If you have erection problems, get your cardiovascular health checked first; don't treat it as only a “private matter”

Cost

Registration costs a few dozen CNY. A blood pressure reading and blood tests for glucose and lipids cost one or two hundred CNY. One hospital trip, then a few days waiting for results.

What you get

A meta-analysis pooled 14 follow-up studies with 92,757 men in all, followed for 6.1 years on average. Compared with men without erectile dysfunction, men with the problem had the following later risks. Overall cardiovascular events were about 44% higher (RR 1.44; 95% CI 1.27 to 1.63, the plausible range). Heart attack was about 62% higher (RR 1.62, 1.34 to 1.96). Cerebrovascular events were about 39% higher (RR 1.39, 1.23 to 1.57). Death from any cause was about 25% higher (RR 1.25, 1.12 to 1.39). For cardiovascular death the gap did not open up (RR 1.19, 0.97 to 1.46). The younger the age, the higher the multiple. In men whose baseline cardiovascular risk was intermediate, the multiple was higher than in high-risk and low-risk men. In studies that used a questionnaire to define the problem, the multiple was 1.61 (1.38 to 1.86). In studies that asked a single question it was 1.27 (1.18 to 1.37).

Notes

All 14 studies followed a group of people to see outcomes; they were not randomized trials. So the “40% higher” is an association and can't be taken as cause and effect. The U.K. National Health Service (NHS) says most men sometimes can't get an erection, often because of tiredness, stress or drinking too much, and there is no need to worry. Only when it keeps happening should you see a doctor. What to check is the same set as in §1.7, §1.8: blood pressure and fasting blood glucose, plus blood lipids, smoking and waist size. Don't buy “male enhancement” supplements online. The legitimate drugs are prescription drugs; their labels list nitrates as a contraindication, and people taking nitroglycerin-type drugs must not take them, because together they can make blood pressure drop sharply. For how to improve, see §1.29 (losing weight and quitting smoking can improve erectile function). The benefit is rated “medium,” not “large”: the 44% is the gap in risk between two groups, not how much “getting checked once” lowers deaths. It is not rated “small” either: unlike the signal in §1.27 (visible blood in the urine), which has only a detection rate, the high blood pressure, diabetes and dyslipidemia found here all have established treatments.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI (2013). Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circulation: Cardiovascular Quality and Outcomes, 6(1), 99-109. https://doi.org/10.1161/CIRCOUTCOMES.112.966903
2. DailyMed (the drug label database of the US National Library of Medicine). VIAGRA (sildenafil citrate) tablet, CONTRAINDICATIONS. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=d905dc8d-917f-4ea3-a4ee-a1ecf6967d4e
3. NHS. Erectile dysfunction (impotence): "Most men occasionally fail to get or keep an erection. This is usually caused by stress, tiredness or drinking too much alcohol, and it's nothing to worry about." "See a GP or go to a sexual health clinic if: erection problems keep happening". https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/

Translated from the Chinese original. Original book, section 1, tip 28. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer