A 52-year-old male patient presents to the clinic with concerns about his inability to maintain an erection sufficient for sexual activity over the past year. He reports that he has been experiencing increasing difficulties, with erections becoming less firm and shorter in duration. He describes feeling frustrated and anxious about his sexual performance, which has begun to affect his relationship with his partner.

The patient has a history of type 2 diabetes for the past 10 years and is currently on oral hypoglycemic agents. He admits to being a smoker for the past 25 years, averaging about 10 cigarettes per day, and has a sedentary lifestyle with little exercise. He denies any history of cardiovascular disease but reports occasional high blood pressure readings. He does not take any medications for hypertension.

During the physical exam, the physician notes slightly elevated blood pressure and a BMI that classifies the patient as overweight. Laboratory tests reveal elevated fasting blood glucose levels, and his lipid profile shows elevated cholesterol. A diagnosis of erectile dysfunction (ED) likely secondary to a combination of vascular, lifestyle, and metabolic factors is made. The patient is advised on lifestyle modifications, and medications such as phosphodiesterase-5 inhibitors are discussed as treatment options.