Most men don’t like to talk about it, but erectile dysfunction is surprisingly common. More than 30 percent of men ages 40–70 have trouble achieving or maintaining an erection.

Many men assume erectile dysfunction, or ED, is a psychological problem. However, research suggests that underlying vascular (blood vessel) problems are the most common cause of ED. And those underlying problems can also put men at risk for other serious medical problems.

Here are 5 things you should know about ED and your health.

1. Erectile Dysfunction and Heart Disease Are Connected

   ED is a common phenomenon among men who have coronary heart disease, says Johns Hopkins cardiologist Michael J. Blaha, M.D., M.P.H., director of clinical research at the Ciccarone Center for the Prevention of Heart Disease. 

   Coronary heart disease occurs when plaque builds up in the arteries, reducing blood flow to the heart and impairing the functioning of blood vessels. Healthy blood flow is also necessary for erectile function. In addition, some medications to treat high blood pressure can contribute to ED.

2. Erectile Dysfunction Can Be an Early Warning Sign

   One of the first stages of coronary heart disease is endothelial dysfunction, a condition in which the blood vessels cannot dilate (open) properly. Endothelial dysfunction often affects the blood vessels of the penis first. In many cases, ED might be the first clue that something is amiss. “Erectile dysfunction is often a hint of underlying heart disease,” Blaha says.

3. Erectile Dysfunction Is Linked to Diabetes, Too

   ED is closely linked with Type 2 diabetes as well. High blood sugar can damage blood vessels and nerves responsible for erectile function. A study by researchers at the Johns Hopkins Bloomberg School of Public Health found that almost half of all men in the study with diabetes also had ED.

4. It’s Important to Connect the Dots

   ED can be embarrassing. Many men don’t mention it, even to their doctor. On the other hand, men who do see the doctor can be so focused on their distress in the bedroom that they fail to mention other worrying symptoms, says Blaha. “Too many men ignore heart disease symptoms such as shortness of breath or chest pain.” If you have ED, talk to your doctor about being screened for risk factors such as high blood pressure, diabetes and heart disease, especially if you’ve noticed other symptoms.

5. Lifestyle Choices Matter

   The good news is that healthy lifestyle choices can have an impact. Eating a nutritious diet, exercising regularly, avoiding smoking, and controlling high blood pressure, high cholesterol and diabetes can reduce the risk of heart attack and stroke — and might improve sexual function in the process.  

   “So many things are rooted in the cardiovascular system,” Blaha says. “Controlling some of these risk factors really can make a difference.”