I've been treating ED since the 1980's. At that time ED treatment involved counseling, vacuum devices, and papaverine. In the early 1990's alprostadil became available for ED. This is very effective medicine for most men, but does have side effects. In the late 1990's, PD5 inhibitors (Viagra, Cialis) revolutionized ED treatment. PD5 inhibitors aren't always effective, and the side effects can be troublesome. In those instances mixtures of papaverine, alprostadil, and phentolamine have a place.
