At first, Douglas Salisbury’s peripheral artery disease, or PAD, crimped his sex life in small ways. “Cramping in my calves during sex was the most obvious related issue,” says the 60-year-old retired chemical dependency counselor.

Salisbury managed the cramps by drinking extra water before sex. He also tried applying ancient magnesium oil to the skin on his calves after hearing that the mineral might also ease the cramping.

He says it helped somewhat, but nothing helped Salisbury more than simply standing up or hanging his legs off the side of the bed. “Gravity helps,” he says.

But over time, PAD began giving Salisbury major problems in the bedroom.

Salisbury had a harder time getting an erection. “It didn’t seem to be a frequent problem at first,” he says. But soon, he realized it was taking longer than usual to become aroused.

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

So Salisbury tried to slow down with his partner and focus on foreplay. Using techniques other than intercourse worked for his partner, but it didn’t help him reach orgasm or improve his sex drive. “At that point, it’s about coming to terms with being satisfied by satisfying others, in other intimate ways besides sex,” Salisbury says.

Then in 2021, Salisbury had an axillobifemoral bypass because all the other efforts to restore flow to his legs failed. This type of bypass creates a new route for blood flow using an artificial graft. For Salisbury, It was a graft connecting his shoulder to his groin area, then splitting off into both legs.

While the bypass was helpful for blood flow to his legs, it made things more complicated in the bedroom. “There’s less flow going to some of my other organs, including my groin,” he says. Frequent erectile dysfunction, which makes it harder to get or keep an erection, became Salisbury’s new reality.

PAD happens when your arteries get too narrow, which can lead to poor blood flow to your penis or vagina. That makes it difficult to get sexually aroused, says Kevin Herman, MD, an interventional radiologist at American Endovascular & Amputation Prevention in West Orange, NJ.

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

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

First, if you have a low sex drive, see your doctor. “Evaluation and identification of compromised pelvic flow is an important part of the workup,” says Bryan Fisher, MD, physician lead for Vascular Services at HCA Healthcare in Memphis, TN. A specialist can help pinpoint causes and recommend treatment strategies that may be right for you.

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

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

Exercise and weight loss may also help improve your sex life. “A healthy lifestyle is often the first step toward achieving sexual satisfaction in men and women,” Fisher says.

Salisbury recently heard about a potential, more permanent solution.

Some doctors are trying 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 by either opening it with a balloon or stent, or bypassing it.

“I learned it’s possible that some highly skilled physicians can restore flow in small vessels such as to the groin. That’s my next move,” he says.

It took some searching, but Salisbury found an interventional cardiologist who says it can be done. He’s planning to undergo revascularization of a narrowed vessel in his groin during a procedure to clear 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 up blocked arteries might help with sexual function, but the data has been mixed and revascularization hasn’t really caught on, at least in the U.S.

And it’s not for everyone. “Due to many factors, less than 10% of men with vascular ED are candidates for penile revascularization,” Herman says. 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 offers advocacy and support to people with PAD. “It’s more likely that a highly trained endovascular specialist who treats arterial blockages in vessels in the abdomen would have the skills and willingness to do it.”

Salisbury hopes that after the procedure, his bedroom issues will improve.

In the meantime, he gets enjoyment from hobbies he’s passionate about. “I love woodworking. I can immerse myself into it and it requires my full attention to create wonderful designs perfectly,” he says.