Erection problems are common but they can be embarrassing for men to discuss with partners and doctors.
The sales of erection drugs on the internet or billboard advertising are boosted by keeping erectile problems in the dark. They reinforce the idea that it's an embarrassing problem that can be fixed without seeking help from doctors.
But this means men are missing out on an opportunity to improve their health.
Many men will be surprised to learn that erectile dysfunction affects about one in five men over the age of 40 and two in three men over 70. There's also increasing research evidence linking erectile dysfunction with other general health problems, such as diabetes and heart disease.
And it's becoming clearer that erectile dysfunction can be an early warning sign of chronic health conditions, but many men and some doctors still don't appreciate this.
Erectile dysfunction and diabetes
The greater risk of erectile problems in men with diabetes has been known for some time with studies estimating that up to four in five men with diabetes will have erectile dysfunction at some time in their lives. This is twice the rate in men without diabetes.
Diabetes can cause reduced blood flow to the penis or affect the function of penile blood vessels, making it more difficult to get an erection. It can also damage the nerves in the penis (and elsewhere in the body).
Diabetes is often associated with high blood pressure, high cholesterol and obesity - each of these is an independent risk factor for erectile dysfunction. Less commonly, the lower levels of testosterone in men with diabetes may contribute to erectile dysfunction.
Just as in men without diabetes, psychological issues including "performance anxiety" can also cause erectile dysfunction or make the situation worse once a man starts to experience erectile problems.
In some cases, men presenting with erectile dysfunction may have undiagnosed diabetes (or hypertension or high cholesterol). A blood glucose test from a doctor, and if levels are high, diabetes treatment, can help both the erectile problems and other health problems caused by diabetes.
Erectile dysfunction and cardiovascular disease
Erectile dysfunction is increasingly being recognised as an early warning sign of future cardiovascular disease, particularly coronary heart disease.
An Australian study has shown about twice the risk of a later cardiovascular event (such as heart attack or stroke) in men aged 20 years or older with erectile dysfunction, compared to similarly aged men in the general population.
Men with diabetes and erectile dysfunction also have a higher risk of a subsequent cardiovascular event, than other men with diabetes.
The risk of a cardiovascular event after developing erectile dysfunction is similar to that of being a smoker or having a family history of coronary heart disease.
One study has shown that within a year of the first significant episode of erectile dysfunction in men aged 55 years or over, one in 50 had a major stroke or heart attack. And within five years, it was greater than one in ten men.
It seems that erectile dysfunction in younger men is an even stronger predictor of later cardiovascular disease than in older men.
The link between erectile dysfunction and cardiovascular disease is thought to be due to a common underlying vascular problem. As blood vessels in the penis are smaller, they may be affected earlier than other parts of the body, such as the heart.
In this instance, the penis acts as a window to the health of the circulatory system.
Getting checked out
The best way to get help for erectile problems is to see a doctor to discuss the problem.
Undergoing a general health check including measurement of cardiovascular disease risk factors including diabetes, hypertension, high lipid levels, smoking, obesity and low level of physical activity will help.
As will a discussion of psychosocial issues that might be contributing to the problem and the importance of restoring sexual function. In some cases, a testosterone measurement may be done.
Discussions of sexual issues and erectile function can be challenging for both doctors and men. But understanding more about erectile dysfunction, and its links with other health problems can be a motivating factor for men to take steps to improve their erectile function and general health.
* Doug Lording is an Endocrinologist and Andrologist, Cabrini Hospital & Honorary Clinical Associate Professor of medicine at Monash University. He does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.