Approximately 90% of men who seek assistance for erectile dysfunction are treated with PDE-5s, all of which are reasonably safe. All are completely contraindicated with concomitant nitrate use; with some additional warnings and/or contraindications attached to use of alpha-blockers. Generally, PDE-5 inhibitors are highly effective, restoring erections in about 70% of men, yet there is a growing body of evidence suggesting that the frequently quoted 20–50% drop-out rate for medical treatments is true for PDE-5 treatment as well. Why? The adverse event profile is excellent for all three PDE-5s, with few patients terminating treatment, because of adverse events. Of course, not all discontinuation of sexual pharmaceuticals are due to failure or complications. There are some who tried the medications out of curiosity and never intended to continue using a PDE-5. There are some reported cases of men with psychogenic erectile dysfunction experiencing a "cure" after temporary use of a PDE-5.

Reciprocally, some people will discontinue PDE-5 because of the severity of their erectile dysfunction. For these individuals, the pharmaceuticals simply do not work. Regardless of the mode of administration, a certain percentage of the population will not experience restored capacity, because the degree of organicity is so 18 Perelman profound as to overwhelm the salutary effects of the drug. In particular, some diabetics and radical prostatectomy survivors may need more powerful medical treatments.

Importantly, PDE-5 treatments do have significant psychosocial limitations and consequences which have created "born-again" roles for sex therapists, albeit more complex and sophisticated ones. Previously, many presumed that high discontinuation rates were due to the objectionable nature a specific treatment, such as self-injecting the penis. They thought that the introduction of efficacious and safe oral agents would decrease this high drop-out rate. However, there is great complexity to the barriers to success story. Although definitely improving, the reported success rate, the ensuing publicity (following PDE-5 launches) still resulted in just a small percentage of people worldwide receiving pharmaceutical therapy. erectile dysfunction treatment, even with its juggernaut of publicity and advertising has penetrated ,15% of the estimated market place. In fact, industry information suggested that a geometrically small number of individuals were actually successfully treated and satisfied repeat "customers". Apparently, a limited number of men were treated and a large percentage of those who tried it, apparently discontinued rather abruptly. There was also a high relapse rate when medication was stopped. The model for all three PDE-5s, as well as ICI and IUI treatments for erectile dysfunction, was chronic pharmaceutical use in order to relieve symptoms. To date, very little was written about "weaning" patients from pharmaceuticals or effectively maintaining them on lower doses. Concepts of "weaning" and relapse prevention offer opportunities for MHPs.