5 percent of them had high cholesterol levels. In addition to hereditary factors, this value is also affected by an incorrect high-fat diet and lack of exercise. Moreover, 26 percent of those surveyed were smokers.

The most well-known solution is PDE-5 inhibitors such as Viagra. They support erections because they have a vasodilatory effect. But only if there is a sexual stimulus. Since 2019, potency drugs such as Viagra have been available in pharmacies without a prescription in the lowest dosage and the smallest package size. However, the costs are usually not reimbursed by the health insurer.

According to Diehm, the high prices compared to abroad and the shame of buying such a product from a pharmacy lead to ordering sexual enhancers online. Erection enhancers have been at the forefront of illegal drug imports into Switzerland for years. In 2023, this was 71 percent of seized imports. The only thing we can warn about is: “Neither the dose nor the ingredients are safe when it comes to preparations ordered abroad,” says the doctor.

PDE-5 inhibitors are not a panacea for all men. “The preparations do not work in about half of the patients,” says the vascular doctor. This experience can lead to further self-doubt and feelings of shame. But: “If these tablets do not work, there is a good chance that the blood vessels are not intact.” For example, the arteries are too narrowed or there is a so-called venous leakage. In such cases, the blood drains too quickly and the limb becomes limp after a short time. Younger patients in particular, for whom no other cause can be found, can be helped with minimally invasive methods. During the procedure, the affected veins are closed with tissue glue.

Interventions are also possible for severe vasoconstriction. Using stent treatment, the arteries leading to the penis can be dilated with a balloon and then stabilized with an inserted vascular support. A routine procedure for Diehm. He performs it twenty times a month. The patients are on average 59 years old. For a year now, both minimally invasive procedures have been reimbursed by health insurance if the problem concerns serious erectile dysfunction. Diehm’s experience shows that this affects approximately ten percent of all patients.

Whether it concerns Viagra or surgery, it is important that the cause is also clarified and treated. In this way, not only your love life will be successfully brought back. Any serious consequences can also be prevented. Because vascular changes in the body are often first noticed in the penile vessels. The arteries leading to the penis are among the thinnest in the body.

If your blood flow becomes disrupted, for example due to high cholesterol or chain smoking, it is only a matter of time before other arteries are also affected. Diehm says: “Erectile dysfunction precedes a heart attack by about three years.” If this is taken as a warning sign and cleared up at an early stage, lives can even be saved.

About half of cardiovascular events in men are related to erectile dysfunction. A study published in January by the Center for Erectile Dysfunction in Aarau found that treating and diagnosing erectile dysfunction could lead to a 21 percent reduction in the risk of heart attack and stroke.

The majority of men (67 percent) were aware of the problem before the cardiovascular event. Diehm says: “40,000 cardiovascular events such as heart attacks or strokes could be prevented in a 10-year period.” This would also save costs, which Diehm said could cover every second stent procedure to restore erections.