It is estimated that the annual sales of pills for sexual difficulty in men, known as erectile dysfunction (E.D.), amounts to about $3 billion per year. In the U.S. 25 million men are affected. By age 40-50 about 5 percent need help and this goes up to 25 percent of men in their 60's. The truth is that nearly every man occasionally has difficulty getting or keeping an effective erection. It is a myth that sexual activity is a hobby only of the young. In one survey 50 percent of men over 70 had intercourse once a week. The most commonly sold prescription medications for E.D. include Viagra, Levitra and Cialis. Until 1998, when Viagra came on the market, men who suffered from E.D. often became withdrawn and emotionally as well as physically unavailable to their partners. In 2003 the FDA approved Levitra and Cialis and this previously very embarrassing issue further began to change with more effective simple treatment becoming available. In spite of this a study in 2003 showed that 74 percent of men still were too embarrassed to discuss erectile dysfunction with their physician. Not all doctors are comfortable or knowledgeable enough in this area of medicine. Today, it is not unusual in my practice for men to eagerly seek help for E.D.