Peripheral arterial disease in the bedroom

At first, Douglas Salisbury’s peripheral artery discomfort, or PAD, crippled her sex life in small touches. “Cramping in my calves during sex was the most obvious related problem,” says the 60-year-old retired chemical addiction counselor.

Salisbury managed the cramps by drinking more water before sex. He also tried applying ancient magnesium oil to the skin of his calves after hearing that the mineral could also relieve cramps.

He says it helped a bit, but nothing helped Salisbury more than just getting up or hanging his legs over the edge of the bed. “Gravity helps,” he says.

But over time, PAD started giving Salisbury major issues in the bedroom.

Salisbury had a harder time getting an erection. “At first it didn’t seem like a frequent problem,” he says. But soon he realized that it took longer than usual for him to wake up.

Salisbury’s doctor told him it was probably a side effect of his medication. But stopping certain medications for cardiovascular disease isn’t always an option.

So Salisbury tried to slow down with his partner and focus on the foreplay. Using techniques other than sex worked for her partner, but it didn’t help her achieve orgasm or improve her libido. “At this point, it’s about accepting to be satisfied by satisfying others, through intimate means other than sex,” says Salisbury.

Then in 2021, Salisbury underwent axillobifemoral bypass surgery because all other efforts to restore flow to his legs failed. This type of bypass creates a new blood flow path with the help of an artificial graft. For Salisbury, it was a transplant connecting his shoulder to his groin area, then separating into his two legs.

While the bypass surgery was helpful for the blood flow to her legs, it made things more complicated in the bedroom. “There is less flow to some of my other organs, including my groin,” he says. Frequent erectile dysfunction, which makes it harder to get or maintain an erection, has become the new reality of Salisbury.

PAD occurs when your arteries become too narrow, which can cause poor blood flow to your penis or vagina. This makes it difficult for sexual arousal, says Kevin Herman, MD, interventional radiologist at American Endovascular & Amputation Prevention in West Orange, NJ.

Erectile dysfunction, or ED, is linked to PAD and can get worse as PAD progresses. Some medications for PAD and related conditions can also cause sexual problems.

PAD management in the room

You can find ways to stay sexually fulfilling and intimate with your partner.

First, if you have a weak sex drive, consult your doctor. “Evaluating and identifying compromised pelvic flow is an important part of the workup,” says Bryan Fisher, MD, physician responsible for vascular services at HCA Healthcare in Memphis, TN. A specialist can help you identify the causes and recommend treatment strategies that may be right for you.

To make things better in the bedroom, some couples use strategies and devices like masturbation and sex toys instead of sex.

If you are a woman with PAD and have poor blood circulation or vaginal dryness, try a water-soluble lubricant. Ask your doctor if hormone replacement therapy might help.

Exercise and weight loss can also help improve your sex life. “A healthy lifestyle is often the first step towards sexual satisfaction for both men and women,” says Fisher.

A possible surgical option

Salisbury recently heard of a potential more permanent solution.

Some doctors try to improve sexual function by using revascularization procedures on the arteries that supply blood to the penis. Revascularization restores blood flow to a blocked vessel either by opening it with a balloon or stent, or bypassing it.

“I learned that it is possible that some highly trained doctors can restore the flow in small vessels like the groin. It’s my next move, ”he says.

It took some research, but Salisbury found an interventional cardiologist who says it can be done. He plans to undergo revascularization of a narrowed vessel in his groin during a procedure to clear the larger arteries in his abdomen and legs.

Robert R. Attaran, MD, director of the Interventional Cardiology Fellowship program at Yale New Haven Hospital in Connecticut, says some studies have tested whether opening blocked arteries could help sexual function, but the data has been mixed and revascularization hasn’t really been taken, at least in the US

And it’s not for everyone. “Due to many factors, less than 10% of men with vascular ED are candidates for penile revascularization,” Herman explains. For those who are optimal candidates, he says, the success rate ranges from 50% to 67%.

“Not all vascular specialists know how to do it,” says Kym McNicholas, founder of The Way To My Heart, an organization that provides advocacy and support for people with PAD. “It is more likely that a highly trained endovascular specialist who treats arterial blockages in the vessels of the abdomen will have the skills and the willingness to do so.”

Salisbury is hopeful that after the procedure his bedroom issues will improve.

In the meantime, he devotes himself to hobbies that fascinate him. “I love woodworking. I can immerse myself in it and it takes my full attention to create beautiful designs perfectly, ”he says.

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