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The small blood vessels that go to the penis can become diseased much earlier than the vessels that go to the heart," Karen Boyle, MD, a urologist at Johns Hopkins School of Medicine, tells WebMD. "In younger or younger middle-aged men, ED is often the first sign of atherosclerosis." Richard, a mechanic from upstate New York, is a muscular, athletic guy. He has a loving wife who has always enjoyed their sex life. But ever since he was a young boy, Richard couldn't get over the feeling that his penis was too small.