Erection problems are a ‘canary in a coal mine’ — and could signal major health issues in a few years

Falling flat in the bedroom could mean trouble out from under the sheets too.

Erectile dysfunction (ED) affects millions of men, both young and old, with between 30 and 50 million experiencing difficulty getting and keeping an erection — in fact, one expert told The Post we’re headed for an “epidemic of erectile dysfunction.”

But being in a not-so-hard place could mean more than a dissatisfying sex life — trouble rising to the occasion could signal some serious health issues in the future, too.

Getting hard is more complex than just feeling attracted to someone — it involves coordination among your brain, nerves, blood vessels and hormones.

So going soft doesn’t necessarily mean you’re not into it. Blood flow issues could be to blame, stemming from hardened arteries, smoking, high blood pressure and high cholesterol.

And that means your inability to rise to the occasion could be a clue that something bad is brewing for your health.

“ED is what I call a canary in the coal mine for systemic vascular and metabolic disease,” Justin Houman, assistant professor of Urology at Cedars-Sinai Medical Center, told The Post, describing it as “an early warning signal from the vascular system.”

“That’s why we say ED precedes cardiac events by an average of three to five years. It’s a window of opportunity, not just an inconvenience,” he said.

Several conditions are strongly linked to erection issues, according to Houman, including:

• Cardiovascular disease, such as coronary artery disease, heart attack, stroke
• Type 2 diabetes
• Hypertension (high blood pressure)
• High cholesterol
• Obesity
• Metabolic syndrome
• Testosterone deficiency
• Sleep apnea
• Chronic kidney disease
• Depression

The link is especially strong for heart disease and diabetes. In fact, he said, men with ED have roughly a 44% higher risk of developing heart disease compared to men without it.

“An erection is fundamentally a vascular event,” he explained. “It requires healthy arterial blood flow, nitric oxide signaling, and compliant blood vessels.

“The penile arteries are small,” he went on. “So when systemic vascular disease begins silently damaging blood vessels throughout the body, the penile arteries show symptoms first, often years before a man has a heart attack or stroke,” he said.

Even if you’re not having sex at the moment, trouble getting an erection is still cause for concern.

“ED is not a relationship problem. It’s a health signal,” Houman said. He likens it to taking your car in when the check engine light comes on, even if you’re not going on a road trip.

“Whether or not you’re having sex with a partner is completely irrelevant to what your vascular system is trying to tell you,” he said.

“A man who develops ED at 45 and ignores it because he’s not in a relationship may be missing a three to five year window to intervene before a cardiac event or a diabetes diagnosis.”

And no matter the age, erection issues warrant a health checkup, as the underlying issue can vary by decade.

While it’s less common for those under 40, ED could signal cardiovascular risk, testosterone deficiency, sleep apnea or psychological factors.

“In men in their 40s and 50s, ED is often the first clinical manifestation of cardiovascular or metabolic disease that hasn’t yet been diagnosed, and this is the group where acting early has the most impact on long-term outcomes,” he said. “Older men sometimes accept ED as inevitable, but even at 60 or 70 it should prompt a health conversation, not just a prescription. No age group gets a pass.”

So what should you do? Houman recommends a few key steps.

1. Talk to your doctor — and be honest. “ED is still underreported because men are embarrassed, but it’s one of the most clinically informative symptoms we can evaluate,” he said.
2. Reduce alcohol and eliminate tobacco.
3. Exercise. “Cardiovascular fitness is one of the most powerful treatments for ED that doesn’t get nearly enough attention,” he said.
4. Get better sleep.
5. Don’t treat the symptom and ignore the cause. Drugs like sildenafil (Viagra) or tadalafil (Cialis) “are effective and safe, but they’re not a substitute for understanding why ED developed in the first place.”