«Should I prescribe medication for this infertile man? Will it be effective? For how long should he take it? Is there evidence that it will help? Anyway, there is nothing else I could do alternatively…..». These are common dilemmas for every Urologist. Likewise, there are similar thoughts for men with erectile dysfunction: “Why doesn’t the drug work?  Should I put him on another one? If the drug does work, should I change it just because of the headache side effect that is associated with the medication? Why is it that sometimes it works and other times it doesn’t? Why doesn’t it work any more, after such a long time that he had been enjoying sex?” Answers will be provided through small secrets that we have learnt from trials and the long clinical experience.