Erectile dysfunction is a commonly encountered clinical problem in men and its frequency is increasing in the aging population. The most prevalent form of organic ED is caused by atherosclerotic damage to the penile arteries. Vasculogenic ED and cardiovascular diseases share common risk factors and pathophysiological mechanisms. Onset of ED can be a warning sign of undiagnosed cardiovascular disease such as coronary artery disease or peripheral artery disease and this should direct the physicians’ attention to the cardiometabolic risk profile of the patient. Antihypertensive medications can have an additional effect on erectile function, which necessitates evaluation of the patients’ medical therapy for medications potentially responsible for treatment-induced ED. Phosphodiesterase-5 (PDE-5) inhibitors are an effective and safe first-line therapy option for ED and should be used in combination with life style modification and optimal control of modifiable cardiovascular risk factors.