The perception of ED has evolved. For centuries, erectile dysfunction has been viewed as an unfortunate consequence of a divine influence. In the seventies, ED was believed to be mainly psychologically induced. Two decades later, with increase basic knowledge, ED’s etiology became mainly organic. Despite these emergent concepts, many were still consider ED as trivial despite numerous studies showing its tremendous negative effect on the quality of life.
From a complication of cardiovascular disease, with which it shares many risk factors, ED has now become one of its early markers. The penis could be seen as a reflection of the health status of an individual, in particular of his vascular health. The erection is a vascular process. The penile arterial tree is however smaller than the heart vessels and as such is very sensitive to structural and functional changes. The endothelium, the inner lining of all blood vessels including the penis and the heart, may be the first affected by functional changes. Endothelial dysfunction, which impairs arterial vasodilatation, is an important pathophysiologic factor of both ED and cardiovascular disease. Furthermore, ED may be the first sign of atherosclerosis. This new information has lead to the emergence of a new concept: preventive vascular medicine based on the penile health. The appearance of ED should trigger changes in life style and modify any risk factors to avoid later further cardiovascular events. These illustrate the changing perception of ED: From divine intervention to marker of cardiovascular risk.
Conflict of Interest: Member of Advisory Board Of Pfizer Canada, Bayer Canada And Eli Lilly Canada
Financial Support/Funding: None disclosed
Sydney Australia, April 2007
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