Happy, Healthy, and Hard
Experts explain the connection between a man's overall health and his sexual health.
Hardening of the Arteries continued...
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
Toward the Ideal Erection
Lamm says he is interested in finding out what ideal erectile function
"Why do we need to wait until a man has erectile dysfunction before we
intervene?" he says.
By definition, having ED means a man cannot get an erection hard enough for
penetration or one that lasts long enough for him to reach orgasm. But in
Lamm's opinion, wellness isn't "the absence of illness." There are shades of
gray between excellent sexual function and dysfunction.
The American Heart Association has defined an optimal cholesterol level.
There should be a similar measure for erectile function, Lamm says. "I think we
need to do this in all areas so that people have some sort of benchmark."
Researchers usually assess erectile function by the International Index of
Erectile Function, a set of five questions such as, "How do you rate your
confidence that you could get and keep an erection?" A patient's answers are
scored, and that score determines whether or not he has ED.
In 2005, when he wrote his book, Lamm was using a tool called a rigidometer
to measure erectile function. A man presses the head of his erect penis against
a sensor attached to the digital device, which measures the precise hardness of
his penis in grams of pressure.