Erectile dysfunction (ED) is associated with modifiable risk factors. Obesity, physical inactivity, and the metabolic syndrome increase the incidence of ED and markers of low-grade inflammation, which in turn are associated with endothelial dysfunction. Intensive intervention with lifestyle advice focusing on a healthy diet, weight loss, and increased physical activity benefits men with ED, reducing the markers of inflammation and improving endothelial function. Though phosphodiesterase type 5 inhibitors are highly effective in treating ED, lifestyle advice and aggressive risk reduction remain fundamental to the overall vascular good health of the individual.