Erectile dysfunction (ED) is highly prevalent in men with cardiovascular disease (CVD), yet it is frequently underrecognized and underdiagnosed in clinical practice. Even among clinicians who acknowledge the relevance of addressing sexual issues in their patients, there is a general lack of awareness of the optimal approach for sexual problem identification and management. Additionally, cardiac rehabilitation programs typically neglect the role of sexual function. The trajectory of CVD and ED may necessitate continuous adjustment by both patients and their partners as they adapt to the chronicity of heart disease and the changing reality of their sexual lives. Health professionals typically approach management of these disorders from a disease-centered perspective, which often fails to incorporate the patient's needs and perspectives. In turn, patients frequently complain of a lack of sensitivity or awareness on the part of their physicians. From a patient-centered perspective, greater emphasis is placed on life satisfaction and quality of life as primary outcomes of treatment. Finally, a patient-centered framework is relevant for both treatment and prevention of cardiac risk in men with ED, in addition to ED management in patients with or without overt CVD.