Laumann's study showed that 7% of men in their 20's complained of difficulties in getting or maintaining an erection satisfactory for sex. This nearly tripled to 18 % in the fifth decade. The Massachusetts Male Aging Study showed that while 52% of men age 40 to 70 had some degree of erectile dysfunction, 5% of all men at 40 have complete erectile dysfunction. With age, this increases to 15% for men at age 70.

Medical treatment for erectile dysfunction has become a primary care skill with the introduction of oral sildenafil (Viagra) proving to be effective in 72% of men and generally well tolerated. Men need to practice with a few doses, and need to be cautioned that onset of action depends on how much food and liquor has been consumed prior to taking the sildenafil. Waiting 1 - 2 hours increases clinical effectiveness, but may increase anxiety. Partners benefit from hearing how sildenafil works, and that it is safe. Many worry that sildenafil could kill their man. This has not been born out in clinical practice. Given its mode of action blocks the breakdown of intracellular nitric oxide, it cannot be taken by men using nitrates for coronary artery disease and angina. Otherwise it is quite benign.

Other treatments include intra-urethral MUSE, and intra-cavernosal injectable Caverject. These prostaglandins work by non-nitric oxide pathway and are safe with nitrates. Patient acceptability remains an issue, but they provide highly effective therapy if sildenafil fails. Penile prostheses are still a fallback treatment if all others fail, however given the effectiveness of newer medications; they are much less often performed currently. Assessment of the couple is imperative before an implant is considered.

next: An Erectile Dysfunction Expert Speaks Up