For example, men with more severe coronary artery atherosclerosis (hardening of the arteries in the heart) also tend to have more erectile dysfunction than men with mild or no coronary artery atherosclerosis. Hardening of the arteries to the penis and pelvic organs, atherosclerosis, causes insufficient blood flow into the penis. Atherosclerosis (a type of vascular disease) typically affects arteries throughout the body and is aggravated by hypertension , high blood cholesterol levels , cigarette smoking , and diabetes mellitus.

Cardiovascular diseases: The most common cause of cardiovascular diseases in the United States is atherosclerosis, the narrowing and hardening of arteries that reduces blood flow. Hypertension can cause troubles with erections related to atherosclerosis or from low levels of nitric oxide being made from the arteries in the penis. Diabetes mellitus: Erectile dysfunction tends to develop 10 to 15 years earlier in diabetic men than among nondiabetic men.

Second, the aging process alone can cause erectile dysfunction in some men by causing changes in the muscle and tissue within the penis. Healthy muscles and fibrous tissues within the corpora cavernosa, which can distend to allow the penis to fill with blood. With less blood coming into the penis, the veins will not be compressed and will drain blood out of the penis, and the erection goes down.

When the amount of cGMP decreases by the action of a chemical called phosphodiesterase type 5 (PDE5), the muscles in the penis tighten, and the blood flow into the penis decreases. As blood flows into the penis, the corpora cavernosa swell, and this swelling compresses the veins (blood vessels that drain the blood out of the penis) against the tunica albuginea. The cGMP causes the muscles of the corpora cavernosa to relax, and this allows more blood to flow into the penis.

Erections are neurovascular events, meaning that nerves and blood vessels (arteries and veins) are involved in the process of an erection and all must work properly to get a hard erection that lasts long enough. While erectile dysfunction can occur at any age, the risk of developing erectile dysfunction increases with age. Erectile dysfunction (ED, impotence) varies in severity; some cannot have an erection at all, whereas other men sometimes have troubles getting a hard erection, and others get a hard erection but it only lasts for a short period of time.

This article focuses on the evaluation and treatment of erectile dysfunction. Erectile dysfunction is common, and the risk of developing ED increases with age. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health.

John Hopkins Bloomberg School of Public Health: "18 Million Men in the United States Affected by Erectile Dysfunction." While pills for ED are convenient, some men sustain stronger erections by injecting medication directly into the penis. All work by improving blood flow to the penis during arousal.

This does not mean every man with ED will develop heart disease, or that every man with heart disease has ED, but patients should be aware of the link.
https://www.mensjournal.com/health-fitness/everything-you-need-to-know-about-erectile-dysfunction-drugs-20150406/
https://www.express.co.uk/life-style/health/924080/erectile-dysfunction-causes-treatment-impotence-diet-strawberries
https://cen.acs.org/articles/96/i4/the-year-in-new-drugs-2018.html
https://www.vaucluse-ambulances.fr/

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