Abstract
Erectile dysfunction (ED) in younger men is an increasing concern. In middle aged and older men, ED was related to lower resting heart rate variability (HRV), but research in younger men is lacking. The present study examined, in a nonclinical sample of 105 men between 18 and 39 years, the association of ED with several parameters of resting HRV. Scores of the 5-item version of the International Index of Erectile Function (IIEF-5) below 22 were considered as indicating ED. Eighteen men (17.1%) reported ED (mild in 16, mild to moderate in 2). Welch's tests revealed that ED was associated with lower low-frequency power (LF), lower high-frequency power (HF), lower standard deviation of interbeat intervals, and lower standard deviation of the heart rate, which is influenced by both sympathetic and parasympathetic activity. After removing outliers, ED was unrelated to HF. In younger men, erections might be facilitated by a combination of higher parasympathetic tone and relatively higher sympathetic tone in the heart, as indicated by LF and greater standard deviation of the heart rate, a largely overlooked parameter in HRV research.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barlow, D. H., Sakheim, D. K., & Beck, J. G. (1983). Anxiety increases sexual arousal. Journal of Abnormal Psychology, 92(1), 49–54. https://doi.org/10.1037/0021-843X.92.1.49.
Brody, S. (2006). Blood pressure reactivity to stress is better for people who recently had penile-vaginal intercourse than for people who had other or no sexual activity. Biological Psychology, 71(2), 214–222. https://doi.org/10.1016/j.biopsycho.2005.03.005.
Brody, S., & Preut, R. (2003). Vaginal intercourse frequency and heart rate variability. Journal of Sex & Marital Therapy, 29(5), 371–380. https://doi.org/10.1080/00926230390224747.
Brody, S., Veit, R., & Rau, H. (2000). A preliminary report relating frequency of vaginal intercourse to heart rate variability, Valsalva ratio, blood pressure, and cohabitation status. Biological Psychology, 52(3), 251–257. https://doi.org/10.1016/S0301-0511(99)00048-4.
Capogrosso, P., Colicchia, M., Ventimiglia, E., Castagna, G., Clementi, M. C., Suardi, N., …, Salonia, A. (2013). One patient out of four with newly diagnosed erectile dysfunction is a young man: Worrisome picture from the everyday clinical practice. Journal of Sexual Medicine, 10(7), 1833–1841. https://doi.org/10.1111/jsm.12179.
Capogrosso, P., Montorsi, F., & Salonia, A. (2016). Erectile dysfunction in young patients is a proxy of overall men’s health status. Current Opinion in Urology, 26(2), 140–145. https://doi.org/10.1097/MOU.0000000000000257.
Capogrosso, P., Ventimiglia, E., Boeri, L., Cazzaniga, W., Chierigo, F., Pederzoli, F., …, Salonia, A. (2019). Age at first presentation for erectile dysfunction: Analysis of changes over a 12-yr period. European Urology Focus, 5(5), 899–905. https://doi.org/10.1016/j.euf.2018.02.006.
Cera, N., Domenico, Di Pierro, E. D., Ferretti, A., Tartaro, A., Romani, G. L., & Perrucci, M, G. (2014). Brain networks during free viewing of complex erotic movie: New insights on psychogenic erectile dysfunction. PLoS ONE, 9(8), e105336. https://doi.org/10.1371/journal.pone.0105336.
Chen, C., Kuo, T. B., Tseng, Y.-J., & Yang, C. C. (2009). Combined cardiac sympathetic excitation and vagal impairment in patients with non-organic erectile dysfunction. Clinical Neurophysiology, 120(2), 348–352. https://doi.org/10.1016/j.clinph.2008.10.155.
Chen, J., Chen, Y., Gao, Q., Chen, G., Dai, Y., Yao, Z., & Lu, Q. (2018). Impaired prefrontal-amygdala pathway, self-reported emotion, and erection in psychogenic erectile dysfunction patients with normal nocturnal erection. Frontiers in Human Neuroscience, 12, 157. https://doi.org/10.3389/fnhum.2018.00157.
Chen, X., Wang, X., Yang, D., & Chen, Y. (2014). The moderating effect of stimulus attractiveness on the effect of alcohol consumption on attractiveness ratings. Alcohol and Alcoholism, 49(5), 515–519.
Coutinho, J., Oliveira-Silva, P., Mesquita, A. R., Barbosa, M., Perrone-McGovern, K. M., & Gonçalves, O. F. (2017). Psychophysiological reactivity in couples during a marital interaction task. Applied Psychophysiology and Biofeedback, 42(4), 335–346. https://doi.org/10.1007/s10484-017-9380-2.
Costa, R. M., & Brody, S. (2012). Greater resting heart rate variability is associated with orgasms through penile-vaginal intercourse, but not with orgasms from other sources. Journal of Sexual Medicine, 9(1), 188–197. https://doi.org/10.1111/j.1743-6109.2011.02541.x.
Costa, R. M., & Brody, S. (2015). Female sexual function and heart rate variability. Applied Psychophysiology and Biofeedback, 40(4), 377–378. https://doi.org/10.1007/s10484-015-9306-9.
Dattatrya, K. Y., Vedpalsingh, T. H., Gorakhnath, W. V., & kiran, P. S. . (2015). Can erectile dysfunction in young patients serve as a surrogate marker for coronary artery disease? Journal of Clinical and Diagnostic Research, 9(11), PC01–PC03. https://doi.org/10.7860/JCDR/2015/14207.6709.
Dogru, T., Kocak, O. M., Erberk-Ozen, N., & Basar, M. (2008). Assessment of the autonomic nervous system is an appropriate biological marker for the well-being in erectile dysfunction. Asian Journal of Andrology, 10(4), 643–650. https://doi.org/10.1111/j.1745-7262.2008.00383.x.
Dutton, D. G., & Aron, A. P. (1974). Some evidence for heightened sexual attraction under conditions of high anxiety. Journal of Personality and Social Psychology, 30(4), 510–517. https://doi.org/10.1037/h0037031.
Giuliano, R. J., Karns, C. M., Bell, T. A., Petersen, S., Skrowron, E. A., Neville, H. J., & Pakulak, E. (2008). Parasympathetic and sympathetic activity are associated with individual differences in neural indices of selective attention in adults. Psychophysiology, 55(8), e13079.
Goldstein, D. S., Bentho, O., Park, M. Y., & Sharabi, Y. (2011). Low frequency power of heart rate variability is not a measure of cardiac sympathetic tone but may be a measure of modulation of cardiac autonomic outflows by baroreflexes. Experimental Physiology, 96(12), 1255–1261. https://doi.org/10.1113/expphysiol.2010.056259.
Gomes, S., Costa, R., Mangia, P., Pestana, J., Pinto Coelho, M., & Correia, C. (2019). Frequência sexual e variabilidade da frequência cardíaca em repouso numa amostra portuguesa: resultados premilinares [Sexual frequency and resting heart rate variability in a Portuguese sample: preliminary results]. Análise Psicológica, 2(XXXVII), 161–712. https://doi.org/10.14417/ap.1524
Guay, A. T., Spark, R. F., Jacobson, J., Murray, F. T., & Geisser, M. E. (2002). Yohimbine treatment of organic erectile dysfunction in a dose-escalation trial. International Journal of Impotence Research, 14(1), 25–31.
Hale, V. E., & Srassberg, D. S. (1990). The role of anxiety on sexual arousal. Archives of Sexual Behavior, 19(6), 569–581. https://doi.org/10.1007/BF01542466.
Harte, C. B. (2013). The relationship between resting heart rate variability and erectile tumescence among men with normal erectile function. Journal of Sexual Medicine, 10(8), 1961–1968. https://doi.org/10.1111/jsm.12197.
Harte, C. B., & Meston, C. M. (2013). Association between cigarette smoking and erectile tumescence: The mediating role of heart rate variability. International Journal of Impotence Research, 25(4), 155–159. https://doi.org/10.1038/ijir.2012.43.
Henderson, L. A., Richard, C. A., Macey, P. M., Runquist, M. L., Yu, P. L., Galons, J. P., & Harper, R. M. (2004). Functional magnetic resonance signal changes in neural structures to baroreceptor reflex activation. Journal of Applied Physiology, 96(2), 693–703. https://doi.org/10.1152/japplphysiol.00852.2003.
Jin, C., Guan M., Dong, M., Wu, J., He, Z., Shi, D., ... Zhang, X. (2018). Aberrant baseline brain activity in psychogenic erectile dysfunction patients: A resting state fMRI study. Brain Imaging and Behavior, 12(5), 1393–1404. https://doi.org/10.1007/s11682-017-9805-9.
Kazmi, S. Z. H., Zhang, H., Aziz, W., Monfredi, O., Abbas, A. A., Shah, S. A., …, Butt, W. H. (2016). Inverse correlation between heart rate variability and heart rate demonstrated by linear and nonlinear analysis. PLoS ONE, 11(6), e0157557. https://doi.org/10.1371/journal.pone.0157557.
Kemp, A. H., & Quintana, D. S. (2013). The relationship between mental and physical health: Insights from the study of heart rate variability. International Journal of Psychophysiology, 89(3), 288–296. https://doi.org/10.1016/j.ijpsycho.2013.06.018.
Kromenacher, B. W., Sanova, A. A., Marcus, F. I., Allen, J. J. B., & Lane, R. D. (2018). Vagal mediation of low-frequency heart rate variability during slow yogic breathing. Psychosomatic Medicine, 80(6), 581–587. https://doi.org/10.1097/PSY.0000000000000603.
Lee, J. Y., Joo, K. J., Kim, J. T., Cho, S. T., Cho, D. S., Won, Y. Y., & Choi, J. B. (2011). Heart rate variability in men with erectile dysfunction. International Neurourology Journal, 15(2), 87–91. https://doi.org/10.5213/inj.2011.15.2.87.
Lehrer, P., Kaur, K., Sharma, A., Shah, K., Huseby, R., Bhavsar, J., & Zhang, Y. (2020). Heart rate variability biofeedback improves emotional and physical health and performance: A systematic review and meta-analysis. Applied Psychophysiology and Biofeedback. https://doi.org/10.1007/s10484-020-09466-z.
Manolis, A., Doumas, M., Ferri, C., & Mancia, G. (2020). Erectile dysfunction and adherence to antihypertensive therapy: Focus on β-blockers. European Journal of Internal Medicine, 81, 1–6. https://doi.org/10.1016/j.ejim.2020.07.009.
Mather, M., & Thayer, J. (2018). How heart rate variability affects emotion regulation brain networks. Current Opinion in Behavioral Sciences, 19, 98–104. https://doi.org/10.1016/j.cobeha.2017.12.017.
McCraty, R., & Shaffer, F. (2015). Heart rate variability: New perspectives on physiological mechanisms, assessment of self-regulatory capacity, and health risk. Global Advances in Health and Medicine, 4, 46–61. https://doi.org/10.7453/gahmj.2014.073.
Meston, C., & Frohlich, P. (2003). Love at first fright: Partner salience moderates roller-coaster-induced excitation transfer. Archives of Sexual Behavior, 32(6), 537–544. https://doi.org/10.1023/A:102603752.
Meston, C. M. (2000). Sympathetic nervous system activity and female sexual arousal. American Journal of Cardiology, 86(2A), 30F-34F. https://doi.org/10.1016/s00029149(00)00889-4.
Morales, A. (2000). Yohimbine in erectile dysfunction: The facts. International Journal of Impotence Research, 12(Suppl. 1), S70–S74.
Moser, M., Lehofer, M., Sedminek, A., Lux, M., Zapotoczky, H. G., Kenner, T., & Noordergraaf, A. (1994). Heart rate variability as a prognostic tool in cardiology. A contribution to the problem from a theoretical point of view. Circulation, 90(2), 1078–1082. https://doi.org/10.1161/01.CIR.90.2.1078.
Mykoniatis, I., Grammatikopoulou, M. G., Bouras, E., Karampasi, E., Tsionga, A., Kogias, A., …, Chourdakis, M. (2018). Sexual dysfunction among young men: Overview of dietary components associated with erectile dysfunction. Journal of Sexual Medicine, 15(2), 176–182. https://doi.org/10.1016/j.jsxm.2017.12.008.
Nguyen, H. M., Gabrielson, A. T., & Hellstrom, W. J. (2017). Erectile dysfunction in young men: A review of the prevalence and risk factors. Sexual Medicine Reviews, 5(4), 508–520. https://doi.org/10.1016/j.sxmr.2017.05.004.
Pais Ribeiro, J. L., & Santos, A. (2007). Metric properties of a Portuguese version of the abridged, 5-item version of the International Index of Erectile Function (IIEF-5). Psicologia, Saúde & Doenças, 8, 271–274.
Park, G., & Thayer, J. F. (2014). From the heart to the mind: Cardiac vagal tone modulates top-down and bottom-up visual perception and attention to emotional stimuli. Frontiers in Psychology, 5, 278. https://doi.org/10.3389/fpsyg.2014.00278.
Parker, L. L. C., Penton-Voak, I. S., Attwood, A. S., & Munafò, M. R. (2008). Effects of acute alcohol consumption on ratings of attractiveness of facial stimuli: Evidence of long-term encoding. Alcohol and Alcoholism, 43(6), 636–640. https://doi.org/10.1093/alcalc/agn065.
Pfaus, J. G. (2009). Pathways of sexual desire. Journal of Sexual Medicine, 6(6), 1506–1533. https://doi.org/10.1111/j.1743-6109.2009.01309.x.
Polanczyk, C. A., Rohde, L. E. P., Moraes, R. S., Ferlin, E. L., Leite, C., & Ribeiro, J. P. (1998). Sympathetic nervous system representation in time and frequency domains índices of heart rate variability. European Journal of Applied Physiology, 79, 69–73. https://doi.org/10.1007/s004210050475.
Pozzi, E., Capogrosso, P., Chierigo, F., Pederzoli, F., Ventimiglia, E., Boeri, L., …, Salonia, A. (2018). Clinical profile of young patients with erectile dysfunction: Preliminary findings of a real-life cross-sectional study. European Urology Focus. https://doi.org/10.1016/j.euf.2018.10.003.
Quintana, D. S., Guastella, A. J., Outhred, T., Hickie, I. B., & Kemp, A. H. (2012). Heart rate variability is associated with emotion recognition: Direct evidence for a relationship between the autonomic nervous system and social cognition. International Journal of Psychophysiology, 86(2), 168–172. https://doi.org/10.1016/j.ijpsycho.2012.08.012.
Rastrelli, G., & Maggi, M. (2017). Erectile dysfunction in fit and healthy young men: Psychological or pathological? Translational Andrology and Urology, 6(1), 79–90. https://doi.org/10.21037/tau.2016.09.06.
Reed-Maldonado, A. B., & Lue, T. F. (2016). A syndrome of erectile dysfunction in young men? Translational Andrology and Urology, 5(2), 228–234. https://doi.org/10.21037/tau.2016.03.02.
Reyes del Paso, G. A., Langewitz, W., Mulder, L. J. M., van Roon, & Duschek, S. (2013). The utility of low frequency heart rate variability as an index of sympathetic cardiac tone; a review with emphasis on a reanalysis of previous studies. Psychophysiology, 50, 477–487. https://doi.org/10.1111/psyp.12027.
Rosen, R., Cappelleri, J., Smith, M., Lipsky, J., & Peña, B. (1999). Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. International Journal of Impotence Research, 11(6), 319–326.
Ruxton, G. D. (2006). The unequal variance t-test is an underused alternative to Student’s t-test and the Mann-Whitney U test. Behavioral Ecology, 17, 688–690.
Sasha, J., & Pluta, W. (2005). Different methods of heart rate variability analysis reveal different correlations of heart rate variability spectrum with average heart rate. Journal of electrocardiology, 38, 47–53. https://doi.org/10.1016/j.jelectrocard.2004.09.015.
Silva, L. E. V., Silva, C. A. A., Salgado, H. C., & Fazan, R., Jr. (2017). The role of sympathetic and vagal cardiac control on complexity of heart rate dynamics. American Journal of Physiology Heart and Circulatory Physiology, 312, H496. https://doi.org/10.1152/ajpheart.00507.2016.
Spaak, J., Merlocco, A. C., Soleas, G. J., Tomlinson, G., Morris, B. L., Picton, P., & Floras, J. S. (2008). Dose-related effects of red wine and alcohol on hemodynamics, sympathetic nerve activity, and arterial diameter. American Journal of Physiology Heart and Circulatory Physiology, 294(2), H605–H612. https://doi.org/10.1152/ajpheart.01162.2007.
Spaak, J., Tomlinson, G., McGowen, C. L., Soleas, G. J., Morris, B. L., Picton, P., …, Floras, J. S. (2010). Dose-related effects of red wine and alcohol on heart rate variability. American Journal of Physiology Heart and Circulatory Physiology, 298(6), H2226–H2231. https://doi.org/10.1152/ajpheart.00700.2009.
Stanton, A. M., Boyd, R. L., Fogarty, J. J., & Meston, C. M. (2019). Heart rate variability biofeedback increases sexual arousal among women with female sexual arousal disorder. Results from a randomized-controlled trial. Applied Psychophysiology and Biofeedback, 115, 90–102. https://doi.org/10.1016/j.brat.2018.10.016.
Stanton, A. M., Lorenz, T. A., Pulverman, C. S., & Meston, C. M. (2015). Heart rate variability: A risk factor for female sexual dysfunction. Applied Psychophysiology and Biofeedback, 40(3), 229–237. https://doi.org/10.1007/s10484-015-9286-9.
Stuckey, B. G., Walsh, J. P., Chinga, H. L., Stuckey, A. W., Palmer, N. R., Thompson, P. L., & Watts, G. F. (2007). Erectile dysfunction predicts generalised cardiovascular disease: Evidence from a case-control study. Atherosclerosis, 194(2), 458–464. https://doi.org/10.1016/j.atherosclerosis.2006.08.043.
Thayer, J. F., Ahs, F., Fredrikson, M., Sollers, J. J., 3rd., & Wager, T. D. (2012). A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health. Neuroscience and Biobehavioral Reviews, 36, 746–756. https://doi.org/10.1016/j.neubiorev.2011.11.009.
Thayer, J. F., & Lane, R. D. (2007). The role of vagal function in the risk for cardiovascular disease and mortality. Biological Psychology, 74, 224–242. https://doi.org/10.1016/j.biopsycho.2005.11.013.
Wang, Y., Dong, M., Guan, M., Wu, J., He, Z., Zou, Z., …, Zhang, X. (2017). Aberrant insula-centered functional connectivity in psychogenic erectile dysfunction patients: A resting-state fMRI study. Frontiers in Human Neuroscience, 11, 221. https://doi.org/10.3389/fnhum.2017.00221.
Yao, F. J., Zhang, Y. D., Wan, Z., Li, W., Lin, H., Deng, C. H., & Zhang, Y. (2018). Erectile dysfunction is associated with subclinical carotid vascular disease in young men lacking widely-known risk factors. Asian Journal of Andrology, 20(4), 400–404. https://doi.org/10.4103/aja.aja_73_17.
Yin, T., Liu, Q., Ma, Z., Li, Z., Sun, R., Ren, F., …, Zhang, P. (2020). Associations between altered cerebral activity patterns and psychosocial disorders in patients with psychogenic erectile dysfunction: A mediation analysis of fMRI. Frontiers in Psychiatry, 11, 583619.
Acknowledgements
This work was supported by Fundação para a Ciência e Tecnologia (FCT) (Grant Numbers FRH/BPD/76130/2011 and UID/PSI/04810/2013) and by Fundação BIAL (Grant Number 103/12).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Costa, R.M., Mangia, P., Pestana, J. et al. Heart Rate Variability and Erectile Function in Younger Men: A Pilot Study. Appl Psychophysiol Biofeedback 46, 235–242 (2021). https://doi.org/10.1007/s10484-020-09499-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10484-020-09499-4