Erectile dysfunction in hypercholestermic patients

Background: Erectile dysfunction (ED), defined as the persistent inability to attain/maintain an erection sufficient for sexual activity, is strongly associated with cardiovascular risk factors including hypercholesterolemia. Elevated cholesterol contributes to endothelial dysfunction and reduces penile blood flow. Aim: This review examines: (1) the pathophysiological link between hypercholesterolemia and ED, and (2) current treatment limitations and emerging therapies. Subjects/Materials and Methods: We analyzed 39 clinical studies (1993-2023) from PubMed/MEDLINE focusing on: (a) cholesterol-mediated vascular ED pathogenesis, (b) efficacy of PDE5 inhibitors (sildenafil, tadalafil), and (c) preclinical stem cell trials. Inclusion criteria required peer-reviewed English publications with validated outcome measures. Results: 78% of studies confirmed hypercholesterolemia as an independent ED risk factor (OR 1.92, 95%CI 1.45-2.54). PDE5 inhibitors showed 68-72% efficacy but required preexisting NO activity. Adipose-derived stem cells demonstrated 89% cavernous nerve regeneration in animal models. Conclusions: Hypercholesterolemia induces ED through atherosclerotic and NO-pathway disruption. While PDE5 inhibitors remain first-line, their dependence on residual endothelial function limits utility in advanced disease. Stem cell therapy shows promise for structural repair but requires human trials. Multidisciplinary management of cholesterol and vascular health is essential for ED prevention.