Please excuse the flippant title. Impotence is a very real and distressing disorder for many men, and even effective medications like sildenafil (Viagra®) aren't always a satisfactory solution.

A paper was given at the 10th Congress of the European Society for Sexual Medicine by a UK physician that is relevant to the problem. A questionnaire was constructed, its design based on data from 20 men taking oral anti-impotence medication. It was then administered to 630 men with ED.

As many as one third of men with erectile dysfunction (ED) failed to perform adequately after their first tablet of Viagra, Cialis®, or Levitra® (all sildenafil-like medications); of these men, a third failed to return to their family doctor for further treatment. When the pills didn't work first time, 68% of the failures reported 'loss of self-esteem', 58% felt their confidence was affected, and 32% were depressed; 24% thought they could never be treated satisfactorily, and 77% worried their ED was permanent.

It's pretty clear that there was inadequate communication between the patient and his doctor, right from the beginning. This requires a readiness for the patient to talk about his problem openly, and the doctor spending time explaining the particular medication - its appropriate use, dose, time required for a fair trial, and so on. Open discussion between doctor and patient should result in trust and a willingness to meet again to explore other possibilities in the event of an initial failure. By 'try, try, try again' I meant the need to consider and try other treatment modalities.