With the 1998 introduction of sildenafil (Viagra), the first available oral phosphodiesterase inhibitor, there has been an increased interest in the treatment of erectile dysfunction (ED), the most common sexual dysfunction of males. Most experts estimate that 25 to 30 million men in the United States experience erectile dysfunction[1]. The incidence of erectile dysfunction increases with age such that 52% of all men at some time can expect to experience dysfunction. Successful treatment of ED has included individual psychotherapy, couples therapy, and cognitive behavioral therapy, among other modalities. More recently, the authors have reported a Collaborative Model which involves both psychiatric consultation with a psychiatrist experienced in sex therapy and a urologic consultation to insure not only a comprehensive psychosexual history but a full physical assessment to establish whether or not organic so-called risk factors are contributing to the etiology of the ED[2,3,4]. One author has also developed a specific Cognitive Group Therapy Model for addressing intimacy, erectile dysfunction, and the integration of the use of a phosphodiesterase inhibitor in the treatment armamentarium[5,6].

Viagra, a type of 5 phosphodiesterase inhibitor, temporarily inhibits the breakdown of cyclic GMP which results in prolonged relaxation of corpus cavernous smooth muscle and the maintenance of an erection. Phosphodiesterase type 5 is an enzyme thought to be primarily found in PDES has been described in the clitoris, vagina, platelets, the esophagus gastric muscles, and in some skeletal muscles[9,10]. In the experience of the authors, for selected patients, the efficacy of concurrent sex therapy with the prescribing of Viagra has been nearly 100% in terms of self-rated satisfaction and self-rated grades of erection[9]. The authors postulate that there would be significantly more patient satisfaction with concurrent sex therapy.

The purpose of this study is to examine the efficacy of a phosphodiesterase inhibitor for the treatment of ED in the absence of even brief, 25-35 min, ongoing sex therapy in patients with multiple risk factors for organic based ED.

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