ABSTRACT
Introduction It is estimated, from 2001-2002 data, that erectile dysfunction (ED) was self-reported by one in five men in the USA. 1 However, the prevalence may be higher, since the rate of ED identified by the International Index of Erectile Dysfunction five-item index (IIEF-5) 2 has been shown to be nearly twice that of self-reported ED. 3 During the past 20 years there has been fundamental change in the way in which ED is treated and also the attitudes of both the medical profession and the general population to this condition. Prior to 1995, when the first treatment for ED (intracavernosal alprostadil) was approved in the USA by the Food and Drug Administration, treatment of ED had been limited to psychotherapy and vacuum tumescence devices, and many considered the condition to be an inevitable consequence of the aging process. However, further understanding of the physiology of erectogenesis and the pathophysiology of ED has resulted in the development of effective therapies with different modes of application: intracavernosal injections, intraurethral administration, and oral therapies. The launch of the first oral agent (sildenafil) in 1998, a decade ago, has not only increased the awareness and acceptance of ED as a treatable condition but has also resulted in the diagnosis and treatment of ED by primary care physicians, where previously it had been the domain of the urological specialist. Thus, it is important that not only the urologist but also the general practitioner should be familiar with the interpretation of clinical trials for ED so that they are able to make informed decisions in treatment planning and in offering the appropriate therapy.
