ObjectiveTo present the pattern of self-report and diagnosis of erectile dysfunction in the US over the time period 1990 through 1998 and examine whether the introduction of sildenafil in March 1998 influenced these findings.Study design and methodsRetrospective database analysis. Data from the National Ambulatory Medical Care Survey (NAMCS) for the years 1990 through 1998 were used. Data from office-based physician-patient encounters for which either a complaint of erectile dysfunction as one of the reasons for requesting an encounter [National Center for Health Statistics (NCHS) code 1160.3] or a diagnosis of erectile dysfunction [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 302.72 or 607.84] was documented were extracted for men aged ≥40 years. National estimates per year were derived for:the number of office-based physician-patient encounters for which a complaint of erectile dysfunction was documented as a reason for requesting an encounter and the number of office-based physician-patient encounters for which a diagnosis of erectile dysfunction was documented;the rate per 1000 office-based physician-patient encounters for which a complaint of erectile dysfunction as a reason for requesting the encounter was documented and the rate per 1000 office-based physician-patient encounters for which a diagnosis of erectile dysfunction was documented; andthe rate per 1000 US male population aged ≥40 years with a complaint of erectile dysfunction as a reason for requesting an encounter and the rate per 1000 US male population aged ≥40 years with a diagnosis of erectile dysfunction.ResultsThe number of office-based physician-patient encounters for which a complaint of erectile dysfunction was documented increased from 764 682 in 1990 to 1 273 730 in 1998. The number of office-based physician-patient encounters with a recorded diagnosis of erectile dysfunction more than doubled over the time period examined, from 647 418 in 1990 to 1 495 793 in 1998. Office-based encounters for which a complaint of erectile dysfunction was documented as a reason for requesting an appointment increased from 5.7 per 1000 in 1990 to 7.0 per 1000 in 1998; the rate of diagnosis of erectile dysfunction increased from 4.8 per 1000 in 1990 to 8.2 per 1000 in 1998. The population-adjusted rate of complaint of erectile dysfunction increased from 17.5 per 1000 in 1990 to 24.2 per 1000 in 1998; the rate of diagnosis increased from 14.9 per 1000 in 1990 to 28.4 per 1000 in 1998. In 1998, 2 142 776 office-based physician-patient encounters documented the prescribing of sildenafil; of these, 41% were for patients with a recorded diagnosis of erectile dysfunction.ConclusionsThe introduction of sildenafil was found not to have influenced the established upward trend in the documented rate of self-report of erectile dysfunction or the diagnosis of erectile dysfunction. However, the prescribing of sildenafil appears to offer greater insight into the actual magnitude of the problem erectile dysfunction represents in the US. Findings suggest there is a reluctance on the part of patients to discuss concerns about erectile dysfunction with their physician and a reluctance on the part of physicians to document patients' expressed concerns regarding erectile dysfunction and/or to record a diagnosis of erectile dysfunction.