Intended for healthcare professionals

Bmj Usa Editorial

Pharmacologic treatment of erectile dysfunction

BMJ 2004; 329 doi: (Published 22 July 2004) Cite this as: BMJ 2004;329:E310
  1. Stephen B Levine (, clinical professor of psychiatry, co-director
  1. Case Western Reserve School of Medicine Cleveland, OH, Center for Marital and Sexual Health Beachwood, OH

    Not always a simple matter

    The phosphodiesterase-5 (PDE-5) inhibitors are remarkable designer drugs. Not only have they benefited countless men and couples all over the world—they have created optimism that other male and female sexual dysfunctions may someday be treatable pharmacologically. Optimism about prosexual drugs needs to be tempered by the awareness that all sexual behavior is the sum of psychological, interpersonal, cultural, and biological elements. Sex can seem like a simple matter, but it is not. As Tomlinson and Wright's study in this issue of BMJ USA (p 339) demonstrates, physicians and patients should not expect a panacea.

    Stripped to its psychological essence, potency requires a man to be willing to make love to his partner and to be able to experience arousal during sexual behavior. If he can feel this emotion and his neural, vascular, and endocrine systems are relatively intact, nitric oxide will be secreted in his corporal endothelial cells. This gas binds to an enzyme that generates cyclic guanosine monophosphate (cGMP), which in turn induces vasodilatation in overlaying smooth muscle cells. All PDE-5 inhibitors slow the degradation of cGMP by competitively binding to the enzyme that hydrolyzes it. …

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