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Recent advances in knowledge of the pharmacology, mechanism and hemodynamics of erection, and the introduction of intracavernous injection have revolutionized our understanding of erectile dysfunction and the approaches to correction. A better appreciation of the basic mechanism of erection and of the rationale, indications, precautions and complications of intracavernous injection is crucial for successful management. Based on our 5 years of experimental studies and our clinical experience in more than 650 patients, we briefly discuss the mechanism and pharmacology of erection, and summarize a practical approach to pharmacological diagnosis and treatment of erectile dysfunction.