The Serendipitous Story of Sildenafil: An Unexpected Oral Therapy for Erectile Dysfunction

Sex Med Rev. 2019 Jan;7(1):115-128. doi: 10.1016/j.sxmr.2018.06.005. Epub 2018 Oct 6.


Introduction: The serendipitous discovery of sildenafil (Viagra [sildenafil citrate]) as a treatment for erectile dysfunction (ED) is one of the most fascinating drug development stories of our time. When sildenafil was approved by the U.S. Food and Drug Administration in 1998, it revolutionized the treatment protocol for men with ED, once considered a psychological issue or an inevitable part of aging.

Aim: To review the discovery of sildenafil and its role in changing the field of sexual medicine in the context of the epidemiology and history of treatment for ED.

Methods: For this narrative review, a literature search was conducted to identify essential articles and was supplemented by author observations from a historical perspective.

Main outcome measure: A broad overview of ED and its past, current, and future treatments.

Results: ED is a prevalent condition for which medical treatment had been limited to genitally localized interventions, including surgery, vacuum pumps, injectable therapies, and intraurethral suppositories. The discovery of sildenafil provided a safe, oral pharmacotherapy for the treatment of ED, sparking greater understanding of the science behind ED and its role in men's overall health.

Conclusion: The approval of sildenafil initiated a global conversation about ED that had profound implications for patients, methods of clinical practice, and academic sexual medicine. These changes will catalyze continued advances in ED treatment. Goldstein I, Burnett AL, Rosen RC, et al. The serendipitous story of sildenafil: an unexpected oral therapy for erectile dysfunction. Sex Med Rev 2019;7:115-128.

Keywords: Clinical Trials; Erectile Dysfunction; Impotence; Nitric Oxide; Sildenafil.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Coitus / psychology
  • Drug Development*
  • Erectile Dysfunction / drug therapy*
  • Erectile Dysfunction / physiopathology
  • Erectile Dysfunction / psychology
  • Humans
  • Male
  • Phosphodiesterase Inhibitors / pharmacology
  • Phosphodiesterase Inhibitors / therapeutic use*
  • Quality of Life
  • Sildenafil Citrate / pharmacology
  • Sildenafil Citrate / therapeutic use*
  • Treatment Outcome


  • Phosphodiesterase Inhibitors
  • Sildenafil Citrate