During a recent powwow with some girlfriends over a few pints of liquid truth, I discovered that each of us has had at least one sexual experience in our life that we wish we could forget or, at the very least, remember a little bit differently. I refer to my first unforgettably forgettable sexcapade as Tom. Mutual friends introduced us when I was twenty-three (eight years ago), and just out of my first long-term relationship. Until our first sleepover, it had been my experience, as naïve as it may sound, that sex pretty much happened the way it did in the movies minus the music and the lighting. Yep, short of an ex-boyfriend or roommate storming in unannounced, the only other sexual roadblocks I had actually tried to mentally prepare myself for, were the What ifs of getting involved with a God-fearing abstinent type. And since I had never really hung out with Baptists, Mormons, or devout Catholics, it was pretty much a non-issue.

Wikipedia.org defines Erectile Dysfunction (ED) or impotence as, "a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation." Studies suggest that about 18 million Americans between the ages of 40 and 70, have male impotence to some degree. Throughout the United States, it affects a total of around 30 million men over a broader age range, and 100 million men worldwide. According to WebMd.com, "common causes of ED include diseases that affect blood flow, such as atherosclerosis (hardening of the arteries); nerve diseases, psychological factors, such as stress, depression, and performance anxiety; and injury to the penis. Chronic illness, certain medications and a condition called Peyronie's disease (scar tissue in the penis) can also cause ED."

In retrospect, I had a sinking feeling that Tom was withholding some pertinent information pretty early on in our relationship. In fear of being too graphic, I'll just say that even before our clothes hit the floor, I never got the sense that he was fully aroused even when, based on my prior sexual experiences, he should have been. Clue number two: the first time we attempted actual intercourse, his penis was as flaccid as rain-soaked road kill.

"Guess I just drank too much," he said, turning his back to my face in one swift roll. "It happens."

I accepted that answer the first, second, even the tenth time Tom said it. After that, I started to take it personally. Could it be me? Am I doing something wrong? I thought to myself. Weeks later, I finally pushed the subject. Tom not only confessed to having a history of severe depression, but also acknowledged taking Lithium as treatment for bipolar disorder. He went on to explain that impotence is a common side effect of the drug. Although I was angry he hadn't told me sooner, the new information did not scare me away. To this day I am certain that, ED aside, I would have stayed with him had that been the only secret not yet revealed. In the same conversation, however, Tom also admitted to having genital herpes (thankfully, I am still herpes free), and - the real kicker here - to still being legally married to a woman he hadn't seen in years. Oh yes, strike one and two I could have lived with. Strike three... not so much.

Erectile Dysfunction - when not talked about - has a similar affect on women as it does on the men living with it. Regardless of the cause, physiological or psychological, I believe that both education and communication have the power to minimize feelings of inadequacy that often plague both partners in a relationship dealing with the issue. My advice to men of any age experiencing symptoms: talk to your doctor. Although there are no formal tests to diagnose ED, he/she may suggest a blood test to exclude underlying diseases that may be the cause. They may also advise one of the following clinical tests: duplex ultrasound, penile nerves function, nocturnal penile tumescence (NPT), penile biothesiometry, penile angiogram, dynamic infusion cavernosometry, corpus cavernosometry, digital subtration angiography, or magnetic resonance angiography (MRA).

Wikipedia.org also states that in many cases ED can, "be treated by drugs taken orally, injected, or as penile suppositories. These drugs increase the efficacy of NO, which dilates the blood vessels of corpora cavernosa. When oral drugs or suppositories fail, injections (e.g. of apomorphine) into the erectile tissue of the penile shaft may work." In the event pharmacological methods fail, penile pumps and implants are also available.

The three drugs currently approved by the FDA for treatment of Erectile Dysfunction are Viagra, Levitra, and Cialis. As reported by the National Kidney and Urologic Diseases Information Clearinghouse, "all three belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide (NO), a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow."

Viagra is the number one doctor-prescribed erectile dysfunction therapy, and was a approved by the FDA in 1998. According to their website, Viagra helps most men with ED achieve and maintain an erection, can work in as little as 14 minutes, works for men who "have a wide range of health issues," and has a proven safety record. It is also covered by a majority of national health care plans. "The most common side effects of Viagra are headache, facial flushing, and upset stomach. Less commonly, bluish vision, blurred vision, or sensitivity to light may briefly occur."

Levitra (vardenafil) and Cialis (tadalafil) were both approved by the Food and Drug Administration in 2003. All three medications are sold by prescription only. According to WebMd.com, Viagra lasts approximately 4 hours, Levitra lasts around 5 hours, and Cialis can last up to 36 hours in some cases. Because all three work the same way, it's unlikely that you'll have success with one if you didn't have success with another. People with uncontrolled high or low blood pressure or those who suffer from a heart condition, should discuss other options with their doctor. Side effects for all three include headache, upset stomach, flushing (feeling warm), nasal congestion, and changes in vision. Back pain is another possible side effect of Cialis.

If you are suffering from Erectile Dysfunction, talk to your doctor about finding the treatment option that's best for you. And, most important, talk to your partner.