Erectile Dysfunction Medication Research

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Erectile Dysfunction Medications - Costs and Effects of Those Costs

Reasons why the costs of brand-name erectile dysfunction (ED) medications are so expensive include the fact that insurance companies are increasingly not covering the medications, there is a lack of price transparency, and the "evergreening" patent process keeps drug prices high. Men who cannot afford brand-name ED medications often turn to the Internet for cheaper alternatives such as fake Viagra, generic ED medications, and herbal supplements.

Insurance Does Not Cover ED Medications

  • In many cases, ED medications are expensive because Medicare and many private insurers do not cover them.
  • Unless ED drugs are used to treat a different condition approved by the FDA, Medicare Part D, which is the prescription component of Medicare, does not cover them.
  • As an example, Medicare may approve the use of sildenafil (generic Viagra) for the treatment of pulmonary arterial hypertension, but it would not be covered to treat erectile dysfunction.
  • Private insurers often follow Medicare guidelines in what they will cover and in the case of ED medications, they have reasoned that "drugs to treat sexual dysfunction are lifestyle-related rather than medically necessary."
  • ED medications can cost hundreds of dollars per month, which is often unaffordable for Americans, particularly older people who are on fixed incomes. As an illustration, 10 pills of 50 mg Viagra can cost as much as $600 and even eight Vagifem pills can reach over $200.
  • Even generic versions of ED medications can be expensive, especially if insurance does not cover any portion of the cost.

Lack of Price Transparency

  • The cost of ED medications does not follow normal economic patterns in that typically, when competition is introduced to the market, the price of the original goes down.
  • Instead, with ED medications, when one company raises its prices, other companies are following suit, making the drugs more expensive across the board rather than driving costs down.
  • A major reason for this is that insurance coverage masks the true cost of the drugs so people do not realize how much they really are.
  • As stated in the Houston Chronicle, "When copays are fixed, consumers have no incentive to use less expensive drugs, and manufacturers cannot gain market share by charging less... Simply stated, when patients use insurance to pay for drugs, prices go up."
  • Therefore, even when insurance covers part of or the full cost of a specific ED medication, patients are only exposed to their portion of the cost, which only changes if their insurance plan changes. They do not notice price increases, nor do they care if they increase unless they lose insurance coverage.
  • According to the Houston Chronicle, a solution to this problem would be to buy prescription drugs directly from pharmacies. When consumers have to pay the full amount for drugs, they become more discerning and will likely purchase less expensive alternatives.

Patent Expiration

  • According to Eli Lilly, manufacturer of the ED medication, Cialis, drugmakers tend to raise the price of their medications as a patent becomes close to expiration.
  • A spokesman for Eli Lilly stated, when medications go off-patent, as with Cialis, drug manufacturers often increase the price to "reflect both the limited time of patent life when an innovator can receive a fair return for their significant R&D costs, as well as the much longer time a generic is available at a dramatically lower cost."
  • However, the U.S. drug patent system can allow manufacturers to extend their patent exclusivity protections in a process called "evergreening," which means the drugs remain expensive well past the original patent expiration date.
  • A study found that 80% of the 100 best-selling drugs in the U.S. "extended their exclusivity protections at least once, and 50% extended their patents more than once."
  • The patent system creates a monopoly during the protection period and "in the absence of genuine competition in the U.S. prescription drug market, monopolies are yielding reckless pricing schemes and prohibitively expensive drugs for Americans."


  • When men are unable to afford brand-name erectile dysfunction medications, they often turn to the Internet to buy similar products online.
  • Even in the UK, where sildenafil is available over-the-counter for about £4 per pill, men still want a deal and would rather pay for a cheaper online version, which can cost as little as £1 per pill.
  • According to the Daily Mail, "The black market in fake or unlicensed erectile dysfunction pills has soared in the UK in recent years," which indicates that even though access to ED medication is no longer a problem, the cost still is.
  • The situation is no different in the U.S., as Dr. Damon E. Davis, a urologist at Mercy Medical Center, notes, "Despite the medications being on the market for over a decade, the costs have not decreased significantly... Additionally, insurances are increasingly refusing coverage for medications to treat erectile dysfunction. The financial burden this places on patients who are sometimes desperate makes it no surprise that some look toward cheaper, illicit sources."
  • New startups such as Hims and Roman Health Medical are marketing themselves as an alternative to big pharmaceuticals, but even their costs are marked up. For instance, Hims charges $3 per 20 mg sildenafil pill and Roman charges $2 per pill. However, the cost to pharmacies is $0.15 per pill.
  • Patients who turn to these startups "may not realize they could have gotten better deals" by using discount programs or coupons."
  • Additionally, Hims and other startups are targeting the "same older customers that the brand-name pharmaceutical companies once sought," which means more men who have trouble getting insurance to cover ED medications may turn to these companies because of advertising.
  • Direct-to-consumer companies like Hims and Roman Health Medical are "leading to an increase in purchasing medications online," so much so that even Pfizer, the manufacturer of Viagra and a generic form offers consumers the ability to purchase these medications directly from its website.
  • Men also turn to generics when they are unable to afford brand-name ED medications.
  • Between December 1, 2018 and January 31, 2019, 65% of ED medication prescriptions filled on GoodRx were for Viagra or its generic version. Of the prescriptions for Viagra or its generic, 90% were for the generic and just 10% were for the brand-name.
  • According to Tori Marsh, data and content manager at GoodRx, "The data can’t explain the reason behind why people take the generic over the brand, or vice versa... but since generic Viagra is more affordable than the brand it’s likely that cost is a factor here."
  • Moreover, if insurance companies are going to cover ED medications at all, they will likely require the generic version be prescribed rather than the brand-name to help hold down costs.
  • Non-prescription, herbal supplements are also an alternative to brand-name ED medications, which may also be less expensive since they do not require a doctor's visit to obtain.
  • Dr. Daniel Shoskes, a urologist at the Cleveland Clinic, stated that his male patients "ask him about so-called herbal supplements all the time," but he warns them that "self-medicating erectile dysfunction is not a good approach."
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Erectile Dysfunction Medications - Generic Medications

Four generic medications for erectile dysfunction that are ineffective and can cause side effects are vardenafil, Viotren, New Stiff Nights Platinum 10K, and Vimax. One is an authorized generic and requires a prescription (vardenafil), but the other three are regular generics that can be purchased without a prescription.


  • Vardenafil is an authorized generic that requires a prescription in the United States. It is the generic version of Levitra and Staxyn.
  • According to WebMD, Vardenafil has the lowest rating for effectiveness out of all authorized generic erectile dysfunction medications at 2.86 out of 5.00.
  • Potential side effects of vardenafil include vision problems, dizziness, headaches, stuffy nose, permanent blindness (rare), loss of hearing (rare), irregular heartbeat, seizures, temporary memory loss, allergic reactions, and trouble breathing.

New Stiff Nights Platinum 10K

  • New Stiff Nights Platinum 10K is a regular generic drug that can be obtained without a prescription through third-party sellers on Amazon.
  • While most of the ingredients in Stiff Nights "help improve blood flow throughout the body including the genital area... they are not clinically proven to be effective or safe."
  • Even though there is a mix of reviews of this product, there is no proof that it is effective and in fact, some reviews say it "isn’t very effective or the product doesn’t work."
  • The FDA has advised people not to purchase New Stiff Nights Platinum 10K because it contains a hidden ingredient not disclosed on its label.
  • This ingredient is "sildenafil, the active ingredient in the FDA-approved prescription drug Viagra," which can dangerously lower blood pressure. This is especially dangerous for anyone taking nitrates for diabetes, high blood pressure, high cholesterol, or heart disease.
  • Other side effects of sildenafil can include warmness, redness, headaches, stuffy nose, stomach pain, nausea, diarrhea, memory issues, back pain, color blindness, loss of hearing, dizziness, and ringing in the ears.


  • Vimax is a regular generic drug that can be obtained without a prescription through Amazon and other retailers.
  • According to the Vimax advertisements, it is designed to increase sexual desire and stamina, improve sexual performance, improve sexual endurance, and result in improved sexual satisfaction.
  • However, there is "no independent scientific proof or clinical studies that assert the efficacy of this herbal formula."
  • In fact, there are many reviews that state Vimax is ineffective, including one who said, "I have been taking Vimax for about a 3 months now. I followed the recommended dosage of 1 pill per day... Today, after 3 months, my hair is much thinner. I went to the doctor, and he ran some blood tests. He said that my DHT levels have spiked way too much. I did not change anything else in my lifestyle aside from taking the Vimax pills. Male enhancement pills are supposed to boost free testosterone levels while inhibiting its conversion to DHT (or something like that, sorry if I got the terms wrong). Vimax fails to do so. So everyone, beware."
  • Another reviewer stated, "Like creams and other pills, this product has no effect."
  • Possible side effects of Vimax include a lower sex drive, allergic reactions, and, because of the undisclosed ingredient tadalafil, it could also cause blurred vision, chest pain, chills, confusion, dizziness, irregular heartbeat, hearing loss, nausea, nervousness, shortness of breath, and pain in various parts of the body (jaw, arms, back).


  • Viotren is a regular generic drug that can be obtained without a prescription from a variety of overseas sellers, typically in China.
  • The medication's manufacturers make "claims that are not supported by evidence," such as increasing testosterone levels in 72 hours, improving blood circulation, and enhanced "well-being, vitality, and sexual performance."
  • The main ingredient in Viotren is tongkat ali (Eurycoma longifolia), which has shown "convincing evidence" in treating male sexual disorders; however, "4 out of the 11 studies they reviewed found no effect."
  • The Natural Medicines Comprehensive Database rates Eurycoma longifolia possibly effective for male infertility and does not indicate it is effective for erectile dysfunction.
  • This organization also found that taking Eurycoma longifolia may increase testosterone after a month or more of use, but definitely not in 72 hours.
  • Moreover, this ingredient can "easily be contaminated with dangerous substances such as lead and mercury."
  • There are currently no testimonials as to the efficacy of Viotren and "two of the main ingredients are literally just regular black pepper."
  • Although the ingredients themselves do not appear to have any side effects, if the Eurycoma longifolia becomes contaminated with mercury, potential effects could include loss of peripheral vision, numbness around the mouth and in extremities, lack of coordination, impaired speech, impaired hearing, impaired movement, and muscle weakness.
  • If contaminated with lead, effects could include abdominal pain, headaches, fatigue, irritability, memory loss, and weakness.

Research Strategy

In an attempt to find generic erectile dysfunction medications that are both ineffective and have side effects, we began by research the authorized generic forms of erectile dysfunction drugs that require a prescription. We found that there are four authorized generics, which are avanafil, sildenafil, tadalafil, and vardenafil. Using the effectiveness ratings on WebMD, we discovered that all are highly rated for effectiveness except vardenafil. Therefore, we added vardenafil to the list. After that, we attempted to research medical and pharmaceutical sites like WebMD, Science Based Medicine, GoodRx, and for articles on ineffective erectile dysfunction medications. Unfortunately, we only found descriptions of regular generic erectile dysfunction drugs and some warnings from the FDA. We followed the FDA warnings to discover two that contain hidden ingredients that could pose a risk to users. These are New Stiff Nights Platinum 10K and Vimax. They have also been known to be ineffective, although the degree of efficacy is not completely known. As most regular generic drugs that can be purchased through various retailers without a prescription, these are not evaluated for efficacy through the FDA. Therefore, the degree to which they are effective is not available.

This strategy also found the fourth drug, viotren, which was reviewed by Science Based Medicine and found to be ineffective. Although the main ingredients do not have side effects, the article noted that they can easily be contaminated by mercury and lead, which could lead to serious medical conditions in some users. Without any additional products that indicate they are both ineffective and have side effects, we elected to include this generic medication because of the potential for side effects.
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Case Studies - Erectile Dysfunction Medication Examples

Two men who purchased unapproved generic Viagra off the Internet suffered severe side effects that impacted their vision. Details of these cases are below.

Case Study #1

  • A 31-year-old man who purchased a liquid version of sildenafil citrate, the generic version of Viagra, developed red-tinted version.
  • This was not an authorized generic, but instead one that has not been approved for the treatment of erectile dysfunction.
  • According to Pfizer director of media relations Steve Danehy, the man "purchased liquid sildenafil online, with no indication whether a prescription was provided, and then ingested an unspecified dosage."
  • After likely consuming more than the recommended dosage, the patient began to see a red tint to his vision and was ultimately diagnosed with persistent retinal toxicity.
  • Doctors who examined the man's eyes stated that he had "suffered microscopic injuries to [the] retina’s cones, which are the cells linked to color vision."
  • A year later, the man's vision has not returned to normal, despite discontinuing the medication.
  • While there is no mention that expense of a brand-name ED medication was the reason the man turned to the Internet to purchase generic Viagra, many men do so because they not only save on the cost of the drug itself, but on the cost of visiting the doctor to obtain a prescription.
  • Additionally, men often turn to online sources of generic ED medications because "over-the-counter drugs tend to be less expensive, so people can potentially take more."

Case Study #2

  • A man in his mid-50s consumed "between 7.5 and 30 times the recommended dose of sildenafil," the generic form of Viagra.
  • This was not an authorized generic, but instead the liquid form of sildenafil citrate that has not been approved for erectile dysfunction treatment.
  • Liquid sildenafil cannot be purchased through a regular pharmacy.
  • After consuming the entire bottle of liquid sildenafil, the man immediately experienced "debilitating night blindness, photophobia, and central doughnut-shaped field defects in both eyes."
  • This means that he was unable to see in low light and became overly sensitive to any amount of light at all. He also saw spots in the center of his field of vision.
  • While the man's inability to see in low light and sensitivity to light improved within a few days, he still saw spots for "at least two months until he actually went to the doctor."
  • When doctors examined his eyes, they noted that rings of color were visible in and around his retinas.
  • It is unknown whether the man fully recovered because he did not return for a follow-up exam.
  • There is no mention of whether the expensive nature of brand name erectile dysfunction medication was a factor in this man purchasing generic Viagra from the Internet, but according to SingleCare, "in a world of online pharmaceuticals and expensive co-pays, counterfeit drugs are becoming a frightening reality for many Americans."
  • This indicates that men often turn to the Internet and generic Viagra due to expensive copays and high drug costs.

Research Strategy

To provide two case studies or examples of men who have had trouble affording brand-name erectile dysfunction (ED) medication and who have had issues from generic ED medication because of that, we started by searching medical research papers on databases such as ReaserchGate, NCBI, JSTOR, Hopkins Medicine, and others. Our thought was that medical researchers would want to understand why men turn to generic forms of ED medications if they potentially have dangerous side effects. We found numerous studies on erectile dysfunction medications, and even some case studies, but the case studies were all on brand-name ED medications. It appears that generic ED medications are so new that research has not yet caught up with their availability.

Then, we turned to reputable media sources such as Vice, Vox, Inverse, and others to identify men who had suffered side effects from generic forms of ED medications. Our idea here was to work backwards to see if men who had tried generic ED drugs and had side effects would state why they turned to generics in the first place. While we were successful in finding case studies of men who had suffered side effects from generic Viagra, neither of them provided the reason why men chose to try the generic rather than the brand.

Finally, we attempted to try to find negative reviews of generic ED medications from men who suffered side effects after trying a generic product with the hopes that they would mention the reason why they tried the generic form. We found ratings for generic Viagra on, but most of the negative reviews were for ineffectiveness rather than side effects. Other reviews were on product sites and were almost exclusively positive. Reviews on startup sites like Roman were skewed toward the positive as well. In addition, none mentioned cost as a reason for trying these products.

Since we were unable to find case studies or examples of men who turned to generic forms of ED medication and had side effects, we decided to present the two case studies we found on Inverse that showed the side effects suffered by two men who tried unapproved versions of generic Viagra. Then, we found evidence in other studies and articles that indicate men often turn to generic or counterfeit ED medications to save money or because their copays are too high. We assumed that the men in these studies may have been trying to avoid paying high costs for brand-name ED drugs, but unfortunately, that is only speculation. They may be other factors involved as well that are not mentioned in the studies. However, knowing that it is often human nature to seek out the lowest price for an item, we submit that price likely played a role in these men's purchases, even if it was so they could buy more of the drug than they otherwise would be able to afford.
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Erectile Dysfunction Medication - Statistics

Data confirms that more erectile dysfunction (ED) medications are purchased around the holidays, especially Christmas and Valentine's Day. Moreover, there is a spike in searches for ED medications after Valentine's Day, perhaps from frustrated men.

Valentine's Day

  • According to the Oxford Online Pharmacy in the UK, in 2017 and 2018, there was a spike in sales of medication to treat erectile dysfunction (ED) during the week of Valentine's Day.
  • Chief pharmacist and owner, Stuart Gale, indicated the increase during the Valentine's holiday is due to the "huge amount of expectation" that comes with the day.
  • Interestingly, Valentine's Day is also National Impotence Day in the UK, which means an increased amount of attention is on erectile dysfunction. This may lead men to think more about getting a prescription.
  • Researchers from The Independent Pharmacy found that Google searches for "Viagra" are more popular than searches for "red roses" during the week of Valentine's Day.
  • In the UK one, there were 34,920 searches for Viagra during February 2018.
  • This suggested to the researchers that "the public are concerned with impressing their partner sexually."
  • In 2018, the Viagra experienced its peak sales in February.
  • Additionally, Google searches for "buy Viagra online" spike the day after Valentine's Day, which may be in response to a disappointing Valentine's night.
  • In the weeks leading up to Valentine's Day in 2018, the International Andrology, a London-based men's health clinic, saw 300% increase in ED-related requests.


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Erectile Dysfunction Medication - How Women Feel About It

Women in the United States (and in other Western countries) often say the use of erectile dysfunction (ED) medications make them feel inadequate and pressured to have sex when they do not really want to. Moreover, there are concerns about ED medications causing trust issues in relationships and men to be unfaithful. Other issues include mismatched desires as men and women age, the lack of sexual spontaneity, and the disappointment when ED medications don't fix a relationship. On the other hand, some women have found that ED medications have saved their relationships because they remove the pressure to perform in the bedroom and can result in more foreplay. Furthermore, over half of all women think ED medications should be covered by insurance.

Women Feel Inadequate

  • Often, men believe that erectile dysfunction (ED) medication "solves a simple mechanical problem," but for women, these drugs can cause them to question if their partner is attracted to them anymore.
  • When one woman found out her husband had been taking Viagra, she said, "If he'd been having a problem, why didn't he tell me instead of going out and buying some pills? Does he need one from now on to feel turned on by me?"
  • Another woman in an online chatroom stated that she was shocked and struggling after discovering her husband had been taking an ED drug for two years without notifying her. She said, "I feel that what I thought was real wasn't after all. What else isn't he telling me?"
  • A third woman said, "My boyfriend can't have sex without Viagra. It's killing my self-esteem," and a fourth said, "[I] was cleaning the bedroom and found my husband's Viagra stash. He's 28. I'm insulted that he'd need that to have sex with me."
  • A 2008 Oprah Magazine survey found that 42% of women "object to chemically induced sex" because it is not the same as the "real thing."
  • ED drugs can lead a woman to think the man is only attracted to her because of the drug and not due to actual desire.

ED Drugs Can Pressure Women to Have Sex

  • Once a male takes an ED drug, a woman may feel pressure to have sex even if she doesn't want to because it would be a waste of money to have taken the pill for nothing.
  • Men sometimes don't feel that they need permission to take the medications, which can lead to arguments if a woman does not want to have sex.
  • Annie Potts, PhD, stated that many women reported feeling "compelled to have sex on demand," either due to the cost of the drug or because they did not want to disappoint their partner.

Women are Worried ED Medication Will Cause Partners to Stray

  • According to the NZHerald, since the introduction of ED drugs, there have been several "Viagra divorces" that women claim are the result of their husbands staying from their marriage after taking Viagra, which they say facilitates "late-life sexual adventures."
  • The possibility that men are using ED medication both inside and outside of a relationship is an "unfortunate side-effect of Viagra for women."
  • The Oprah Magazine survey found that 15% of women claimed that Viagra had "wrecked their relationship."
  • Additionally, 10% of respondents said that their partner had cheated on them for the first time after taking Viagra.

A Woman's Libido Goed Down With Age, but ED Drugs Cause Men's Libido to Increase

  • In 2018, fashion designer Diane von Furstenberg stated that Viagra was the "worst thing to happen to women" because it tricks nature into allowing men to continue to have a high libido even as they age. She said, "There was a certain fairness. A woman couldn’t have a child after 40, right? But the man could have a child until 65, but sexually after a while... Now, with Viagra... they just feel… I think Viagra is the worst thing."
  • Menopausal Women often experience pain with sex and are naturally less interested in sex as they age, but ED drugs help men have stronger libidos, causing a mismatch in desires.
  • Some women report feeling upset that an ED drug had "'disrupted' their sexual routines with their partners—or reintroduced activity they thought they were 'done' with."
  • The Oprah Magazine survey indicated that about a third of participating women were annoyed at their partner's "ability to have sex at the drop of a pill."

ED Medications Do Not Always Fix Relationships

  • Since ED medications are designed only to help the mechanical process of getting and obtaining an erection, they do not always solve emotional issues in a marriage, even though both men and women often think they will.
  • Therapist Christine Webber states: "Clearly, Viagra isn't a miracle cure — it deals with mechanics not emotions. It works on a symptom and it works very well, but it doesn't solve a troubled relationship or create a desire that isn't there."
  • In fact, nearly 25% of women surveyed by Oprah Magazine said they were less emotionally connected after their partner began taking Viagra.
  • ED medications are marketed as promising "eternal youth, sexual prowess and extreme virility," but tend to only shield men from the embarrassment of sexual dysfunction and "from behind this barrier, a man doesn’t have to reckon with the very feelings of vulnerability that, ironically, might help him grow his empathy and sensitivity, and connect more honestly and intimately with his partner."

Sex Cannot Be Spontaneous

  • Many ED medications, such as Viagra, take about an hour to take effect, sex often has to be planned, which can cause women to feel as if sex is more a duty than a pleasure.
  • As one woman stated about her partner who was taking a medication for erectile dysfunction, "If we wanted guaranteed sex then it had to be planned, so it was less spontaneous and felt fake."
  • However, for some women, this is a positive because a couple can take more time enjoying each other before the actual sexual act occurs.

Men Often Take Erectile Dysfunction Drugs Secretly

  • Due to the stigma surrounding erectile dysfunction, men don't always tell the women in their lives that they are taking medication.
  • This secrecy can cause trust issues within a relationship, as with the woman in the chatroom mentioned above.
  • Hiding ED drug use can cause women to become suspicious about their partner possibly having an affair.
  • A common statement that marriage counselors hear from women is, "My husband is taking Viagra without telling me, and it hurts."

Some Women Believe ED Medications Can Save a Relationship

  • Approximately half the women surveyed by the Oprah Magazine indicated that Viagra made their sex lives better and 17% said it "saved their marriage."
  • Many women who are satisfied with their partner's use of ED medication were included in the choice to take it, which can deepen emotional connections.
  • Some women even believe Ed drugs remove pressure from a sexual relationship because the man can stop worrying about his inability to perform and just enjoy the experience.
  • Overall, 53% of women believe ED medications should be covered by insurance.
  • There are women who encourage their partners to take ED medications so the ease the pressure to perform in the bedroom.
  • Many men become irritable or even despondent when they suffer from ED and some women believe that medication makes them happier and can lead to a stronger relationship.

Research Strategy

In our attempt to provide information, data and statistics that show and explain how women in the United States feel about erectile dysfunction drugs for the men in their lives, we first searched for formal studies on sites such as ResearchGate, NCBI, JSTOR, and others. The research we found was either very old (before 2005) or for different geographies that did not resemble U.S. demographics. As such, we looked for less formal surveys to see how women feel about ED medications. We thought these would still give us data, but would also provide more anecdotal information as well. We found some blogs and women's magazine articles that provided some quotes from U.S. women, but there wasn't enough to draw solid conclusions about women's attitudes toward ED medications. However, we did come across several articles from the UK and New Zealand that seemed to offer evidence that supported the quotes from U.S. women. During our examination of these articles, we found an old survey conducted by O Magazine that was still being used in 2019 publications. For this reason, we assumed that very few, if any, studies have been formally conducted on how U.S. women feel about their partners taking ED medications.

We set these UK and New Zealand articles aside and made one more attempt to search for solid recent U.S. data. To do this, we focused our attention on Viagra, which is the most well-known ED medication in the U.S. (and possibly the world). This allowed us to find addition quotes from U.S. women on their feelings toward Viagra that provided additional evidence that women in the UK and New Zealand have similar feelings toward ED medications as U.S. women. Therefore, we decided to use the UK and New Zealand information as a proxy for U.S. data, but we also provided anecdotal evidence of the validity of this proxy from U.S. women in the form of quotes. In addition, we also used the older data from the O Magazine survey as all indications are that women's attitudes toward ED drugs have not significantly changed in the intervening decade.