Erectile dysfunction is a common sexual dysfunction, with an estimated prevalence of 8% among men aged 40 years and 40% among men aged 60 years. It is associated with cardiovascular risk factors. Treatment is commonly with ‘as required’ or daily phosphodiesterase type 5 inhibitors: sildenafil citrate, tadalafil, or vardenafil, although other options are available. The selection of treatment is dependent on accurate assessment, estimation of cardiovascular risk, and patient choice. In this article, treatment choices are considered and strategies for optimizing treatment are recommended.