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These muscular complications, except primary hypotonia, are instead very frequent in hEDS and they intensely contribute to the poor QoL in adulthood [50, 69], when patients usually show generalization and progressive chronicity of musculoskeletal pain, which is often diagnosed as fibromyalgia [79], summation of other forms of chronic pain, such as pelvic pain (in women) and migraine as well as exacerbation of fatigue, together with additional complaints including paresthesia, mixed functional gastrointestinal disorders, and orthostatic intolerance [71]

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This is because it creates nitric oxide, which relaxes the smooth muscles in the penis and enables an erection