Milton M. Lakin MD’s scientific contributions

Before the early 1970s, impotence was almost always considered to be the result of psychological causes, and its treatment usually consisted of empiric testosterone administration or referral to a psychiatrist (1). Three sentinel events mark the modern history of impotence treatment. These include the invention of the inflatable penile prosthesis in 1973 (2), the introduction of penile injection therapy in the early 1980s (3,4), and the launch of the first significantly effective systemic agent, sildenafil citrate, in 1998 (5). The first two of these sentinel events established urologists as the primary caregivers for men with impotence; however, since 1998, the availability of effective systemic therapy has shifted the focus for the initial treatment of this disorder away from the urologist and toward the primary care physician (PCP). Indeed, according to Pfizer, Inc, the manufacturers of sildenafil citrate, PCPs write more than 60% of the prescriptions for this medication (data on file; Pfizer, Inc., New York, NY).

Erectile dysfunction (ED), the inability of a man to achieve and maintain an erection, is often classified as psychogenic, organic, or mixed. Although ED can exist for only psychogenic reasons, organic ED is almost always associated with some degree of psychogenic dysfunction; thus, nonpsychogenic ED is actually mixed. In the past, when the principal treatment for ED was penile prosthesis implantation, the distinction between psychogenic and organic or mixed ED was of considerable importance. Since many of today’s treatment options are nonsurgical, this distinction is less critical. For men who are contemplating surgical treatment, such as penile prosthesis implantation, however, it is still desirable to exclude temporary or potentially reversible forms of erectile impairment, such as psychogenic ED. Erectile dysfunction must also be distinguished from other sexual disorders, such as decreased libido, premature or retarded ejaculation, painful erections or orgasm, and erectile deformity. Of course, any of these disorders may coexist.