Combining the MMAS data with Census Bureau projections would mean that twenty-five million U.S. men will suffer with erectile dysfunction by 2005. Overall, 50 percent had some degree of erectile dysfunction; 10 percent had total loss of erectile function; 25 percent had moderate erectile dysfunction; and 17 percent had mild erectile dysfunction problems. For example, the Massachusetts Male Aging Study (MMAS) was a community-based survey of thirteen hundred men aged forty to seventy from 1987 to 1989. Studies in the United States reveal that erectile dysfunction occurs in 5 percent of men at age forty and increases to 15-25 percent by age sixty-five, although impotence is not an inevitable and untreatable result of aging. However, erectile dysfunction profoundly affects quality of life and is frequently associated with loss of self-esteem, poor self-image, depression, and increased tension with one's sexual partner. For today's busy primary care physician, it takes no longer to write a prescription for Cialis, for example, than to write one for other commonly treated problems such as high blood pressure or upper respiratory infections. Now that we have an effective oral medication, Cialis, that can be prescribed by the primary care physician, hopefully they will be more inclined to ask patients about their sexual history.

In addition, many health care providers have been reluctant to ask detailed questions about sexual history and sexual function, partly because they may have been misinformed or poorly informed regarding the availability of treatment. For the male patient it has always been an important but very difficult step for them to admit that they have this problem and to seek professional help from their primary physician or their urologist. This may actually be a low estimate because many patients in the past have been reluctant to tell their primary care physician that they were having difficulty with erectile dysfunction. This is also the case for the estimated twenty million men in the United States who complain of some degree of erectile dysfunction. From the above definition of erectile dysfunction, and from my experience over the past twenty years of treating these problems, I have seen a range of erectile dysfunction that stretches all the way from the patient who can never initiate an erection to the patient who occasionally is unable to maintain an erection quite as long as he would like.