RESUMO
INTRODUCTION: Erectile dysfunction (ED) is a common complaint in men over 40 years of age and prevalence rates increase with age. Comorbidities such as heart disease, diabetes, dyslipidemia, hypertension, and depression have been described as primary risk factors for the development of ED. Additionally, a number of modifiable lifestyle factors, including physical activity, smoking, alcohol consumption, diabetes control, and obesity, have been associated with ED. AIM: The association of modifiable behavioral factors with ED, mainly among men without recognized comorbidities, opens the possibility for intervention strategies to prevent and potentially improve erectile function in patients suffering with ED. CONCLUSION: While intriguing, most of the literature and evidence is not completely scientifically compelling as to how modifying lifestyle risk factors can improve erectile function. Weight loss may reverse ED through other mechanisms, namely, decreased inflammation, increased serum testosterone levels, and improved mood and self-esteem. Currently, the evidence at hand recommends that patient education should be aimed at increasing exercise, reducing weight to achieve a body mass index less than 30 kg/m(2), and stopping smoking to improve or restore erectile function, mainly in men without established comorbidities. When comorbidities are present, lifestyle modifications may be important in preventing or reducing sexual dysfunction. These modifications may include precise glycemic control in diabetic men and the use of pharmacologic therapies for hypertension and depression, which are less likely to cause sexual side effects.