Erectile dysfunction and ‘poor morning erections’ predicts mortality in middle age – study

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Most men occasionally fail to get or keep an erection but if the problem is ongoing, it can signal you have erectile dysfunction. The sexual problem is not always a sign of something more serious but it has been associated with mortality. A recent study published in Age and Ageing builds on previous research into this association, concluding that erectile dysfunction predicts mortality in middle-aged and older men independent of their sex steroid status.

“Erectile dysfunction is associated with mortality, whereas the association between low testosterone (T) and higher mortality remains controversial,” wrote the study’s researchers.

They continued: “Sexual dysfunction and low T often coexist, but the relative importance of sexual symptoms versus low T in predicting mortality is not known.”

Testosterone is the male sex hormone that is made in the testicles. Testosterone hormone levels are important to normal male sexual development and functions.

The researchers studied the interrelationships between sex steroids and sexual symptoms with all-cause mortality in a large prospective cohort of European men.

Survival status was assessed in 1,788 community-dwelling men, aged 40–79, who participated in the European Male Ageing Study (EMAS).

EMAS was launched to identify and measure the differences in the symptoms and disabilities associated with ageing in men from various regions in Europe.

Sexual symptoms were evaluated via a validated questionnaire (EMAS-SFQ).

Among the key findings was that men with three sexual symptoms (erectile dysfunction, reduced morning erections and lower libido) had a higher mortality risk compared with men with none of these symptoms.

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Particularly, erectile dysfunction and poor morning erections, but not lower libido, were associated with increased mortality.

Further adjusting for total testosterone, free testosterone (total testosterone concentration that is not bound to any protein) or oestradiol (a steroid hormone) did not influence the observed risk.

The researchers concluded: “Sexual symptoms, in particular erectile dysfunction, predict all-cause mortality independently of sex steroids and can be an early warning sign of a poor health status.”

What underlying health conditions can erectile dysfunction signify?

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels.

Many chronic diseases and conditions can cause erectile dysfunction.

According to the Mayo Clinic, these include:

• Heart disease
• Clogged blood vessels (atherosclerosis)
• High cholesterol
• High blood pressure
• Diabetes
• Obesity
• Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
• Parkinson’s disease
• Multiple sclerosis
• Certain prescription medications
• Tobacco use
• Peyronie’s disease — development of scar tissue inside the penis
• Alcoholism and other forms of substance abuse
• Sleep disorders
• Treatments for prostate cancer or enlarged prostate
• Surgeries or injuries that affect the pelvic area or spinal cord
• Low testosterone.

There is also a psychological dimension to erectile dysfunction. As the Mayo Clinic explains, the brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement.

“A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction.”

These include:

• Depression, anxiety or other mental health conditions
• Stress
• Relationship problems due to stress, poor communication or other concerns.

How to treat it

Treatments for erectile dysfunction are usually effective and the problem often goes away.

There are also specific treatments for some of the causes of erectile dysfunction.

For example, medicine to lower blood pressure or statins to lower cholesterol can counter the narrowing of penis blood vessels that causes erectile dysfunction.

Healthy lifestyle changes can sometimes help erectile dysfunction, notes the health body, which include:

• Losing weight if you’re overweight
• Stopping smoking
• Eating a healthy diet
• Exercising daily
• Trying to reduce stress and anxiety.

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