Erectile dysfunction is often the first sign of something else
The arteries that supply the penis are among the smallest in the body, so they show narrowing first. Why a urologist treats ED as a reason to check the heart, the hormones and the sugar.
The vascular argument
An erection is a vascular event: arteries open, blood fills the erectile tissue and veins close to hold it there. The arteries involved are a few millimetres across, narrower than the vessels of the heart. When the lining of arteries starts to stiffen and narrow, the smallest vessels show it first. That is why erectile dysfunction frequently appears before chest pain or a cardiac diagnosis, and why we treat a new complaint of ED as a prompt to look at cardiovascular risk.
What else we check
- Blood sugar and HbA1c, because diabetes damages both nerves and vessels
- Lipids and blood pressure
- Testosterone and related hormones, which affect desire and response
- Thyroid function
- Medication, since several common drugs, including some for blood pressure and mood, affect erections
- Sleep, alcohol, smoking and stress, asked about without judgement
A penile Doppler ultrasound, done in clinic, measures blood flow in and out of the penis directly and separates arterial from venous causes.
Treatment is layered
- Address the cause: control blood pressure and sugar, review medication, treat low testosterone where confirmed.
- Oral medication that improves blood flow, effective for many men.
- Low-intensity shockwave therapy, a course of in-clinic sessions aimed at improving vascular function.
- Regenerative injections using platelet-rich plasma from your own blood.
- Devices and, for some, surgical options, discussed where appropriate.
Confidentiality
Consultations are private, records are handled under GDPR and no one is treated on a first visit unless they choose to be. Most men who come in have waited longer than they needed to.
The point
ED is common, treatable and, often, informative. Finding the cause does more than restore function: it can be the first step in preventing a heart attack years later.
