["Penis angina" or the current revolution in erectile dysfunction (ED)].

Erectile dysfunction (ED) can no longer be neglected by the medical profession, as the presence of ED is never entirely benign, but is always a reliable marker of a sexual disorder but also (and sometimes especially) a non-sexual disorder (physical and/or mental). Its documented association with many chronic diseases and high-risk situations is in the process of extending the significance of ED beyond the purely sexual domain, as this symptom, easily detected by simple clinical interview, appears to be not only a barometer of health, but also a warning indicator of situations that can sometimes be dangerous for the patient's health. For example, in male populations with a high vascular risk, ED is as frequent as diabetes and metabolic syndrome, and must be considered, until proof to the contrary, to reflect angina of the penis, i.e. an exercise-induced vascular symptom, which has a double warning value: 1) marker of deterioration, 2) potential prodrome of acute vascular accidents. These close relations between ED and cardiovascular disease give a completely different dimension to ED, which now constitutes a potential candidate for a new clinical vascular marker and possibly, in some cases, a new marker of cardiovascular risk. These unexpected roles of revealing factor and clinical marker of multiple health states (cardiovascular or other) paradoxically contribute to "desexualization" of ED, as sexual health no longer appears to be the major risk involved. In particular, they open the realistic perspective of opportunistic and proactive detection of ED in well targeted populations for the purposes of primary prevention of cardiovascular disease, a public health priority. For all these reasons, the development of ED requires a minimal evaluation of the patient's state of health, regardless of the doctor's qualification, by clearly distinguishing quality of life and health objectives. This modern management of ED is part of an individual (humanistic) and social (civic and ethical) approach. This "revolution" complies with the requirements of a good quality scientific approach, which comprises the concepts of evidence-based medicine and a rational approach to the service rendered to the patient, as management of his sexual health (and not his sexuality) also comprises management of his general health.