November 20, 2019

Why Erectile Dysfunction May Signal Cardiovascular Problems

Learn the many causes of erectile dysfunction

older man upset in bed with wife

Erectile dysfunction (ED) isn’t the inevitable result of aging. Yet mild, moderate or severe ED strikes more than 50% of American men between age 40 and 70. So if getting old is not the “cause” of ED, what is?


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Erectile dysfunction may be caused by numerous diseases and conditions including vascular disease, nerve disease (such as multiple sclerosis and diabetes mellitus), psychological conditions (such as stress, depression or performance anxiety) and injury to the penis. In addition, chronic illnesses, certain medications, as well as prostate, bladder and colon surgery can lead to ED.

However, it’s estimated that vascular disease such as atherosclerosis (or hardening of the arteries) and diabetes may be responsible for as much as 50 to 70% of ED cases. While ED treatments include lifestyle changes, prescription medications or outpatient procedures such as penile implants, Cleveland Clinic is offering a novel endovascular intervention for selected patients.

Vascular Disease and ED

“Vascular disease was first identified as a cause of ED by a French surgeon, Rene Leriche, more than 100 years ago,” says interventional cardiologist Joseph Campbell, MD. “He determined that men who were heavy smokers had blockages of plaque (fatty deposits) build up in their aorta, the main artery that delivers blood to a complex network of artery branches throughout the abdomen and pelvis, including the male genitals.”

Build up of plaque in any of these arteries essentially blocks sufficient blood flow to the penis, preventing men from obtaining an erection.


“Patients who suffer from peripheral vascular disease (also known as peripheral arterial disease, or PAD), described as clogged arteries in the legs, neck or carotids, renals or aorta can be at higher risk for ED,” Dr. Campbell says. These individuals should be evaluated for possible arterial blockages that may be contributing to ED.

What treatment options are available for ED?

Treatment options depend on the underlying cause of ED. These may include:

  • Psychosocial interventions.
  • Lifestyle changes such as regular exercise, a low-fat diet, weight loss, smoking cessation.
  • Medications to treat hormonal deficiencies.
  • ED medications.
  • Penile injections, a vacuum pump or a penile implant.

However, a small subset of patients who have significant blockages in arteries that deliver blood to the penis may be candidates for a novel endovascular intervention. This type of minimally invasive procedure enables physicians to treat blocked arteries from inside the blood vessel using sophisticated medical equipment.

The physician gains access to the main artery in the patient’s leg by way of a small needle through which wires are passed. A catheter, a thin flexible tube, is then threaded up to the blocked artery. The catheter also carries a deflated balloon and a stent, or a tiny wire mesh tube. The physician inflates the balloon to open the artery and then installs stents, which push the blockage aside and keep the artery open, improving blood flow.


“This novel approach has been available for a little over a decade now,” explains Dr. Campbell.

Still considered an investigational, or “off-label” use of an FDA-approved technology, ideal candidates for this procedure are chosen according to strict criteria. Cleveland Clinic will be participating in clinical trials to determine how effective endovascular treatment is for treating ED.

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