Summary
The medical treatment of erectile dysfunction includes the systemic (oral, epidermal, intramuscular) as well as the local (intracavernosal, intraurethral) application of pharma cological agents. Up to now only yohimbine, a well-known alpha-receptor blocking agent, and sildenafil, a newly introduced phosphodiesterase V inhibitor with predominant peripheral action, have been approved and listed in Germany. Other oral agents under investigation are trazodone and apomorphine (central action) as well as phentolamine (peripheral action). For the small group of patients with an established testosterone deficit, the epidermal or intramuscular substitution of testosterone seems to be a reasonable alternative to other therapeutic options. For the local application of pharmacological agents, intracavernosal injection therapy and intraurethral application (“medicated urethral system for erection”, MUSE) are available. Currently, several promising pharmacological agents with different modes of action and routes of administration are under investigation. The ultimate goal of these basic and clinical research efforts is to develop a specific and “tailored” therapy for each individual patient. While the pharmacological therapy of erectile dysfunction will most likely continue to be the therapeutic standard for most patients, it will certainly be augmented by devices (i. e. vacuum erection devices, “functional electromyostimulation of the corpus cavernosum”, FEMCC) and surgical treatment options (vascular and prosthetic surgery).