Brought to you by Deepak Chopra, MD, Alexander Tsiaras, and TheVisualMD.com Men who experience sexual dysfunction generally don’t react by reaching for the phone and speed-dialing the doctor. Being unable to achieve and maintain an erection seems like a private, and sometimes embarrassing, issue. How many men and their partners are suffering in silence, hoping that the malfunction will pass? What they may not know is that most cases of erectile dysfunction (ED) have an underlying physical cause. An erection is a successful collaboration between the circulatory system, nerves, hormones and brain. If blood cannot reach the network of vessels in the spongy erectile tissue of the penis, game over. Any factor that compromises your circulation can also compromise your sex life. Smoking, high blood pressure, hardening of the arteries and other vessel damage are the most common. Overweight and obese men can have uneven levels of the hormone testosterone, which is essential to sexual performance. Diabetics should be especially vigilant, as nerve damage from their disease commonly interferes with their ability to get an erection. And sometimes sexual dysfunction is the result of stress, depression or other psychological issues.If you have normal blood pressure, good general health, don’t smoke and have no chronic illnesses, you have very low risk of ED. As men age, their chance of experiencing ED is greater, but all men improve their chances of maintaining good sexual health by eating well and exercising. In one study, men who began exercising in midlife had a 70% reduction in ED risk compared with sedentary men in their age group. If you experience ED more than 25% of the time, call your doctor. He or she will likely take a full medical history, examine your genitals, give you a blood test to assess your hormone levels and other factors, take your blood pressure, and perhaps give you an ultrasound to get more information about circulation in your penis. If there is no obvious physical cause, and your ED persists, depression or stress may be the culprit. There is a simple device that determines whether men are having erections in their sleep. Those who have regular, involuntary erections while sleeping, but not when they are with their partner, most often are contending with a psychological issue. Time and treatment can resolve most of those cases, too. But the first step toward getting your sex life back on track is talking to your doctor. Learn more about sexual health issues: TheVisualMD.com: Barry R. Komisaruk, Ph.D.