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The realm of sexual dysfunction (SD), in particular erectile dysfunction (ED), has changed significantly over the past 20 years. ED was originally considered to be a nonorganic entity and, accordingly, much of the treatment by physicians was focussed on the psychosocial aspects of the patient and his partner. With increased focus on research in this area, there is now a better understanding of the pathophysiology of ED and effective treatments have been developed, including oral medications. As a result, there has been a paradigm shift from nonorganic roots to specific organic etiologies such as diabetes and atherosclerotic vessel disease.
A majority of health care providers completed their education before the release of the first phosphodiesterase 5 inhibitor, sildenafil. Has the change in our understanding of ED now led to attitude changes in our approach to the problem? Do we have a firm understanding of the impact of the role of oral agents, especially with the advent of newer and potentially more effective therapies?