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Treatment Model for Young Patients with Psychogenic Erectile Dysfunction and Resultant Infertility
04:22

Treatment Model for Young Patients with Psychogenic Erectile Dysfunction and Resultant Infertility

Published on: May 30, 2025

Managing concomitant cardiac disease and erectile dysfunction

Richard A Stein

    Reviews in Urology
    |September 21, 2006
    PubMed

    Insights

    Sexual activity poses minimal cardiovascular risk, even for patients with a history of myocardial infarction (MI). Guidelines help physicians assess risks for erectile dysfunction (ED) patients with cardiovascular disease (CAD), ensuring safe management.

    Area of Science:

    • Cardiology
    • Sexual Medicine
    • Cardiovascular Disease Management

    Background:

    • Early beliefs suggested sexual activity posed significant cardiovascular risk.
    • Subsequent research indicates heart rates during coitus are comparable to physical exercise or anger.
    • Coronary artery disease (CAD) is strongly linked to erectile dysfunction (ED), sharing similar risk factors.

    Purpose of the Study:

    • To re-evaluate the cardiovascular risks associated with sexual activity in patients with cardiovascular disease.
    • To assess the safety and efficacy of sildenafil citrate in patients with cardiovascular disease and erectile dysfunction.
    • To provide guidance on risk stratification for patients with ED and cardiovascular disease.

    Main Methods:

    • Review of early and subsequent studies on cardiovascular responses during coitus.
    • Analysis of the absolute and relative risk of myocardial infarction (MI) following sexual activity.
    • Examination of studies evaluating sildenafil citrate use in patients with cardiovascular disease.
    • Reference to clinical guidelines for risk classification of patients with ED and cardiovascular disease.

    Main Results:

    • The absolute risk of MI during coitus is low (10 per million per hour), with a negligible impact on annual risk even when doubled post-coitus.
    • Sildenafil citrate is safe and effective for treating ED in patients with cardiovascular disease, with the sole contraindication being concurrent nitrate use.
    • Clinical guidelines allow for risk stratification of patients with ED and cardiovascular disease into low, intermediate, or indeterminate risk categories.

    Conclusions:

    • Sexual activity is generally safe for most patients with cardiovascular disease.
    • Physicians should utilize established guidelines to manage patients with ED and cardiovascular disease, differentiating risk levels.
    • Sildenafil can be prescribed cautiously, avoiding concomitant use with nitrates, to manage ED in this population.

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