Erectile dysfunction is defined as a problem in getting or maintaining an erection during sex. Erectile dysfunction that occurs progressively or regularly during intercourse is a health problem and should be treated. There are many causes of impotence. A number of organic and functional problems are at the basis of its development. The physical causes responsible for the problem include atherosclerosis, diabetes mellitus, affecting the nerve endings involved in the innervation of the genitals. Surgery or radiation for cancers in the lower abdomen or pelvis can also cause impotence. Treatment for prostate cancer, colorectal carcinoma, or bladder cancer often causes erectile dysfunction. Some medications have side effects and may be the cause of the problem. In addition, excessive use of alcohol and certain toxic substances may affect a man’s sexual capabilities. Emotional health can also impact erectile function. Depression, anxiety, conflicts in relationships are potential causes responsible for the development of impotence, especially in younger people. Erectile dysfunction is a common disease state, just as cardiovascular diseases are the most common disease entity worldwide. It is not uncommon for both conditions to co-exist because they share common risk factors. The disease shows a high prevalence, with up to 150 million men worldwide affected to date. The incidence of impotence increases progressively with age, affecting two-thirds of men over the age of 70. Erectile dysfunction often precedes cardiovascular disease and is often a presenting complaint in comorbid men. Common risk factors responsible for their development include arterial hypertension, dyslipidemia, diabetes mellitus, and smoking. Endothelial dysfunction responsible for the development of cardiovascular diseases turns out to be the cause of the development of erectile dysfunction as well. In 2001, two reports suggested that erectile dysfunction may be a marker of silent (asymptomatic) coronary artery disease. There is a hypothesis that the difference in “artery size” explains the appearance of erectile dysfunction before that of cardiovascular disease. Penile arteries have a diameter of 1-2 mm, and coronary arteries – 3-4 mm. Endothelial dysfunction and plaque accumulation in smaller-caliber arteries would be symptomatic before a similar process affects blood flow in larger arteries. Asymptomatic lipid-rich plaque in coronary arteries may be vulnerable to rupture to cause acute coronary syndrome. In this line of thought, impotence may predict acute coronary syndrome or death, especially given that most acute events, including sudden cardiac death, occur without cardiac warning symptoms.In a meta-analysis of 12 prospective cohort studies involving 36,744 men, erectile dysfunction significantly increased the risk of cardiovascular disease. In men in whom it is reported, the risk of ischemic heart disease, stroke and all-cause mortality is increased, making it independent of conventional risk factors predicting these events. It is precisely because of all the above that the benefits of using erectile dysfunction as a prognostic factor for concomitant cardiovascular disease should be taken into account. Of course, before drawing such conclusions it is extremely important to rule out all other possible causes of impotence, especially in younger men. Evaluation of patients with erectile dysfunction should include a range of laboratory and functional tests. A detailed history may rule out the use of various medications and substances that affect erectile function. In addition, lipid profile, fasting blood glucose and glycated hemoglobin levels, thyroid function and blood testosterone levels should be assessed in all patients. Cardiological examination can point to complaints from the cardiovascular system and, above all, the appearance of anginal pain at rest or during exertion. Different methods of provoking ischemia – stress test with exercise or pharmacological drugs can identify lesions in the coronary vessels that do not cause complaints at rest. References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442980/ https://www.jacc.org/doi/10.1016/j.jacadv.2023.100384Different methods of provoking ischemia – stress test with exercise or pharmacological drugs can identify lesions in the coronary vessels that do not cause complaints at rest. References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442980/ https://www.jacc.org/doi/10.1016/j.jacadv.2023.100384Different methods of provoking ischemia – stress test with exercise or pharmacological drugs can identify lesions in the coronary vessels that do not cause complaints at rest. References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442980/ https://www.jacc.org/doi/10.1016/j.jacadv.2023.100384