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Erectile dysfunction (ED) can be embarrassing. It can also be a symptom of serious health problems. So, when should a man make an appointment to see a doctor, and when should he write off ED as just being one of those days?

"ED can mean many things. Most think of it as 'impotence' or total ED," said William Brant, a urologist with University of Utah Health Care. "It can also be a tendency to have brief erections or an inconsistent ability to achieve erections."

Vascular problems are the most common underlying health issue associated with ED. The plaque that builds up causing problems in the heart can also cause problems in the reproductive organs.

"The blood vessels of the penis are relatively small compared to those in other areas of the body, such as in the heart. As such, the penis may serve as a 'barometer' for general vascular health," says Brant. "That is, vascular problems may show up in the penis years before they get bad enough to cause symptoms of heart disease."

When determining if a vascular problem is involved in ED, a variety of other factors come into play. Family history, blood pressure and lifestyle habits all should be reviewed. Also, the age of the man suffering from ED is key.

"ED is more common as men get older," Bryan said. "Around 50% of men over 50 have lost some erectile function, 60% at 60, and so on. We are most concerned with younger men who develop ED, as they may be found to have very significant and dangerous underlying vascular disease."

While vascular problems are the most common underlying cause of ED, they also can be the easiest to resolve with diet and lifestyle changes. Quitting smoking, eating a healthy diet, keeping blood pressure in check, maintaining a reasonable weight, and getting enough exercise all can increase heart health and eliminate the likelihood of ED.

"A good guideline to remember is that heart-healthy is penis-healthy," says Brant. "It is important to concentrate on the things we can control."

There are conditions outside a man's control that could lead to ED. Diabetes is one. In some men, diabetic blood sugar imbalances lead to damaged blood vessels and heart problems — causing ED. In other cases, diabetes may have damaged nerve endings leading to decreased sensation — including sensation in the penis.

"Around 10% of men who present to us with ED are found to have diabetes that they were not aware of," Brant said.

Beyond diabetes and vascular disease there are several other conditions that could result in ED. Rheumatoid arthritis could cause inflammation of the penile blood vessels making erections difficult. A low testosterone level could lead to a lack of sex drive and the inability to perform. Metabolic conditions, pelvic surgeries, penile injury, neurologic disorders, and side effects of medications all could lead to ED. By seeking help, men can uncover the reason and work toward returning to full function.

It is important to think about the entirety of a man's health while also treating ED specifically, said Brant. While men are being treated for ED, we also make sure that the ED is not a symptom of a larger problem.

Whatever the cause of ED, men need to know that help is available. All they have to do is make an appointment. There are so many treatments available that a man with ED really has no reason to suffer in silence and should seek medical attention, Bryant said.

Are you concerned about ED? Call the University of Utah Health Care Mens Health Clinic at 801-213-4500.