There's more than one reason Erectile Dysfunction, which affect more than a third of men over the age of 40, should not be ignored.

Drugs like Viagra are just one set - among several - of time-tested Erectile Dysfunction treatments.

Viagra enabled 83 percent of men struggling with ED to have intercourse at least once compared with 45 percent of those taking a placebo.

Still, other drugs may be necessary to deal with vascular disease or diabetes, which often accompany ED. And long-impotent men may want to consider options like penile implants because, as vascular disease progresses, the usefulness of Viagra and its kin often wanes.

ED heralds heart trouble because arteries in the penis have about a quarter the diameter of coronary arteries. When plaque builds up, the slender vessels reach the strangling point first--but cardiac problems are often just around the corner. "In many cases, erectile dysfunction is quite literally vascular disease under the belt," says Randy Fagin, a urologist and director of the Prostate Center of Austin.

Symptoms often occur three to four years before cardiac problems, such as chest pain or heart attack, begin to crop up, says Robert Kloner, a cardiologist at the University of Southern California.

New guidelines in 2006 advised physicians to consider a man with erectile dysfunction and no cardiac symptoms a cardiac patient until proved otherwise. In addition to any treatment they may need for vascular disease or diabetes, men have options for fixing ED. Eating better and exercising regularly can not only stave off plaque buildup in arteries but reverse it, research has shown. A 2004 study of obese men with erectile dysfunction found, for example, that erectile function improved in a third of men who adopted healthful behaviors and lost about 30 pounds.

Among medical options, doctors say, one of the best is to inject a medication such as alprostadil into the base or side of the penis. A quick, relatively painless shot, which can produce an erection within 10 minutes, costs about twice as much as a dose Viagra.

Other ED fixes are made to last. Vacuum pumps put negative pressure on the penis, creating an erection that can be maintained for about 30 minutes by placing an elastic band around its base. Studies report success rates of 70 to 94 percent with the devices, but side effects can include pain, numbness, bruising, and obstructed ejaculation.

Surgical implants are pricier but have upsides. Men can inflate the implants at will, using a pump placed in the scrotum. Satisfaction rates are high. Yet despite the availability of solutions, many harried doctors are not as aggressive as they could be about sleuthing out sexual problems. That puts the burden of speaking up on men.

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