Erectile dysfunction: the earliest sign of generalized vascular disease?

Until sildenafil, the first effective oral agent for erectile dysfunction (ED), was introduced, only genitourinary physicians concerned themselves with this problem. Certainly cardiologists rarely asked their patients with cardiovascular disease about difficulty developing or maintaining a penile erection. Physicians knew that ED could be caused by atherosclerosis of the internal iliac arteries, the smaller vessels supplying the penis, neural damage frequently related to radical prostatectomy, certain medications, and a deficiency of testosterone. Lacking these, ED was attributed to psychologic problems.