A great deal of progress has been made in the pharmacological treatment of ED. Modern treatment of ED
has been revolutionized by the worldwide availability of the three PDE5 inhibitors (sildenafil, tadalafil,
vardenafil) for oral use, which are associated with high efficacy and safety rates, even in difficult-to-treat
populations (e.g. diabetes mellitus, radical prostatectomy). Patients should be encouraged to try all three
PDE5 inhibitors and to develop their own opinions. They will choose the compound perceived by them to
have the best efficacy, as well as considering other features such as time of onset, duration of action,
window of opportunity and their own individual experience with side-effects.
Treatment options for patients not responding to oral drugs (or contraindicated) include
intracavernous injections, intraurethral alprostadil, vacuum constriction devices and implantation of penile
prosthesis.
It must be emphasized that the physician should warn the patient that sexual intercourse is
considered to be a vigorous physical activity, which increases heart rate as well as cardiac work.
Physicians should assess the cardiac fitness of patients prior to treating ED.
Any successful pharmacological treatment for erectile failure demands a degree of integrity of the
penile mechanisms of erection. Further studies of individual agents and synergistic activity of available
substances are underway. The search for the ideal pharmacological therapy for erectile failure aims at
fulfilling the following characteristics: good efficacy, easy administration, freedom from toxicity and sideeffects,
with a rapid onset and a possible long-acting effect.