Erectile dysfunction (ED) is common, affecting 40% of men over 40years of age (so-called 40 over 40) and 1 in 3 men over 70years of age. It is predominantly a vascular condition, often preceding a cardiovascular event by 3–5years. ED is associated as a consequence with acute coronary syndromes and increased cardiovascular and all-cause mortality. Its early identification therefore offers a window of opportunity for cardiovascular risk reduction. ED has for many a devastating impact on a couple's relationship. Its treatment is often successful, maintaining quality of life in the middle aged and elderly. ED should always be queried as part of the ongoing health care worker and patient relationship – its early detection may prevent early death.