Role and Management of Coagulopathies in Vascular Erectile Dysfunction

Abstract

Erectile dysfunction (ED) is frequently a symptom of underlying vascular disease. Vascular risk factors are the most common cause of erectile dysfunction. Endothelium of the penile vasculature plays an important role in the physiology of penile erection. Most patients presenting with vascular erectile dysfunction have a combination of trivascular disease, that being diabetes, hypertension and dyslipidemia, which may result in endothelial dysfunction. Other co-morbidities for vascular erectile dysfunction include smoking, sedentary life style, obstructive sleep apnea syndrome and obesity. When common vascular risk factors are absent, the critical role of a hypercoagulable state as contributing risk factor should be suspected. The inherited hypercoagulable syndromes primarily have an effect on veins, and only occasionally result in arterial thrombosis. The acquired hypercoagulable states which may cause endothelial dependent erectile dysfunction include antiphospholipid antibody syndrome, protein s, protein c and antithrombin III deficiencies, factor V Leiden and prothrombin gene mutation, hyperhomocysteinemia, dysfibrogenenmia and plasminogen deficiency. This paper reviews common hypercoagulable states that may result in endothelial dysfunction, and be an unsuspected cause of ED.