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Although erectile dysfunction is sometimes assumed to be a symptom of the aging process in men, it is unclear if the incidence is directly related to increasing patient age. Erectile dysfunction more likely results from concurrent medical conditions of the patient (e.g., hypertension, arteriosclerosis, hyperlipidemia, diabetes melli-tus, or psychiatric disorders) or from medications that patients may be taking for these diseases. " For example, up to 50% of patients with diabetes mellitus develop erectile dysfunction, and medications such as /3-blockers are associated with a high incidence of erectile dysfunction. 

Vascular pathology may involve lesions of the inflow or outflow mechanisms of penile erection. Erectile dysfunction may be a manifestation of generalized atherosclerosis and may even be its initial presentation. Common risk factors associated with generalized penile arterial insufficiency include hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus, and pelvic irradiation (Rosen et al. 1991). Less commonly, local stenosis of the conunon penile artery may occur in men who have sustained blunt pelvic or perineal trauma (Levine et al. 1990). 

Erectile dysfunction may be the first manifestation of many diseases including diabetes mellitus, coronary artery disease, hyperlipidemia, hypertension, spinal-cord compression, pituitary tumors, and pelvic malignancies. For example, a recent prevalence study found that men with erectile dysfunction were twice as likely to have DM and concluded that erectile dysfunction may be used as an early marker for DM. This relationship was particularly strong in the younger age groups, in vdiich the odds ratio of having DM was 3 (Sun et al. 2006). Two earlier studies found that 11% (Maatman et al. 1987) and 12% (Deutsch and Sherman 1980) of impotent men were found to have previously undiagnosed DM. 

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