1. If you have ED, It is a matter of concern because itresultsintaking awaythe joy fromlife, low self
esteem,marital discord,stressandlowlevel of satisfaction
there isa biggerreason
There are manyreasonswhyED couldbe a signof impendingcardiacproblem-
1- Both Heartand Sex Organsare basically vascular structures,dependinggreatlyonhormonal,
psychological andneuronal factorsforoptimumfunctioning so adequate bloodsupplyisan
essential pre requisite.
2- Heart issuppliedoxygenviacoronaryarteriesandmale organ by cavernous andhelicine
arteries.
3- Heart disease isaresultof narrowingof Coronaryartery due to depositionof cholesterol or
spasmdue to tobacco . Samething happensinpenis.Helcine arteryis the narrowestarteryin
bodyso impairmentdue tonarrowingof bloodvessels appear inpeniletissues before coronary
arteries ,resultinginED.
4- Reducedbloodsupplywhenneeded( atthe time of erectioninpenisandaddedloadinheart)
cause dysfunctionineitherorgan
5- Researchtellsthat40-50 % of people withEDhave vascularinsufficiencyasasole/contributory
cause.
6- Riskfactors forED and CADare commonas* Diabetes* Hypertension*
Hyperlipidemia*Smoking*Stress/Depression*Obesity*Sedentarylife style

2. Causesof ED afterMI-(HeartAttack) –
1- Wife becomesoverprotectiveanddiscouragesintimacyforfearof furtherattack
2- There isphobiaof sex in the personhimself
3- Performance anxiety –self doubtsof beingable tosatisfythe partner
4- PostMI depressive disorderandotherpsychiatricmorbidity
5- S/E of medicinesbeingtakenlikebetablockers,statins,diuretics,manyhypertensiveslike
calciumantagonists.
6- Sedentarylife style adds tothe risk
Whento start sexlife after Heart Attack -
Do youthinkthat postMI, your sex life isfinished.No, Itisa myth.The fact is that once the
crisisof MI isoverand conditionstabilized,you canresume your sex life asearlyas 8-10 weeks after
the episode,providedthe heartbeatisregular,you are nottakingbeta blockerordiureticsandthere is
no CHF . You shouldstartgraduallybyintimacyandnot hurry aboutpenetration.Whenyoustartdaily
20-25 minute walkandTMT is normal,penetrative sex canbe initiated. Butif atany time,youfeel
discomfortwithsweating,excessive tiredness, unusual palpitation, stopandconsultyour cardiologist
Causesof ED after MI-
1Wife becomes overprotective anddiscouragesintimacyforfearof furtherattack
2There is phobiaof sex inthe personhimself
3Performance anxiety –self doubtsof beingable tosatisfythe partner
4Post MI depressive disorderandotherpsychiatricmorbidity
5 S/E of medicinesbeingtakenlikebetablockers,statins,diuretics,manyhypertensiveslike
calciumantagonists.
Sexual activitiesshouldbe delayedif youhave
1- CHF meansthe muscle wall of heartis weak
2- Have arrhythmia( irregularheartbeat) whichcouldbe precipitatedbyarousal/physical activity
3- Unstable angina, confirmedby abnormalityonTMT
-

3. Chances of deathduring sex(coital death)
It increasesif sex wasdone close toa large meal, afterexcessivedrinking,witha youngerpartner or
someone otherthanspouse .Sex withspouse issaferthan youroccasional partnerbecause of higher
performance anxiety,higherarousal level andmore vigorousactivitiesbutoverall,riskof deathdue to
coital activityis veryrare . If womencan tolerate usual house holdactivitieslikefloormopping,dusting,
washingclothes andcooking,the riskisalmostequal tothe one withoutsex activity.It isstill verylowif
youleada active life and are notoverweight.Chancesof death2 hours aftersex is almostsame as in
normal life butslightlymore inmenthanwomen.
Remember,sex activityisalsoapsychological andphysical activity.If youcan tolerate stresstesting like
TMT, youcan tolerate sex activityaswell.Researchhasshownthatregularsex activitywithyourspouse
increasesintimacy,lowersstress,bringsharmonyandthe hormonesreleasedare goodforhealth
Treatmentof Sex ProblemsinMen
1- Counselingplaysamajorrole . Team approachincludingSexologist,PsychiatristandCardiologist
isthe best.
2- PDE-5 inhibitorsmaybe contraindicateddue tonitrates beingtakenbypatient
3- Intrapenile injisagood choice provideddue precautionsare observedtopreventandmanage
priapism.
4- VED isa preferredchoice formanycouples
5- If nothingworks,penile implantcan be the treatmentof choice.
In women,there couldbe issuesof low sex derive orreducedlubricationwhichare largely
helpedbycouple sex therapy.