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10 November 2020
Movember - Erectile dysfunction can be an early indication of heart disease - Prof Ralf Henkel
Erectile dysfunction can be an early indication of heart disease, and male reproductive health can be regarded as a mirror of general health.

This is according to world renowned Andrology expert Professor Ralf Henkel who researches male reproductive biology at the University of the Western Cape’s Department of Medical BioScience.

He said globally, almost 200 million couples at reproductive age are suffering from infertility. But not many realise that in half of these couples, the cause of the infertility lies with the man.

Educate yourself about reproductive health

The challenge is that the root of the problem lies with men themselves. “They often do not relate their reproductive health to their general health which is why fertility knowledge in men is significantly lower compared to women in most countries,” said Prof Henkel. In addition, in most male-dominated societies, many men are blaming the female partner for the couple not achieving a pregnancy.

“This alongside a continuously decreasing semen quality in men due to a number of reasons including environmental pollution or poor lifestyle, which raises serious concerns for the general health of the global male population.” 

Family Planning involves healthy parents, which requires both women and men to be healthy. But strangely, although infertility is a globally underestimated public health issue, reproductive health, especially in men, is often neglected.

This is the case today even with family planning being a key element in the five United Nations Sustainable Development Themes, and a key driver of all 17 Sustainable Development Goals. 

A major culprit for many diseases including infertility here is oxidative stress, which is the imbalance between free radicals and antioxidants in the body. It is a major contributor to male infertility, affecting almost 60 million men worldwide. This condition has been named “Male Oxidative Stress Infertility” (MOSI).

Realise that fertility potential is affected by comorbidities

Since oxidative stress is caused by many diseases such as systemic diseases like diabetes or obesity, this can then reflect on the fertility status of a man. Environmental factors such as smoking, pollution, radiation or infections aggravate the situation.

Research has shown the link between oxidative stress and men’s general and reproductive health. It leads to a significantly reduced male reproductive function, especially in men with comorbidities.

Endothelial Dysfunction is linked to Erectile Dysfunction

Moreover, oxidative stress caused by hypertension, high cholesterol levels or diabetes is also negatively affecting the functioning of the arteries, but not only arteries in general, but also in the penile artery. This directly links general endothelial dysfunction - a dysfunction of the inner lining of arteries - with coronary artery disease, compromised heart health and erectile dysfunction, which is why erectile dysfunction can be regarded as an early indication of heart disease.

Prof Henkel bases this on a study by Montorsi and co-workers (2003) which has shown that erectile dysfunction occurs three to five years before coronary heart disease. This is due to the fact that the penile artery has a much smaller diameter as compared to the large artery, clogging much faster and therefore earlier than the larger arteries. Consequently, these patients may not only suffer from erectile dysfunction, but also have a two times higher risk of a heart attack (myocardial infarction).

He advises men who wish to maintain good sexual health. “In cases of low testosterone and those suffering with diabetes, I’d advise a healthier lifestyle together with testosterone replacement therapy (after proper medical consultation). This has been shown to decrease the mortality rate in men.” 
However, he also warns about the worrying trend of men consuming excessive amounts of antioxidants to help ward off the negative effects of free radicals on overall reproductive health.

“The perception is that antioxidants are good for anti-aging. However, the body needs a small amount of these free radicals to trigger important bodily functions like sperm production and the process of programmed cell death (apoptosis) which is essential to eliminate pre-cancerous cells. An overuse of anti-oxidants brings its own negative effects - pushing the body into so-called reductive stress which is as dangerous as oxidative stress. Therefore, it is essential that one maintains a healthy balanced diet.”