 I am Dr. Ranjit Shetty, Senior Consultant, Department of Urology, Kasurba Hospital's Mangalore. Today I would like to talk on erectile dysfunction. What is erectile dysfunction? Erectile dysfunction broadly is inability to achieve or maintain a female erection which leads to unsatisfactory sexual intercourse. So this is a very personal problem and usually associated with a lot of reluctance, concealment and embarrassment which the patients refrain from getting expert opinions. But it is a very common problem and today there are more than 150 million cases of erectile dysfunction worldwide. If you are in the age group of 40-70, one in two persons has some form of erectile dysfunction. And the statistics for the year 2025 have been predicted to be 325 million cases worldwide. So what causes this erectile dysfunction? There are many reasons for erectile dysfunction. It is not just one reason, it could be vascular, medical like hypertension, diabetes, surgical problems, post-operative problems, neurogenic problems, psychogenic problems. So it is a varied approach and varied causes for this problem. So because of this the patient needs a detailed information of his history as well as examination and usually there may be more than one cause for the patient's condition. The treatment itself can be tailored to specific patients and it may vary from just lifestyle modifications to medication and even change of medications because a lot of the previous medication may be contributing to his erectile dysfunction. It may involve injections or intraurethral placement of medication which will help the patient. What are the risk factors involved in this condition? There are obesity, diabetes, hypertension, smoking, dyslipidemia or abnormal cholesterol. So if you notice these are the same risk factors for coronary artery disease or heart problems. There is a strong connection between erectile dysfunction and coronary artery disease when patients with early onset or severe erectile dysfunction who are otherwise normal for any cardiac event where evaluated was found that a good percentage of them had cardiac abnormalities. The problem is the erectile dysfunction will be in connection with the coronary artery disease. So it is important to evaluate both. It is found that patients with severe coronary artery disease also have a history of erectile dysfunction and the interesting thing is usually erectile dysfunction precedes the symptoms of cardiac disease by about one to two years. This is primarily because the penile arteries are smaller than the coronary arteries and the penile arteries are end arteries and do not have collateral blood supply like the coronary arteries. So the important take home points are erectile dysfunction is a very common problem. It affects maybe more than 150 million people worldwide and if in the age group above 40 1 in 2 people will be suffering from some form of erectile dysfunction. The treatment is varied because of the multiple causes causing this condition and the important fact also is the strong correlation with this and coronary artery disease which require coronary screening also in specific cases.