 A rectile dysfunction is defined as the recurrent or persistent inability to attain and or maintain an erection in order for satisfactory sexual performance. It is present in up to 30 million men in the US and approximately 100 million men worldwide. Wait a second. The US has less than 8% of the world's population, yet up to 30% of the impotence? We're number one. Who cares though? We've got red, white, and blue pills like Viagra. The problem though is the pills just cover up the symptoms of vascular disease and don't do anything for the underlying pathology. A rectile dysfunction and our number one killer coronary artery disease are just two manifestations of the same disease, inflamed, clogged, and crippled arteries, regardless of which organ. Atherosclerosis is considered a systemic disorder that uniformly affects all major blood vessels in the body. Hardening of the arteries can lead to softening of the penis because stiffened arteries can't relax normally, open wide, and let the blood flow. So a rectile dysfunction may just be the flaccid tip of an iceberg in terms of a systemic disorder. In two-thirds of men showing up to emergency rooms for the first time with crushing chest pain, their penis had been trying to warn them for years that something was wrong with their circulation. Why does it tend to hit the penis first? Because the penile arteries in the penis are half the size of the coronary arteries in our heart. That particular artery is the so-called widowmaker. So the same amount of plaque in the heart that you wouldn't even feel could half-clog the penile artery, causing a symptomatic restriction in blood flow. You may not feel chest pain until about here. That's why a rectile dysfunction has been called penile angina. In fact, by measuring blood flow in a man's penis, you can predict the results of his cardiac stress test with an accuracy of 80%. Male sexual function is like a penile stress test, a window to the hearts of man. 40% of men over 40 have a rectile dysfunction, 40 over 40. Men getting erection difficulties in their 40s have a 50-fold increased risk of having a cardiac event, like sudden death. You've heard me say various things, you know, increased heart disease risk 20%, 30%. That's nearly 5,000%, leading the latest review to ask, is there any risk greater? That's because it's not so much a risk factor for atherosclerosis. It is atherosclerosis. A man with a rectile dysfunction, even if he has no cardiac symptoms, should be considered a cardiac patient until proven otherwise. It's considered to be a cardiac equivalent. It's a marker of the coronary artery disease you likely already have. There's therefore more to treating erectile dysfunction than just establishing an erect penis. It offers an opportunity for reducing cardiovascular risk. The reason that even young men should care about their cholesterol is because it predicts erectile dysfunction later in life, and that predicts heart attack, strokes, and a shortened lifespan. Just going to keep eating crap because you can pop some pills? All the Viagra in the world may not help your sex life after a stroke. The take-home message is a simple equation. ED stands for early death.