Obesity, hyperlipidemia, smoking

The bad news is that obesity associated with overeating, lack of exercise, a sedentary lifestyle, gluttony, and smoking may contribute to ED. The good news is that in about 30% of these cases, regular exercise, a balanced diet, cessation of smoking, and loss of weight may lead to recovery of sexual function without the need for any therapy.

While 26% of patients with ED have elevated serum cholesterol levels, this figure increases to about 40% to 80% if they also suffer from hypertension. The exact mechanism for the loss of normal sexual functioning due to high levels of serum cholesterol is still unknown. Several theories, based on experimental studies in rats and rabbits, attribute their relationship to poor endothelium-dependent relaxation of the vascular bed; accumulation of the "bad" cholesterol (LDL) in plaques, clogging the penile arteries; fewer nerves or endothelial cells; and higher concentration of smooth muscle cells.

As for smoking, several studies have reported direct correlation between the number of cigarettes per day and the duration of smoking with ED's development and severity, even in the absence of other risk factors. Contributors to the sexual problem include deficient endothelium-dependent smooth muscle relaxation of the penile vasculature, narrowing of the pudendal arteries, and poor rigidity during nocturnal erections. Among other factors are impaired autonomic function, endothelial damage, vasospasm of the penile arteries, decreased concentrations of NOS and NO, and increased toxic free radicals and aromatic compounds, which may cause poor arterial blood flow or lead to venous leakage in the penis.