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Erectile dysfunction is not just a problem with the penis, but rather a reflection of underlying endothelial health. The penis serves as a barometer for something called endothelial health, which is the condition of the single layer of cells lining the arteries, veins, and lymphatic system. Erectile dysfunction is often an early sign of peripheral artery disease, which affects the arteries in the legs and arms. While there may not be noticeable symptoms in the early stages, individuals may eventually experience cold feet, painful legs, cramping, color changes, slow wound healing, and hair loss on the lower legs. This connection between peripheral artery disease and erectile dysfunction highlights the importance of maintaining a healthy endothelium for achieving and maintaining an erection.