Foreword

Erectile dysfunction (ED) is a unique health problem, because it affects millions of men; there are many misperceptions surrounding it; and men and their partners are embarrassed to talk about it. The fact that millions of men suffer from ED has motivated doctors and scientists to conduct a great amount of medical research. Scientists have always been fascinated by the fact that the penis is the only organ in the body that can generate and sustain two extremes: very high pressure during erection (almost equivalent to the top pressure in the large arteries of the rest of the body), and very low pressure during flaccidity (almost equivalent to the low pressure in the veins of the rest of the body). Everyone knew, a long time ago, that this elaborate system achieved erection and flaccidity by opening (dilation) and closing (constriction) the blood vessels and small spaces inside the erectile tissue of the penis. Furthermore, it was also clear that nerves in the penis (which are ultimately connected to the brain) controlled these blood vessels by producing small amounts of "messenger-chemicals." Scientists call these messenger-chemicals "neurotransmitters." Many years of work by our laboratory led to our discovery that nitric oxide (NO) was the principal neurotransmitter responsible for penile erection. This breakthrough in the science of medicine has opened unprecedented new avenues of research, contributing to the development of new treatments for this problem.

My journey to the 1998 Nobel Prize in Medicine started on the East Coast at the College of Pharmacy at Columbia University in New York City, and settled on the West Coast in another great institution, the University of California at Los Angeles. I am very happy to see a fellow scientist from Columbia University, Dr. Ridwan Shabsigh, make the major effort of bringing the intricate science of ED to the large number of men and their partners in clear and reader-friendly language. His book, Back to Great Sex, empowers men concerned with ED with the two things they urgently need: up-to-date knowledge and effective communication skills. Louis J. Ignarro, Ph.D.

The 1998 winner of the Nobel Prize in Medicine Professor, Nitric Oxide Research Department of Molecular & Medical Pharmacology University of California, Los Angeles