Intracavernosal pharmacotherapy forms the corner-stone for the current management of erectile dysfuntion. Prostaglandin E1 is the primary drug of choice. Polypharmacotherapy is associated with a success rate of 85–90%. However, the early drop-out rate from most pharmacologie erection programs is nearly 50%. The major cause of patients dropping out is related to dissatisfaction with or fear of needle injection. Improved non-injectable delivery systems, such as topical or intra-urethral drugs, and more physiologic pharmaceutical agents will form the critical area of future development.