Number 28, 2005
Sex and the Heart
Sex and the Heart
 Back to the Summary
Graham Jackson
Cardiothoracic Centre, St. Thomas’ Hospital, London, UK
Correspondence: Dr Graham Jackson, Consultant Cardiologist, Cardiothoracic Centre, St. Thomas’ Hospital, London SE1 7EH, UK.
E-mail: gjcardiol@talk21.com
Erectile dysfunction is common affecting over 50% of men aged 50–70 years. It increases with age so that men over 70 years of age have three times the incidence of men in their 40s. It is an important cause of relationships breaking down with the man losing self-esteem, feeling inadequate, and a failure. The commonest cause is organic though psychological consequences will result and both aspects of management need to be addressed. Vascular disease (endothelial dysfunction) is the common denominator in over 70% of cases which is why this issue of Heart and Metabolism focuses on the cardiovascular aspects of erectile dysfunction. Female sexual dysfunction is also an important management concern but it is not as clearly linked to cardiovascular problems and as it is a more complex subject needing specialised therapists we have not included it in this issue.
The recognition that male sexual ED (erectile dysfunction) can be a marker for cardiovascular ED (endothelial dysfunction) has led to the recognition that sexual ED can be an early indicator of cardiovascular disease in a man otherwise asymptomatic from the cardiac perspective. The importance of this observation, which applies to both chronic and acute cardiac presentations, has led to the belief that early aggressive risk factor reduction may delay or prevent a cardiovascular presentation. The articles by Kevin Billups and Michael Kirby cover this concept with erectile dysfunction assuming the status of “cardiovascular equivalent” in the same way we view diabetes.
The clinical articles take us from the haemodynamics of sex through cardiac risk to safe management. The phosphodiesterase type 5 (PDE5) inhibitors have transformed the management of erectile dysfunction but cannot be used in the presence of oral or sublingual nitrates due to an unpredictable profound fall in blood pressure. Here there is a role for trimetazidine as a non haemodynamic nitrate alternative (pages 22–24) - the presence of nitrates should not be a bar to PDE5 therapy without considering whether they are needed at all or whether they can be substituted.
For 4 years now I have run a male cardiovascular health clinic with Emma Waring who is a fully trained cardiac nurse specialist with a diploma in sexual medicine. So far we have treated 342 cardiac patients with erectile dysfunction who have been followed up and we have an 85% success rate in restoring couples to sexual intercourse using PDE5 inhibitors in 95% of these. We have experienced no acute cardiac events in this carefully supervised outpatient clinic. However writing about the successes is not a match for the patient expressing his views in his own words. The following email says it all in two paragraphs – the first a typical light-hearted approach then the second vividly illustrating the pain and suffering. Sadly there is little cardiological interest in sexual ED but if we think of it as a means for early detection (another ED) of vascular disease cardiologists clearly need to be involved in both its evaluation and management – however the email alone should be convincing enough. ED is too important to be left to the urologists, we need a multidisciplinary approach which actively involves cardiologists.
“I was married in the Philippines on the 4th July 2005, something I would only have dreamed about until I came to your clinic, “Dare I say this”? My wife is 18 years younger than me, and very fit in all departments, “Boy oh Boy” did we have a really great honeymoon? We sure did. Please tell Dr. Jackson from me, “I was as good, or even better than “Way back when” I most certainly didn’t let the side down –
Joking Apart – May I say a big THANK YOU, without the kind care, consideration, professionalism of your clinic towards making a ‘man out of me again’ I certainly would have never gained a priceless gift – someone to love and be loved, my new wife. No more “nuptial shame, embarrassment, “sickening self-loathing” for being this inadequate, incomplete, incompetent “half-man”. Always One Big Guilty Secret. Too Scared to Woo a Lady. “No More”.” Thank you both Again. Very Best Wishes.
Further Reading
1. Kloner RA. Ed. Heart Disease and Erectile Dysfunction. Totowa, New Jersey: Humana Press, 2004.
2. Jackson G. Sex the Heart and Erectile Dysfunction. London, Taylor and Francis, 2005.
|
