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It is difficult to believe that the availability of erectile dysfunction medication is just 22 years old, and the realisation of sildenafil’s effect is only just over 30 years old.

On 27th March 1998, the Food and Drugs Administration in the United States approved viagra for use for erectile dysfunction, and it is difficult to explain how much that changed everything.

Given that we live in a world after erectile dysfunction medication is more readily accessible to the point that you can order vardenafil online via prescription and can even get some ED medications over the counter, it is bizarre to think of a world before the blue pill.

The key to what made it and other ED medication successful was a matter of convenience.

Before And After Sildenafil

Most of the history of ED ‘medicine’ which consisted of a mix of dubious natural cures and outright quackery. From the talismans in Ancient Rome to John Brinkley’s mercury injections and goat gland implants, there were a lot of terrible fake treatments that had no effect.

The first successful erectile dysfunction treatments were either prosthetic surgeries which started to be effective in the mid-1960s, or penis pumps, which were invented in the early 1800s but only received FDA approval in a more advanced form in 1982.

Both treatments are still used to this day, albeit typically as treatments that are used if standard PDE5 inhibitors do not work or cannot be used due to side effects. However, they are not exactly convenient treatments

Surgery is a prosthetic treatment that is seen as a last resort, and penis pumps tend to be used in situations where medication was not an option. The latter was bulky and complicated, so a simpler solution was needed in most scenarios.

One step closer to modern ED treatments came in the form of penile injections, which are also still infrequently used, and were most famously showcased in the Brindley Lecture in which physiologist Giles Brindley dropped his trousers to show a chemically induced erection.

It was a step closer, but the way he had induced it was similar to the later PDE5 inhibitors, but in practice a penile injection needing to be applied every time a man wanted to have sex was far from convenient. Syringes need to be stored at precise temperatures and needles need to be sterilised.

When sildenafil started to make waves as a result of the unexpected results of clinical trials, there finally appeared to be a solution, one that was confirmed when the FDA approved it for treatment of erectile dysfunction.

Because it was a treatment that was more readily available, more convenient and would act quicker, it changed erectile dysfunction from a nebulous unknown problem into something diagnosable, and treatable, even if it was not always curable.

What doubtless helped this was the widespread marketing of viagra, most famously an advert featuring former senator Bob Dole, whose story about suffering from a condition that led to ED as a side effect and the bravery in talking about it opened up the conversation about ED.