Erectile dysfunction is a topic many are reluctant to discuss, but flagging the problem with a doctor could be important.
In some cases, the condition may be an early sign of disease.
The ability to get or maintain an erection requires a physical, psychological, neurological, hormonal, and vascular symphony, where one wrong note can lead to error.
Dysfunction can occur for many reasons, impacting young and old, but it becomes more common as a person ages. Between 40 and 70, the prevalence of erectile dysfunction tips over 50 percent.
But some surveys have found that almost 20 percent of those over 55 would not seek advice from a healthcare professional for erectile dysfunction.
That could be a serious mistake.
"Erectile dysfunction is often a hint of underlying heart disease," cardiologist Michael Joseph Blaha has said in a review for Johns Hopkins Medicine.
Erectile dysfunction can also be an early sign of mental health disorders, type 2 diabetes, and hormonal issues. What's more, it is a highly common issue in those with pancreatic cancer.
Erectile dysfunction does not necessarily cause all these health conditions, but it is possibly an early outward sign of hidden hormonal, vascular, or metabolic issues.
A recently published academic book, from leading endocrinologists in Italy, aims to share more information on these associations for the wider public.
Its title, The Canary in the Coal Mine: Erectile Dysfunction as the Best Biomarker of Non-Communicable Chronic Diseases, sums up their main message about how erectile dysfunction may indicate other health problems.
It was edited by sexologist Emmanuele Jannini at the University of Rome Tor Vergata, and was published in partnership with the Italian Society of Andrology and Sexual Medicine.
Chapter two summarises the current available literature on erectile dysfunction as a specific harbinger of cardiovascular disease.
For instance, a meta-analysis of seven cohort studies found that erectile dysfunction was associated with a 1.4-fold higher risk of cardiovascular disease compared to those without the condition.
In fact, a common treatment for erectile dysfunction, the vasodilating class of drugs to which Viagra belongs, was originally proposed for coronary artery disease.
The drug's benefits for erectile dysfunction were only discovered by accident. Perhaps heart disease and erectile dysfunction share similar origins. After all, the function of both organs is heavily reliant on the body's vascular system.
The authors of The Canary in the Coal Mine note that both cardiovascular disease and erectile dysfunction share similar risk factors, such as smoking tobacco or a lack of exercise.
Erectile dysfunction, however, often shows up years before cardiovascular issues.
A similar trend exists for type 2 diabetes, as chapter three explains.
Poor or very poor erections are an issue for an estimated 50 percent or more of men with diabetes mellitus, possibly reflecting systemic vascular or metabolic dysfunction.
What's more, erectile dysfunction often precedes this metabolic disorder, suggesting that it may be a useful early symptom of insulin issues.
In a review published this year, another team of scientists in Spain explained that "erectile dysfunction may function not only as a complication of type 2 diabetes but also as an early clinical marker of cardiometabolic disease."
When someone with type 2 diabetes experiences erectile dysfunction, the review authors argue it "should be regarded as a clinically relevant marker of systemic vascular disease."
They suggest that some of the shared mechanisms uniting the two conditions are oxidative stress, inflammation, autonomic neuropathy, and low hormone levels.
The authors of The Canary in the Coal Mine are thinking along the same lines.
"The earlier identification of erectile dysfunction in men with type 2 diabetes, as well as the consideration of erectile dysfunction as an early marker of type 2 diabetes or insulin resistance, has the potential to improve the recognition and management of both conditions," they conclude.
Related: Erectile Dysfunction Drugs May Lower Risk of Alzheimer's
The associations are strong, but this idea remains speculative until high-quality, randomized controlled trials can confirm that erectile dysfunction is an early marker of disease.
Emerging research is even starting to find links between erectile dysfunction and conditions of the gut.
Men with irritable bowel syndrome, for instance, are more than twice as likely to develop erectile dysfunction, according to a small study of 133 students.
Inflammatory bowel disease is also linked to the condition.
If erectile dysfunction turns out to be a reliable indicator of poor health, it's possible that it could be better integrated into routine health screenings to give a heads-up to those most at risk.
Mayo Clinic urologist Tobias Köhler was part of a panel that published consensus recommendations for clinicians on erectile dysfunction in 2024. The panel argued that this condition wasn't just a "quality of life" issue but a cardiovascular issue.
In a recent population study, men with erectile dysfunction and known risk factors for cardiovascular disease who took Viagra-like drugs were linked to some incredible health outcomes.
These include 25 percent reduction in all-cause mortality, a 39 percent reduction in cardiovascular death, a 17 percent lower rate of heart failure, and a 15 percent lower rate of revascularization (a procedure to restore blood flow).
That's part of why Köhler personally encourages all healthcare professionals to ask their patients: "Are you having any trouble with erections?"
There's no shame in being health-conscious.
The book The Canary in the Coal Mine is freely available online here. The March 2026 review was published in Frontiers in Clinical Diabetes and Healthcare.
This article was fact-checked by Rachel Garner and edited by Clare Watson. While we pride ourselves on our process, we are only human. If you spot a mistake, please let us know.