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Those men who reported “unsatisfactory sexual performance” or who were “usually able to penetrate partner” were included in the “mild ED” category. Given these flexible definitions, of 1 290 men surveyed aged forty to seventy, 52% fell in the “mild, moderate, or complete erectile dysfunction” categories. This statistic, that half of men over forty experience ED, was published in the Journal of Urology and is now cited regularly by Pfizer in their promotional material. Based on these figures, Dr. Irwin Goldstein, a prominent urologist working as a consultant for Pfizer, estimated that the number of American males “impaired” by sexual dysfunction was thirty million, thereby creating a huge potential market for oral sildenafil (Loe, 1994). This finding also found its way onto Pfizer’s promotional materials which often state that “ED, to some degree, affects approximately 30 million males in the United States” (Pfizer Pharmaceutical Website, 2006). The incidence of the condition is known to increase with age, and estimates by other sources confirm that the number of American men with erectile dysfunction ranges from 10 to 20 million. Inclusion of individuals with partial erectile dysfunction increases the estimate to about 30 million (NIH Consensus Development Panel on Impotence, 1993; Feldman et al., 1994; Kinsey et al., 1948). A majority of these individuals are older than 65 years of age, with a prevalence of about 5% observed at age 40, increasing to 15-25% at age 65 and older (NIH Consensus Development Panel on Impotence, 1993). By supporting the development and promotion of the findings from the MMAS, Pfizer largely constructed erectile dysfunction in terms of ‘who has it’. In order to answer what erectile dysfunction actually is, the corporation decided to make the inability to get an erection solely that - a mechanical problem stripped of the important psychological and behavioral overtones which were once a crucial part of its definition. This was done largely through funding the creation of the International Index of Erectile Function (IIEF). The index is a subjective measure composed of 15 questions, focusing solely on penetration as a measure of sexual satisfaction. It is used extensively by Pfizer in publishing, including by Goldstein et al., who used two of itsquestions as the main measures of sildenafil efficacy in the first peer-reviewed article on sildenafil, which is also the most cited (Goldstein et al., 1998). Although the IIEF is often stated as a means of treatment analysis by researchers, upon closer examination of research methods, it becomes apparent that only selected questions from the IIEF are often used to evaluate subjects’ results. In theory, it is possible to publish only the results from questions which support one’s hypothesis, and not those from all fifteen. Perhaps presenting physical symptoms of erectile dysfunction does not mean that one is “suffering in silence” (Pfizer pamphlet, 2000). In their study evaluating the epidemiology of male sexuality in Germany, Braun and colleagues found that when treatment need was defined as the co-occurrence of erectile dysfunction along with dissatisfaction with one’s sex life, 6.9% of men were determined to be in need of erectile dysfunction treatment, which is significantly less than any estimated prevalence of the condition itself (2000). In a related study, Klotz et al. found that the need for erectile dysfunction treatment is modulated by numerous outside factors such as situational and partner-related reasons (2004). These findings may also hint as to why the abandonment rate of Viagra is relatively high. From Figure 1, it is evident that the term impotent remained more popular in the scientific literature until the late 1980s, after which the term erectile dysfunction gained popularity. From the figure, two trends are noted: first, the entire field of erectile function became more prevalent in the literature beginning in the late 1980s, and also, that with time, the term erectile dysfunction became far more common than the previously-used terms. The usage of the term erectile dysfunction in the literature grew exponentially in the 1990s, possibly due to the NIH Consensus Development Panel’s preference for the term, the MMAS study’s usage of the term, or Pfizer’s fondness for, and frequent employment of the term in sponsored research.

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