For centuries, men suffered in silence. Erectile dysfunction (ED or impotence) has been present since creation of man and there was never a satisfactory treatment. The prevalence of this devastating disorder increases gradually with age and is much higher than expected.

Worldwide, more than 100 million men are estimated to have some degree of ED. ED is estimated to affect as many as 30 million men in the US. Surveys in the United Kingdom and France have estimated the overall prevalence of moderate-to-complete ED to range from 30% to 40%.

Given such shocking statistics one can only wonder how come the public awareness is so limited in this area. Not only are the patients uninformed about the availability of treatment to almost every case of impotence, but also physicians are unaware of such modern diagnostics & therapeutics for this problem. Viagra (Sildenafil) and more recently Vardinafil (in clinical trials) are excellent medications but are certainly not the only tool.

Management of erectile dysfunction requires a thorough understanding of the various causative factors whether psychogenic or organic, knowledge and experience in requesting investigations -as needed- as well as interpreting results wisely. Empathy and respecting the couple's preferences in treatment are basic qualities of any effective Andrologist or sex therapist.

The patient's needs are best served through what is known as a goal-directed approach. A proper sexual & medical history as well as a focused physical examination will allow us to reach a diagnosis in most cases. Investigations are ordered if deemed necessary to confirm a certain condition or direct future treatment. Patients should not be subjected to multiple, expensive & invasive diagnostic procedures if this was not expected to alter the treatment plan. This doesn't only save patients unnecessary expenses but also saves them from additional trauma resulting from what is referred to as 'false positive results'.

Therapy for erectile dysfunction is generally classified into first line, second line, and third line treatments.

Treatment decision-making

. 1st line therapy Oral erectogenic agents e.g. Viagra and new medications in clinical trials Vardenafil & Cialis Vacuum devices Couples/sexual therapy

. 2nd line therapy (Local treatments) Intraurethral alprostadil Intracavernosal self injections

. 3rd line therapy (Surgery) Penile prosthesis

Finally, the general public as well as physicians must be made aware that at the beginning of the third millennium, Impotence might be the first disorder that could almost always be reversed by proper treatment.