Nowadays, a patient may put across this problem frequently to his primary care doctor.

The cause of ED has become less and less important. As one treats it, one must examine the penis for anatomical abnormalities such as cordee or scarring that may cause pain as one medically treats ED.

Few things to know are:

1. Sildenafil (pharmacological name for Viagra) : It is successful in 70% of patients with ED. This does not vary with cause of the ED.

Contraindicated if patient is on ANY form of Nitroglycerin/Nitrates. Not contraindiacted in patients with CAD if not on nitrates.

2. Intracavernosal Prostaglandin PG-E1: Success is approximately 80%. Compliance is poor. (Can't blame them)

3. Intra-urethral Prostaglandin PG-E1 (Muse): effective in 40% but painful in 35%.

4. Topical PG-E1 - effective in 70%.

5. Vacuum devices: Effective in approximately 80% but only distal portion of penis is firm.

6. Yohimbine: Effective in about 60%. Possibly safer than Sildenafil.

SURGICAL OPTION is a penile implant. Effective, expensive, infection rate 2-7%