Gather a group of men and the conversation is likely to revolve around many topics. Weather, politics, sports, hobbies, work or travel are all likely. But erectile dysfunction is unlikely to be freely discussed. This is because most men don’t like to talk about it. This can create feelings of embarrassment, shame, guilt, and inadequacy.

Erectile dysfunction, formerly called impotence, is a term that refers to the continued inability to achieve an erection acceptable for satisfying sexual activity. Over 150 million men worldwide suffer from some form of erectile dysfunction.

Misconceptions or misunderstandings about erectile dysfunction may cause some men to forego treatment.

Let’s debunk some common myths to help men start talking about this condition:

Myth: Erectile dysfunction only affects men over 70.

Do: Erectile dysfunction is more common in older men, but it can occur at any age. It affects about half of men between the ages of 40 and 70.

Some erectile functions change with age. Erections may take longer to develop, may not be as rigid, or may require more direct stimulation to achieve. Men may notice that orgasms are less intense, ejaculate volume is reduced, and recovery time increases between erections. Although these changes are expected, the persistent inability to achieve a satisfactory erection is not a normal part of aging.

Myth: Erectile dysfunction is annoying but not dangerous.

Do: Erectile dysfunction can be a red flag that you are at higher risk for certain life-threatening conditions. This includes heart disease, type 2 diabetes and stroke.

The same factors that contribute to heart disease and stroke can cause erectile dysfunction. A man in the early stages of heart disease could develop erectile dysfunction long before he experiences heart symptoms. Indeed, the arteries supplying the penis are smaller than the heart. If you develop erectile dysfunction, it is recommended to be screened for heart disease, diabetes, hardening of the arteries and high blood pressure.

Myth: Erectile dysfunction is all in your mind.

Do: In the past, it was thought that only psychological factors caused erectile dysfunction. Now, medical specialists know that physical conditions can cause or contribute to erection problems.

Many diseases can lead to an inability to get or keep an erection. This includes diabetes; nerve damage; heart disease; and chronic lung, liver or kidney disease. Also, many medications can interfere with nerve impulses or blood flow to the penis. Certain antidepressants, antihistamines and sleeping pills, and certain medicines to treat high blood pressure; pain; Prostate cancer; and conditions of the stomach, intestines or bladder, are known to contribute to erectile dysfunction.

Sometimes erectile dysfunction can result from depression, stress, anxiety, or fatigue. Personal relationship issues can also lead to difficulty getting an erection.

Myth: Erectile dysfunction means there is something wrong with the penis.

Do: To produce an erection, a man needs a healthy brain and penis, healthy blood vessels and nerves, and adequate amounts of the male hormone testosterone. If any aspect of this system is affected, erectile dysfunction can result.

Although a problem with the erectile bodies of the penis or the blood flow can cause erectile dysfunction, there are also many other potential causes. A complete physical exam and medical history with a medical professional can help determine the cause of your erectile dysfunction and appropriate treatment options.

Myth: If you struggle once in the bedroom, you have erectile dysfunction.

Do: It’s normal to have trouble maintaining an erection from time to time. This happens to most men and is perfectly normal. Discuss with your primary care provider if this becomes a persistent problem and interferes with your self-image or sex life.

Myth: Erectile dysfunction means you’re not attracted to your partner.

Do: There are many possible causes of erectile dysfunction. Personal relationship issues can lead to difficulty getting an erection. However, this is probably due to a different reason. If you enjoy your partner’s company, it’s likely that stress, anxiety, fatigue, specific medications, or other health issues are to blame for your erectile dysfunction.

Myth: Taking testosterone supplements will cure erectile dysfunction.

Fact: Hormonal changes, like low testosterone levels, can cause erectile dysfunction, but they’re not the only cause. Talk with your health care team before starting testosterone supplements.

Myth: Drugs are the only way to treat erectile dysfunction.

Do: Many options are available to treat erectile dysfunction. Medication works for some men, but others benefit from simple mechanical devices, surgery, or counseling. Learn more about erectile dysfunction treatment options.

Erectile dysfunction can become a source of stress for a man and his partner. If you occasionally suffer from erectile dysfunction, try not to assume that you have a permanent problem or that you don’t expect it to reoccur.

If you have more frequent difficulties, talk to your primary care provider. By working together, you and your healthcare team can determine the cause of your symptoms and explore treatment options for a satisfying sex life.

J. Nicholas (Nick) Warner, MD, is a urologist in La Crosse, Wisconsin. He also cares for patients at the Mayo Clinic in Rochester, Minnesota.