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    Happy, Healthy, and Hard

    Experts explain the connection between a man's overall health and his sexual health.

    Hardening of the Arteries

    There is little doubt about the common cause of ED and heart disease. It's atherosclerosis, also known as hardening of the arteries.

    In atherosclerosis, fatty deposits build up inside arteries and form a plaque, making the walls of the arteries stiff and restricting blood flow. Eventually, chunks of plaque may break off into the bloodstream and lodge somewhere else, where they block blood flow. If a blockage forms in the heart, it causes a heart attack; in the brain, it causes a stroke.

    Scientists think that the disease starts with damage to the endothelium, a layer of cells lining the arteries.

    What does that have to with an erection?

    To get erect, the penis must become engorged with blood; and for that to happen, the endothelium must relax, allowing the arteries to widen and let blood flow into the penis.

    "Arteries that lead to the penis are smaller than the arteries that lead to the brain or the heart," says Ira Sharlip, MD, a urologist at the University of California, San Francisco.

    Hardening of the arteries begins to affect those small arteries long before any change is noticeable in the larger arteries.

    Sharlip has been studying ED for more than a decade. In 1996, two years before Viagra was approved, he was one of the doctors who wrote the American Urological Association's guidelines on treating ED. At the time, ED was the domain of specialists in sexual medicine, particularly urologists.

    That is changing. "If a man of 45 or 50 with no other problems develops ED, he should go to a primary care physician," Sharlip says.

    Doctors assume that if ED is diagnosed early, some men could head off heart disease by making lifestyle changes, such as quitting smoking, eating a healthier diet, and exercising.

    But right now, that's just an assumption; there isn't evidence yet showing that men who have ED but not heart disease could take measures to prevent it.

    Toward the Ideal Erection

    Lamm says he is interested in finding out what ideal erectile function is.

    "Why do we need to wait until a man has erectile dysfunction before we intervene?" he says.

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