Erectile dysfunction (impotence) is commonly found in people suffering from CHD. Artherosclerosis (hardening of the arteries) affects all arterial beds throughout the body including the penile arteries (see diagram in introduction). It’s clear at the moment we don’t know what medications Ben is prescribed but review of cardiac medications is required as well as a physical/psychological assessment as some cardiac drugs are known to cause impotence and Ben has entered into a new relationship after being a widow for several years which potentially may be linked emotionally.
Ruth considers Ben’s request:
Has a cardiac history:
Required percutaneous coronary intervention a year ago (for more information on PCI please see Module 4)
Isn’t compliant with medication:
I need to find out why he isn’t taking medication and refer him back to the GP or practice nurse to discuss this.
Understanding of medications and coronary heart disease:
even though Ben’s procedure was a year ago it is important to clarify if he has fully understood his diagnosis and management of the condition
Is there something else going on?
impotence is a highly sensitive condition and can cause a lot of stress and worry in a patient’s life. Ben has several obvious reasons why he could be suffering from impotence but none of the reasons below should be a presumed cause without a full assessment for a qualified practitioner.
Pulse point
Opportunistic encounters such as this require consideration in terms of likely causes of ED. The arteries to the penis are small in diameter (1-2mm) whereas the coronary arteries to the heart are 3-4mm. This means that a similar problem in the coronary arteries may be silent because the arteries are big enough not to be restricted whereas the smaller penile arteries suffer earlier leading to ED. It takes longer for the bigger arteries to be affected by the narrowing process but if it is allowed to continue a man with ED and no heart complaint may develop a heart complaint in the five-year period after his ED began. This means ED can identify someone at future risk of a heart attack giving a chance for us to prevent it occurring.
Reference: Sexual Advice Association
For more information about Health behaviour change and techniques to use access: Public Health Scotland – Virtual Learning Environment
References: Miller,W.R.,Rollnick,S.(2002).Motivational Interviewing:Preparing People for Change.2nd Edition. NewYork: GuilfordPress.
Miller,W.R.&Rollnick,S.(2009).Ten things that Motivational Interviewing is not. Behavioural And Cognitive Psychotherapy, 37, 129–140
Page last reviewed: 04 Jun 2020
