Erectile dysfunction is a common condition that is most often reported after the age of 40, though it can occur at any age. A vascular origin is the most frequent organic cause. Diagnosis relies on an integrated sexual medicine approach, which uses tools such as penile pharmaco-doppler sonography to allow for a more precise etiological assessment. Regardless of the underlying etiology, management of cardiovascular risk factors remains essential. While phosphodiesterase type 5 inhibitors are the first-line therapy, new therapeutic options and vascular interventions are emerging, offering more personalized management perspectives.