Senior physicians, cardiologists, urologists, psychologists, and pharmacologists critically review the relation between heart disease and erectile dysfunction (ED) and explain for the practicing physician the effective new treatment options available for the cardiac patient with ED. The authors detail in concise language the latest thinking about the risk of sexually induced cardiac events, the efficacy and risks to cardiac patients of drugs used to treat sexual dysfunction, and the expert guidelines developed by prominent organizations on the optimal approach to sexual dysfunction in the cardiac patient. They also discuss the physiology of ED and the currently available therapies (sildenafil, tadalafil, and vardenafil) may interact with the cardiac system, and the potential application of newer agents like phosphodiesterase-5 inhibitors to cardiovascular disease.