If you were to develop a “top five” list of ailments to report to your doctor, chances are erectile dysfunction would not be one of them. Yes, it’s the talk with the doctor that you giggle about when you see those television commercials for ED medications. But a frank talk with your doc about sexual performance issues could reveal problems brewing in your body: Heart disease and diabetes come to mind.

The first goal is to get to the doctor’s office for a check-up. And it’s hard enough to get guys to do this! Once there, discuss any erection problems you may be experiencing. And realize you are not alone. According to urologist Brett Mellinger, who has an extensive background in the evaluation and treatment of male ED, Peyronie’s disease, ejaculatory disorders and low testosterone, it’s estimated that half of men between the ages of 40 and 70 have some degree of erectile dysfunction. “The incidence does increase with age, not necessarily because of the aging process itself, which also contributes to some extent in loss of potency over time, but also because of the diseases men acquire as they age,”says Mellinger.

Mellinger says while ED has a physical cause 80 to 90 percent of the time, “men can become withdrawn, not only with their partners, but with family members…It can be quite devastating to some men.” In a small percentage of patients, according to Mellinger, ED can be related to causes such as anxiety or a change in relationships.

According to Mellinger, men who have had prostate cancer treatment can experience ED, but “for most men it’s a vascular cause…in some men it can be the first predictor of impending cardiovascular disease.” Mellinger says, “If I see a 50-year-old man who has no obvious risk factors…hypertension, elevated cholesterol, smoking, diabetes, anything that causes vascular disease, if they don’t have any of that in their history, I will invariably do a penile blood flow study, where we can demonstrate poor circulation to the penis. I’m sending that patient back to his primary care physician or cardiologist advising further cardiovascular work-up.” Some physicians, adds Mellinger, will send him patients requesting a penile blood flow study “to determine if they’ve got penile arterial disease, which may then prompt that physician to be more aggressive in treating the patient’s elevated cholesterol.”

In some cases, a visit to the urologist for an ED symptom can lead to the discovery of diabetes. Mellinger says a patient may see his doctor for ED, and a urinalysis could reveal elevated glucose. “The urologist can be the first physician that can have an impact on that man’s health, because it’s a male health issue.”

It’s a dialogue men need to have with their doctors. Mellinger says guys should be proactive. A healthy lifestyle is vital. “If you’re smoking, stop smoking, if you’re overweight, reduce your weight. Think about what’s good for your heart. What’s good for your heart is going to be good for your penis, your erections, your prostate, your reproductive system, it’s all connected.”

Adds Mellinger, “I’ll see patients with elevated cholesterol, hypertension and diabetes. I call it the three strikes. Three strikes and your penis is out.”