This article looks at the current treatment of impotence and recent developments in the pharmacological treatment of erectile dysfunction. Sildenafil (Viagra) threatens to become the most costly drug treatment within the NHS, but its value may be overestimated and its effectiveness under-researched. This oral treatment has received a lot of recent press attention and is perhaps overshadowing the value of established treatment regimens. Pharmacological treatment may also fail to tackle the important psychological problems often associated with this distressing condition.