Aspirin and Erectile Dysfunction: What the Science Really Says
Aspirin and Erectile Dysfunction: What the Science Really Says
Medically Reviewed by Courtney LaSumner Bass, NP | Arsenal Men's Health Clinical Team | Updated: December 2024
Reading Time: 12 minutes | Evidence Level: Peer-Reviewed Research
KEY TAKEAWAY: While preliminary research suggests aspirin may improve erectile function in men with vascular ED, it is NOT an FDA-approved treatment for erectile dysfunction. The evidence remains limited and conflicting. Proven treatments like PDE5 inhibitors (sildenafil, tadalafil) remain the gold standard. If you're experiencing ED, consult a qualified healthcare provider for a proper evaluation.
Introduction: The Aspirin-ED Connection
If you've searched for solutions to erectile dysfunction (ED), you may have encountered claims about aspirin's potential benefits. As one of the world's most widely used medications—with applications ranging from pain relief to cardiovascular protection—aspirin's theoretical connection to erectile function has sparked both scientific curiosity and patient interest.
At Arsenal Men's Health, we believe informed patients make better healthcare decisions. This comprehensive analysis examines the current scientific evidence regarding aspirin and erectile dysfunction, separating fact from speculation while providing you with actionable insights for your health journey.
Understanding Erectile Dysfunction: A Vascular Perspective
Erectile dysfunction—the consistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance—affects an estimated 30 million American men. While psychological factors contribute to some cases, research indicates that organic (physical) causes account for approximately 80% of ED cases, with vascular dysfunction being the most prevalent underlying mechanism.
The Physiology of Erection
Penile erection is a complex neurovascular event requiring precise coordination between the nervous system, blood vessels, and hormones. The process begins with sexual stimulation triggering parasympathetic nerve activity, which initiates a cascade of molecular events:
Nitric oxide (NO) release: Neuronal and endothelial cells in the corpora cavernosa release NO, the primary chemical mediator of erection.
cGMP activation: NO activates soluble guanylyl cyclase, increasing cyclic guanosine monophosphate (cGMP) levels.
Smooth muscle relaxation: cGMP regulates calcium channels and contractile proteins, causing corpus cavernosum smooth muscle relaxation.
Vascular engorgement: Relaxation allows arterial blood flow to increase dramatically, filling the erectile tissue and producing rigidity.
Reference: Burnett AL. The role of nitric oxide in erectile dysfunction: implications for medical therapy. J Clin Hypertens. 2006;8(12 Suppl 4):53-62.
Vasculogenic ED: When Blood Flow Fails
Vasculogenic erectile dysfunction occurs when blood vessels carrying blood to or from the penis don't function properly due to blockages, narrowing, or endothelial dysfunction. This form of ED is directly linked to cardiovascular health—so much so that researchers have termed ED "the canary in the coal mine" for cardiovascular disease.
The connection makes physiological sense: the penile arteries are significantly smaller than coronary arteries. When systemic endothelial dysfunction or atherosclerosis begins, ED symptoms often appear before cardiovascular symptoms manifest. Studies suggest ED may precede coronary artery disease by 2-5 years in many men.
CLINICAL INSIGHT: If you're experiencing erectile dysfunction, it may indicate underlying cardiovascular risk factors that warrant evaluation. ED should never be ignored—it's often your body's early warning system.
How Aspirin Works: Mechanism of Action
Aspirin (acetylsalicylic acid) is a non-steroidal anti-inflammatory drug (NSAID) with multiple pharmacological effects that theoretically could influence erectile function:
Antiplatelet Activity
Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), preventing the formation of thromboxane A2—a molecule that promotes platelet aggregation. By reducing platelet "stickiness," aspirin improves blood flow and reduces clot formation. This mechanism underlies aspirin's use in cardiovascular disease prevention.
Potential Nitric Oxide Enhancement
Some research suggests aspirin may stimulate nitric oxide production or protect nitric oxide synthase (NOS) enzymes from impairment. Since NO is the primary mediator of erection, enhanced NO bioavailability could theoretically improve erectile function. However, this mechanism remains scientifically contested.
Anti-Inflammatory Effects
Chronic inflammation contributes to endothelial dysfunction, a key factor in vasculogenic ED. Aspirin's anti-inflammatory properties could theoretically protect vascular health. However, aspirin also inhibits prostaglandin synthesis—some prostaglandins (like PGE1) actually promote vasodilation and erectile function, creating a complex pharmacological picture.
The Scientific Evidence: A Critical Analysis
The relationship between aspirin and erectile dysfunction has been examined in several clinical studies, with results that range from promising to cautionary. Here's what the peer-reviewed literature reveals:
Studies Suggesting Potential Benefit
The 2018 Turkish Randomized Controlled Trial
In a landmark 2018 study published in the International Urology and Nephrology journal, Bayraktar and Albayrak conducted a prospective, randomized, double-blind, placebo-controlled study of 184 men with vasculogenic ED. Participants were divided into two groups:
Aspirin group (n=120): 100 mg aspirin daily for 6 weeks
Placebo group (n=64): Placebo daily for 6 weeks
Key Findings:
IIEF-EF scores improved from 14.1 to 21.3 in the aspirin group (7.2-point improvement)
Placebo group showed only a 2-point improvement (14.3 to 16.3)
88% of aspirin-treated men reported successful intercourse vs. 59% in placebo group
Reference: Bayraktar Z, Albayrak S. Antiplatelet (aspirin) therapy as a new option in the treatment of vasculogenic erectile dysfunction. Int Urol Nephrol. 2018;50(3):411-418.
The 2020 Meta-Analysis
A 2020 meta-analysis published in the American Journal of Men's Health examined the cumulative evidence from randomized controlled trials. Researchers analyzed data from 214 men across two qualifying studies and found:
Pooled mean effect size: 5.14 points improvement on IIEF-EF scale (95% CI: 3.89-6.40)
Heterogeneity: I² = 0% (indicating consistent results across studies)
Conclusion: Significant improvement in erectile function with aspirin treatment
However, the authors noted critical limitations: Only two RCTs met inclusion criteria, aspirin doses varied between studies, and the narrow study population (vasculogenic ED only) limits generalizability.
Reference: Irfan M, et al. Efficacy of Aspirin for Vasculogenic Erectile Dysfunction in Men: A Meta-Analysis of Randomized Control Trials. Am J Mens Health. 2020;14(5):1557988320969082.
Lithium-Induced ED Study (2013)
A smaller study examined aspirin's effect on men with lithium-induced sexual dysfunction. Among 30 men with bipolar disorder taking lithium:
Aspirin group showed 85.4% improvement in erectile function domain scores
Placebo group showed only 19.7% improvement
80% of aspirin-treated patients met criteria for clinically meaningful improvement
Reference: Saroukhani S, et al. Aspirin for treatment of lithium-associated sexual dysfunction in men: randomized double-blind placebo-controlled study. Bipolar Disord. 2013;15(6):650-6.
Studies Suggesting Potential Risk or No Benefit
The 2023 Mendelian Randomization Study
A 2023 genetic study using Mendelian randomization—a method that uses genetic variants to assess causal relationships—examined data from over 330,000 European individuals. The findings were concerning:
Results suggested a potential causal association between aspirin use and increased ED risk
The Prostate Cancer Prevention Trial found aspirin associated with 16% increased risk of severe ED
Some population studies reported 22-38% increased ED risk with regular NSAID use
Important Caveat: These associations don't prove causation. Men who take aspirin regularly often have cardiovascular conditions that themselves cause ED. The aspirin may simply be a marker for underlying disease rather than a cause of dysfunction.
Reference: Wang C, et al. Potential causal association between aspirin use and erectile dysfunction in European population: a Mendelian randomization study. Front Endocrinol. 2023;14:1266652.
Systematic Review: The Controversy Continues
A comprehensive 2018 systematic review examined all available research on NSAIDs and ED, concluding:
"The available research studies revealed that association between aspirin or non-aspirin NSAIDs and ED is controversial. Considering the high frequency of drug use, further clinical and basic investigations should be conducted to clarify their exact relationship."
Reference: Li T, et al. Association between use of aspirin or non-aspirin non-steroidal anti-inflammatory drugs and erectile dysfunction: A systematic review. Medicine. 2018;97(29):e11367.
The Clinical Bottom Line
Based on the current body of evidence, here's what you need to know:
What We Know
Limited positive evidence: Small, well-designed trials suggest aspirin may improve erectile function specifically in men with vasculogenic ED
Mechanism plausible: Aspirin's antiplatelet effects could theoretically improve penile blood flow
Not FDA-approved: Aspirin has never been approved by the FDA for treating erectile dysfunction
Conflicting data: Some studies suggest aspirin may actually increase ED risk
What We Don't Know
Optimal dosing for potential ED benefit
Long-term effects on erectile function
Whether benefits apply to non-vascular ED
Precise mechanisms underlying observed effects
Why You Shouldn't Self-Treat With Aspirin
Despite the intriguing preliminary evidence, using aspirin as an ED treatment is not recommended for several important reasons:
Bleeding risk: Aspirin significantly increases risk of gastrointestinal bleeding, particularly with long-term use or higher doses
Drug interactions: Aspirin interacts with many medications including blood thinners, other NSAIDs, and certain supplements
Underlying conditions: ED often signals cardiovascular disease requiring proper medical evaluation
Proven alternatives exist: FDA-approved treatments with established safety and efficacy profiles are readily available
Proven Treatments for Erectile Dysfunction
If you're experiencing erectile dysfunction, evidence-based treatments with established safety profiles offer the best outcomes:
PDE5 Inhibitors: The Gold Standard
Phosphodiesterase type 5 (PDE5) inhibitors are the first-line treatment for ED, with efficacy rates of 60-80% across various patient populations. These medications work by enhancing the nitric oxide-cGMP pathway—the same mechanism that some theorize aspirin might influence, but through a proven, targeted approach.
Sildenafil (Viagra): Takes effect in 30-60 minutes, lasts 4-6 hours
Tadalafil (Cialis): Available as daily or as-needed dosing, effects last up to 36 hours
Vardenafil (Levitra): Takes effect in 25-60 minutes, lasts 4-6 hours
Avanafil (Stendra): Fastest onset (15-30 minutes), minimal food interactions
Reference: Rosen RC, Kostis JB. Overview of phosphodiesterase 5 inhibition in erectile dysfunction. Am J Cardiol. 2003;92(9A):9M-18M.
Combination Therapy Approaches
Interestingly, one study (Bayraktar & Albayrak, 2019) compared aspirin alone, tadalafil alone, and combination therapy in 336 men with vascular ED:
Aspirin 100mg alone: 7.2-point IIEF improvement
Tadalafil 5mg alone: 7.3-point improvement
Tadalafil + Aspirin: 7.5-point improvement
Placebo: 2.0-point improvement
While this suggests aspirin may be similarly effective to low-dose tadalafil in vascular ED, it's crucial to note that this represents a single study and does not establish aspirin as equivalent or superior to proven treatments.
Comprehensive Treatment Approaches
Effective ED management often requires a multimodal approach addressing underlying factors:
Cardiovascular optimization: Managing hypertension, cholesterol, and blood glucose
Hormone evaluation: Testosterone testing and replacement therapy when indicated
Lifestyle modification: Exercise, weight management, smoking cessation, limiting alcohol
Psychological support: Addressing performance anxiety, relationship issues, depression
Medication review: Identifying drugs that may contribute to ED
Can You Take Aspirin With ED Medications?
For men already taking low-dose aspirin for cardiovascular protection, the good news is that aspirin is generally safe to use with PDE5 inhibitors. However, important considerations apply:
Recent cardiovascular events: If you've had a heart attack recently and are taking aspirin, PDE5 inhibitors may be contraindicated—not because of aspirin, but because of your cardiac status
Nitrate use: PDE5 inhibitors are absolutely contraindicated with nitrate medications regardless of aspirin use
Bleeding risk: Combined use may increase bleeding risk in some procedures
ALWAYS disclose all medications—including over-the-counter aspirin—to your healthcare provider before starting ED treatment.
The Arsenal Men's Health Approach
At Arsenal Men's Health, we understand that erectile dysfunction is more than an inconvenience—it impacts confidence, relationships, and can signal underlying health concerns. Our clinician-led approach ensures you receive:
Comprehensive evaluation: We assess cardiovascular risk factors, hormone levels, and contributing conditions
Evidence-based treatment: We prescribe FDA-approved medications with proven efficacy
Personalized protocols: Treatment tailored to your specific needs, not one-size-fits-all approaches
Discreet, convenient care: Utah-based telehealth consultations from the privacy of your home
Ongoing optimization: We monitor your response and adjust treatment for best results
Conclusion
The aspirin-ED connection represents an intriguing area of research with preliminary positive findings in specific populations. However, the current evidence is too limited and conflicting to recommend aspirin as an ED treatment. The potential risks—including gastrointestinal bleeding and masking of cardiovascular symptoms—outweigh uncertain benefits.
If you're experiencing erectile dysfunction, resist the temptation to self-treat with aspirin or other unproven remedies. Instead, seek evaluation from a qualified healthcare provider who can identify underlying causes and recommend evidence-based treatments with established safety profiles.
Remember: ED is often an early warning sign of cardiovascular disease. Treating it effectively means addressing the root cause—not just the symptom.
Ready to Address Your ED With Evidence-Based Treatment?
Schedule your confidential consultation with Arsenal Men's Health today.Call (385) 666-6292 or visit arsenalmenshealth.com
Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice. Treatment decisions should be made in consultation with a licensed healthcare provider who can evaluate your individual circumstances. Arsenal Men's Health services are available only to Utah residents. All treatments are clinician-prescribed based on appropriate medical evaluation.
Peer-Reviewed References
Irfan M, Ismail SB, Mohd Noor N, Nik Hussain NH. Efficacy of Aspirin for Vasculogenic Erectile Dysfunction in Men: A Meta-Analysis of Randomized Control Trials. Am J Mens Health. 2020;14(5):1557988320969082. doi:10.1177/1557988320969082
Bayraktar Z, Albayrak S. Antiplatelet (aspirin) therapy as a new option in the treatment of vasculogenic erectile dysfunction: a prospective randomized double-blind placebo-controlled study. Int Urol Nephrol. 2018;50(3):411-418. doi:10.1007/s11255-018-1786-0
Bayraktar Z, Albayrak S. Efficacy and safety of combination of tadalafil and aspirin versus tadalafil or aspirin alone in patients with vascular erectile dysfunction. Int Urol Nephrol. 2019;51(9):1491-1499. doi:10.1007/s11255-019-02211-4
Saroukhani S, Emami-Parsa M, Modabbernia A, et al. Aspirin for treatment of lithium-associated sexual dysfunction in men: randomized double-blind placebo-controlled study. Bipolar Disord. 2013;15(6):650-656. doi:10.1111/bdi.12108
Li T, Wu C, Fu F, et al. Association between use of aspirin or non-aspirin non-steroidal anti-inflammatory drugs and erectile dysfunction: A systematic review. Medicine (Baltimore). 2018;97(29):e11367. doi:10.1097/MD.0000000000011367
Wang C, Shen Z, Yang H, et al. Potential causal association between aspirin use and erectile dysfunction in European population: a Mendelian randomization study. Front Endocrinol (Lausanne). 2023;14:1266652. doi:10.3389/fendo.2023.1266652
Burnett AL. The role of nitric oxide in erectile dysfunction: implications for medical therapy. J Clin Hypertens (Greenwich). 2006;8(12 Suppl 4):53-62. doi:10.1111/j.1524-6175.2006.06026.x
Dean RC, Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction. Urol Clin North Am. 2005;32(4):379-395. doi:10.1016/j.ucl.2005.08.007
Rosen RC, Kostis JB. Overview of phosphodiesterase 5 inhibition in erectile dysfunction. Am J Cardiol. 2003;92(9A):9M-18M. doi:10.1016/s0002-9149(03)00824-5
Burnett AL. Nitric oxide in the penis: physiology and pathology. J Urol. 1997;157(1):320-324.
Melis MR, Argiolas A. Erectile Function and Sexual Behavior: A Review of the Role of Nitric Oxide in the Central Nervous System. Biomolecules. 2021;11(12):1866. doi:10.3390/biom11121866
Dzeshka MS, Shantsila A, Lip GYH. Effects of Aspirin on Endothelial Function and Hypertension. Curr Hypertens Rep. 2016;18(11):83. doi:10.1007/s11906-016-0688-8
About Arsenal Men's Health
Arsenal Men's Health is a premium, clinician-led telehealth practice dedicated to optimizing men's health throughout Utah. Led by Courtney LaSumner Bass, NP—a board-certified nurse practitioner and military veteran—we specialize in evidence-based treatment for erectile dysfunction, testosterone optimization, weight management, and comprehensive men's wellness. Our discreet, convenient telehealth services bring expert care directly to you.
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