Viagra can put a rocket in your pocket after years of impotence, but there's no guarantee that you'll resume an active sex life, according to a French survey.

The survey, conducted by doctors at the Cochin Hospital in Paris, found that nearly one in five impotent men successfully treated for their condition still did not have sex with their partners once their equipment was back in working order. Women sometimes refuse to have sex with their partners after treatment, the survey showed, because they feel the renewed sexual urges are fueled by the drugs instead of good old-fashioned lust.

Dr. Sylvian Mimoun, head of the fertility unit at Cochin Hospital, said at a press conference, "The woman may attribute the return of post-treatment erections to chemical substances rather than to the man's desire for her, and may refuse sexual relations." Mimoun said that a woman needs to be involved with the entire consultation and treatment process, or she might not respond when her partner's flame is rekindled.

The survey results, presented during the World Health Organization's first conference on erectile dysfunction (ED) last week in Paris, found that 91 percent of the 50 men included in the survey responded to anti-impotence treatments including Viagra. But 17 percent of those men did not resume sexual relations with their partners -- even after they got their mojo back.

According to the American Foundation for Urologic Disease, an estimated 20 million men in the United States suffer from ED. Since Viagra's launch two years ago, more than 6 million of those men have lined up to take the drug.

So, are American men having the same problem jump-starting their sex lives, despite Viagra?

Dr. James Barada, a urologist at Upstate Urology in Albany, N.Y., says, "Yes. I'd say about a quarter of patients have a response to Viagra but stop using it for precisely that reason -- relationship discord."

Barada served on the American Urologoical Association (AUA) panel that developed guidelines for treating ED. He recommends medication combined with sexual counseling to put treatment in perspective. "In my practice we actively involve the couples; we bring the partners in. ED is not an individual's disease. It's a couple's disease. It's something physical, but it also has a psychological aspect."

Dr. Helen Friedman, a clinical psychologist in St. Louis, agrees: "The biggest sex organ is between the ears," she says. "I've worked with men who take Viagra, and it's not like suddenly their sex life is back to normal. There are psychological issues to deal with."

Friedman says that women who give Viagra all the credit for their partners' boost in desire are missing the point. "If the guy's not turned on, he can take all the Viagra he wants but nothing's going to happen. If the natural desire's not there, it's not going to happen."

As Barada says, "Good erections do not fix bad relationships. Sex therapy doesn't always take place in the doctor's office -- it takes place between the sheets."

So Friedman has a final bit of advice for those couples struggling with a post-Viagra crisis. "Achieve your goal by any means possible," she says. "Live your life fully. If it takes Viagra to do that, thank heaven there is Viagra. Women with a healthy attitude toward sexuality will say, 'Great! It's working! Let's go!'"