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Erectile dysfunction is a neurovascular phenomenon that requires an intact psychological, neural, and vascular component. The advent of Food and Drug Administration approval of sildenafil citrate (Viagra) in 1998 has resulted in increased awareness and a large population of patients seeking treatment. Unfortunately, the estimated number of patients seeking medical therapy still persists at approximately 10%. The predominant reasons suggested here are the complexity of sexuality, taboos, cultural restrictions, lack of satisfactory treatment, and acceptance of the situation as a normal sequence of aging. This perspective discusses the global prevalence and the differences in prevalence on a worldwide basis.Recent epidemiologic studies from Spain and Germany have suggested lower rates of erectile dysfunction. This, however, may actually reflect population or cultural differences in the perceptions and attitudes towards the condition. Aging, diabetes, coronary artery disease, and cigarette smoking as epidemiologic factors are reviewed extensively, including some of the controversies with the prevalence rates on a global scale. Chronic renal failure, pelvic surgery, and lifestyle determinants similarly suggest there may be subtle differences, requiring further education from the medical care provider in order to have patient acceptance on a relatively earlier scale.Erectile dysfunction is a worldwide health issue that affects nearly half the men over the age of 40. As the world population ages, the number of patients affected by this disorder will certainly be increased. With the identification of risk factors, it may be possible to identify patients at risk of erectile dysfunction.