[Sildenafil: hopeful or unreasonable?]

Due to its specific action on the intracavernous mechanism of erection, sildenafil is the first oral treatment for erectile dysfunction therefore much more effective than earlier oral therapies. Patient acceptance is greatly improved with the simple oral dose one hour before sexual activity, avoiding commonly observed dissatisfaction with intracavernal injections or vacuum devices: will its efficiency be the same? Treatment with nitrate derivatives for angina pectoris is the major contraindication. Global management, for the patient and his partner, remains essential for optimal efficacy of this new compound. Considering patient habits and medical prescriptions in France where use of anti-anxiety and anti-insomnia drugs is relatively high but use of vitamins and regenerating drugs relatively low, only the future will tell whether use of sildenafil will remain within 'reasonable' limits. No decision concerning reimbursement by the French Social Security health care scheme has been made to date.