From the medical point of view erectile dysfunction (ED) is accepted as a disease. However, there is a difference between the medical definition and the definition used by the official health insurance companies. This means that these health insurance companies have sometimes refused payment to the urologists for work done in the diagnosis and treatment of ED, especially in elderly men. Studies on the sexual behavior of elderly men show that 53-80% of men older than 75 years are still interested in sex and that 26% of this group have intercourse several times a month. Therefore, no one can say that sexual interest and activity decrease in elderly men to the point of complete inactivity. For this reason, the basic principle of maintaining the health of the individual is just as applicable in this case as it is in elderly people who are hard-of-hearing or who have weak eyesight. Thus, the diagnosis and therapy of ED must, strictly speaking, be considered a medical service that is recognized and paid for by the official health insurance companies. The substances used have not been licensed for this indication by the German BGA (German equivalent of the FDA), but this does not influence the possibility of prescribing them. Generally speaking papaverine, papaverine/phentolamine and prostaglandin E1 can be prescribed. In our opinion, prostaglandin E1 is to be preferred.