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Anthea Rowan

A man’s erections, or lack of them, can say a lot about his overall heart health.
Having trouble getting or keeping an erection firm enough for satisfactory sex is not a topic men like to talk about, but erectile dysfunction, or ED, is surprisingly common: more than half of men aged 40 to 70 experience some degree of impotence.
One of the major ways in which heart health is related to erections is in the state of our arteries, says Dr Boon Lim, a consultant cardiologist at Imperial College London in the UK.
Healthy arteries enable a healthy flow of blood, which a man needs to achieve and sustain an erection.
Phallus and fallacy: everything important about the penis explained
But the build-up of cholesterol inside artery walls, leading to an inflammatory condition called atherosclerosis, leads to a narrowing of the arteries.
“If the heart’s arteries are narrowed, causing an increased risk of angina or heart attacks, then it is highly likely that the same process causing atherosclerosis within the heart’s arteries is happening in other areas of the body,” Lim says.
This includes arteries in the brain, arms, legs, pelvis, kidneys – and penis.

If blood circulation to the penis is hampered by narrowed arteries then it may be difficult to get an erection, because for one to happen, arteries must dilate and increase blood flow to the penis, Lim says.
A number of diseases may cause ED but atherosclerosis is a common cause, says Dr Andrew Yip, a Hong Kong-based urologist.
If arteries to the penis are narrowed then it’s very likely vessels to the heart are also blocked, Yip says. That’s why ED is a predictor for heart disease and about a third of men with ED will also have heart disease, he adds.

ED is often the first sign of a change in cardiovascular health and can precede the onset of a significant cardiovascular event, such as a heart attack, by three to five years – so there is a window of warning to address heart problems.
The severity of erectile dysfunction can even predict the severity of subsequent heart attack, and the degree of heart blockage.
Few men recognise the relationship between heart disease and erectile dysfunction, though. Many assume it is a result of ageing, which isn’t true, Yip says. A man might experience fewer erections with age, but if they stop altogether, that’s a red flag.

Healthy men experience as many as five erections a night during deep REM sleep, each lasting up to half an hour. And they frequently wake with an erection.
When men start to notice they no longer do, it might be time to think about their heart health, says Dr Leen Antonio, an endocrinologist at University Hospitals Leuven in Belgium.
A recent study Antonio led on sexual symptoms as predictors of mortality found that loss of early morning erections is another sign all may not be well with a man’s heart.
Men who regularly woke up erect were 22 per cent less likely to have a heart attack or stroke in the next three to five years, the study found.

The autonomic nervous system is another link between general cardiovascular health and erections, Lim says.
This part of our primitive nervous system controls all the automatic functions in a body that are subconscious. It is a kind of master regulator for processes such as maintaining adequate blood pressure, skin and temperature regulation, and digestion processes.
The autonomic nervous system is also involved in controlling erections and ejaculation. It can be negatively affected by a number of diseases, conditions and even lifestyle choices, including Parkinson’s, cancer, autoimmune diseases, diabetes and alcohol abuse. It can also be affected by atherosclerosis.
“Poor autonomic control, arising from whatever process, is likely to affect the heart negatively, but also may impact the ability to maintain, or initiate, an erection,” says Lim, who is also the author of the 2021 book Keeping your Heart Healthy.
6 expert tips and tricks for how to live a longer, healthier life
When should men worry? And can better heart health improve erections?
Lim says preventing atherosclerosis, promoting a healthy autonomic system and improving overall heart health requires making holistic lifestyle choices.
These include having a healthy diet and a regular exercise programme, coupled with adequate rest and sleep, and not to be overcome with stress.
The reason most men have no idea of the connection between their heart health and the ability to have an erection “is that there is often a stigma with respect to inability to initiate or maintain an erection”, Lim says. A man does not like to admit to anyone, not even a doctor, that he cannot have sex.
Erectile dysfunction scare in his 20s a light-bulb moment for Singapore man
There are many psychological components to having an erection, Lim adds. But if there are no psychological issues, do not suffer in silence. An erection problem should prompt a doctor’s visit for a check-up of your overall cardiovascular status.
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Wellness

Why erectile dysfunction means a heart attack could be close

Few men recognise the link between cardiovascular health and impotence: about a third of men with erectile dysfunction, or ED, will also have heart disease. Photo: Shutterstock

Dr Boon Lim is a consultant cardiologist at Imperial College London in the UK.

Atherosclerosis is an inflammatory condition caused by the build-up of cholesterol inside artery walls that leads to a narrowing of the arteries and can impair the ability to have an erection. Photo: Shutterstock

Dr Andrew Yip is a Hong Kong-based urologist.

A loss of early morning erections is another sign all may not be well with a man’s heart, a recent study suggests. Photo: Shutterstock

Do you wet yourself uncontrollably? Don’t suffer in silence – your pelvic floor muscles could be the problem. What they do and how to strengthen yours

The pelvic floor is a muscle group that supports the bladder, bowel, and reproductive organs. Problems with them can affect men and women of any age, but there are solutions. Photo: Shutterstock

The pelvic floor muscles support the uterus, bladder, rectum and other organs. Illustration: Shutterstock

Up to 40 per cent of men who undergo prostate surgery will suffer incontinence as a side effect. Photo: Shutterstock

Katy Megson, who works with clients of all genders in her practice, has observed that many of her male clients tend to be athletes or engage in intense physical activity like weightlifting. Photo: Joint Dynamics Evolve

Intense physical activity can weaken the pelvic floor, says Katy Megson, senior physiotherapist in pelvic health at Joint Dynamics Evolve in Hong Kong. Photo: Joint Dynamics Evolve

Pelvic floor physiotherapy can be used as a conservative treatment option for conditions like incontinence, mild prolapse, and painful intercourse. Photo: Momentum

Harmful misconceptions about incontinence include that it’s unavoidable and untreatable – requiring the use of adult diapers to control leakage. Photo: Shutterstock

Jocelyn Tam is a manager at the Rehabilitation Centre at Hong Kong Adventist Hospital. Photo: Jocelyn Tam

Although pelvic floor problems are commonly associated with pregnancy and childbirth, they can also arise due to age-related muscle loss, prostate surgery, heavy lifting, and chronic constipation or coughing.

Physiotherapist Jocelyn Tam sits on the Emsella chair, a non-invasive device that targets the pelvic floor with high-intensity electromagnetic waves. Photo: Adventist Hospital 

Aislinn MacPhail is a physiotherapist specialising in orthopaedics and pelvic health at Momentum, in Hong Kong. Photo: Aislinn MacPhail/Momentum

Erectile dysfunction: why men don’t talk to doctors about it enough – penis transplant pioneer and fellow expert explain

Few men get help. Fewer men know impotence is a warning sign of heart disease, diabetes, or worse. Hong Kong doctor, and another who did first US penis transplant, talk about why men need to take their health more seriously

Dr Andrew Yip Wai-chun, Specialist in Urology with a model of the male anatomy, room 1807, 18/F, Wing On House, 71 Des Voeux Road Central, in Hong Kong on August 01, 2017. 01AUG17 [FEATURES HEALTH] SCMP / Jonathan WONG

shutterstock_181632251.jpg This shutterstock shot of Clogged artery and atherosclerosis disease medical concept with a three dimensional human artery with blood cells that is blocked by plaque buildup of cholesterol as a symbol of vascular diseases. [FEATURES] Photo: SHUTTERSTOCK

Dr Dicken Ko, director of regional urology for Massachusetts General Hospital and one of the surgeons that performed the first penis transplant in the US last year. Poses for a photography at Renaissance Harbour View Hotel in Wan Chai. 03AUG17 SCMP / Jonathan Wong

Erectile dysfunction may be a symptom of other health problems, such as high blood pressure, diabetes or heart disease. Photo: Shutterstock

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Amyloid plaques and tau tangles found in Alzheimer’s sufferers’ brains are caused by build-ups of proteins that block electrical messages. 
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Dr Andrew Lees, author of “The Silent Plague”, is a professor of neurology at the National Hospital in London and University College London. Photo: Dr Andrew Lees

Lee’s image of “sepia galactic storms”: the rust-coloured clumps are stained amyloid plaques, the little black squiggles are tau tangles. Photo: Andrew Lee

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Avinash Gowda before he began losing weight a second time in January 2022 (above, left) and eight months later. Photo: Avinash Gowda

Singapore IT executive Avinash Gowda shows off his slimline form as personal trainer Owen Bisman holds up a now much too large jacket. Strength and cardio training, a keto diet, intermittent fasting, drinking less alcohol and quitting smoking helped Gowda shed 29kg. Photo: Avinash Gowda


Avinash Gowda in January 2022 (above, left) after putting on weight he had lost during the Covid-19 pandemic, and in September 2022. Photo: Avinash Gowda

Gowda recorded his weight-loss progress on Facebook. Photo: Avinash Gowda

Gowda (right) and personal trainer Owen Bisman at Ultimate Performance gym in 2022. Photo: Avinash Gowda

Gowda usually eats fish or steak with vegetables for lunch and dinner. Photo: Avinash Gowda

Gowda shares his weight-loss journey on Facebook.

A fitter, happier Gowda with his wife and sons in 2022. Photo: Avinash Gowda

Lifestyle

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Erectile dysfunction (ED) could be a sign your heart health is not good, and can precede the onset of a significant cardiovascular event by three to five years
A loss of early morning erections is another sign all may not be well with a man’s heart, a recent study suggests


Erectile dysfunction, or ED, could be a sign your heart health is not good, and can precede the onset of a significant cardiovascular event, such as a heart attack, by three to five years.


Sex and relationships

The human body

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Explainer | Why erectile dysfunction means a heart attack could be close

Erectile dysfunction (ED) could be a sign your heart health is not good, and can precede the onset of a significant cardiovascular event by three to five years A loss of early morning erections is another sign all may not be well with a man’s heart, a recent study suggests

Erectile dysfunction (ED) could be a sign your heart health is not good, and can precede the onset of a significant cardiovascular event by three to five years

A loss of early morning erections is another sign all may not be well with a man’s heart, a recent study suggests