A total of 336 patients with organic impotence completed a testing protocol of penile vasoactive intracavernous pharmacotherapy (VIP) using papaverine hydrochloride (30 mg/ml) or a combination of papaverine (25 mg/ml) and phentolamine mesylate (0.83 mg/ml). Transient functional erections were achieved in 97.2% of patients with neurogenic impotence, 81.6% of those with vascular impotence, 90.7% of those with undetermined organic impotence, and 100% of patients with psychogenic and hormonal impotence. Of the responders, 273 elected to practice VIP as a method to restore erectile function and completed a training session on self- or partner-assisted injection. After an average follow-up of 9.2±6.7 months, 170 patients were still administering self-injections at home, 16 were lost to follow-up, and 87 discontinued the protocol. The average follow-up of patients actively practicing VIP was 11.6±6.5 months. Significant complications were few and included dizziness, sustained erections, and intracorporal hardening and fibrosis. Vasoactive intracavernous pharmacotherapy is a powerful tool in the management of impotence. Careful analysis of the risks and benefits and accurate definition of the long-term complications and their incidence are necessary to establish the role of VIP among other treatment options for impotence.