Editor’s note: This is part of a series of articles focused on health issues men need to talk about with their primary care physicians.

With all the erectile dysfunction (ED) commercials invading our TVs, it may seem like everyone is talking about this issue. Not true.

Most men don’t mention erectile dysfunction to their doctors. Let’s face it, it’s not the easiest conversation to have, but don’t be embarrassed or think you’re less of a man. ED affects nearly 30 million men in the U.S., according to National Institutes of Health estimates.

But guys, listen up: Erectile dysfunction is more than an issue that affects your sex life. It’s a clue that may serve as a predictor for early development of heart disease or it may also be a nerve complication of uncontrolled diabetes, said Dr. Odette Morgan, an endocrinologist at Marshfield Clinic.

“Guys often fail to bring it up, but we clearly need to be talking about it,” she said. “Realize it’s an extremely common problem and that erectile dysfunction may be the result of more serious underlying health concerns.”

Erectile Dysfunction: Close to your heart

Most erectile dysfunction is caused by a reduction of blood flow to the penis in addition to impairment of nerve function. The decreased blood flow could be the result of arteries hardening and thickening, Morgan said. For that reason, make sure your doctor knows about any erectile dysfunction you have.

“If a man at age 30 has erectile dysfunction, it would be unusual and it’s a big red flag for doctors,” Morgan said.

If your doctor is concerned about vascular disease they often will first check your blood’s sugar, fat and cholesterol levels. If those levels are above normal range, it’s an indication you’re at higher risk for heart disease.

Head games – Erectile Dysfunction isn’t always physical

Morgan often checks testosterone levels, because low levels can lead to ED and a reduced sex drive. Uncontrolled diabetes and some prescription drugs also can be the root cause.

At times, erectile dysfunction also can be a psychogenic disease, meaning the problem originates in your mind. Often an erectile dysfunction medication can improve sexual function. However, addressing underlying issues such as stress, excessive alcohol consumption, lack of sleep and improving high cholesterol and diabetes are important factors to improve erectile dysfunction.

“Erectile dysfunction drugs can be fairly effective in helping some men regain erectile function.” Morgan said. “Often, an improvement in erectile dysfunction helps men regain their confidence and then they may no longer need medications. The latter can be a sign that the ED has a psychogenic origin rather than an underlying medical problem.”