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How is erectile dysfunction treated?

Dr. Jeanne Morrison, PhD
Family Practitioner

There are several treatment options that may be used for erectile dysfunction, depending on the cause of the condition. Sometimes, treating any underlying medical conditions may be enough to improve erectile dysfunction. This may include psychological counseling or other therapy to help improve anxiety or relationship issues that may be causing erectile dysfunction. In many cases, doctors may prescribe an oral medication, such as tadalafil, sildenafil, or vardenafil. These medications are taken about an hour before sexual activity, and they work by increasing blood flow to the penis. Other types of medication, such as alprostadil, may be injected into the penis using a very fine needle. Alprostadil may also be used as a suppository that's inserted into the urethra. If medications aren't right for you, devices such as penis pumps and constrictive devices may be used to fill the penis with blood and slow the rate at which blood flows out of the penis. In some cases, surgery to insert firm or inflatable rods in the penis may be used.

Dr. Madeleine M. Castellanos, MD
Psychiatrist (Therapist)
Treatment options for erectile dysfunction (ED) include:
  • Phosphodiesterase inhibitors: As an abundance of television and print ads make clear, oral medications can help treat ED. There are three medications: sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). All three belong to a class of drugs called phosphodiesterase inhibitors and work by enhancing the effects of nitric oxide, a chemical that a man's body produces to relax the muscles in his penis. ED drugs make it easier for a man to get and keep an erection. Although phosphodiesterase inhibitors aren't fool-proof, they appear to improve ED in about 65 to 70 percent of men who take them.
  • Alprostadil: This medication can be injected directly into the shaft of his penis. Although it's very effective -- about 90 percent of men experience erections from this process -- it can be painful and result in scar tissue. Alprostadil can also be inserted into the penis in the form of suppositories, which can cause pain, bleeding, dizziness, and scar tissue. Both forms of alprostadil work by increasing blood flow to the penis.
  • Testosterone: Patches, creams, or injections of testosterone may help encourage erections in men whose ED is caused by low levels of this hormone.
  • Penile implants: Penile implants have been around for 30 years and are still used successfully in men who don't respond to ED medications. They are surgically inserted into the spongy tissue of the penis, where they remain permanently. Implants can be semi-rigid or inflatable, with a corresponding device inserted into the scrotum to be used when a man wants to achieve an erection. They carry the general risks of surgery and usually need to be replaced after about 10 years. Studies show that 70 to 80 percent of men are satisfied with their penile implants, which makes them a useful option for men who can't take ED medications.
  • Penis pumps: A man places this hollow tube over his penis and uses either a hand- or battery-powered pump to create a vacuum that draws the blood into the penis, resulting in an erection. He then applies a constriction device (cock ring) at the base of his penis and removes the tube. Pumps and cock rings can be effective in the short-term but require a bit of learning curve for proper use and may cause pain, bruising, and difficulty ejaculating.
  • Counseling: If the cause of his erectile dysfunction (ED) is psychological in nature, seeing a sex counselor or sex therapist may help.

The treatment of erectile dysfunction should begin with the identification of other concomitant diseases. For example, high blood pressure, diabetes, and psychosexual disorders. If detected, they should be effectively addressed and treated.

Currently available treatments for erectile dysfunction include: oral medications (for example, Cialis, Levitra, Viagra), intra-urethral medication (for example, MUSE), intracavernosal vasoactive drugs (penile injections), vacuum constriction devices, and penile prosthesis (surgical implantation device).

Discuss treatment options with your healthcare provider. Treatments are usually applied in a stepwise fashion with risks, benefits and desired outcomes\results considered.   

There are several treatments available. In choosing a treatment, find the one that is most compatible with the needs and desires of both you and your partner.

  • Medications. There are several drugs available for treatment, and many men with diabetes have found them to be effective. Sildenafil and vardenafil can help stimulate and maintain an erection 30–60 minutes after taking a pill. Tadalafil is similar but lasts for up to 36 hours. Ask your provider about these drugs if ED is a problem for you. Some medications such as nitrates can be dangerous if taken with ED medications.
  • Penis Injection. Another option is to inject a form of the drug alprostadil directly into the penis. This induces an erection that lasts about 30 minutes to 1 hour. Side effects include bruising and prolonged erection. Some men also develop scarring in the penis, which occasionally results in a permanent curvature during erection.
  • Vacuum Pump. Another option uses a vacuum pump to create an erection. A cylinder is placed around the penis. A small vacuum pump pulls air out of the container, creating a vacuum. This causes blood to flow into the penis, triggering an erection. To maintain the erection, the container is removed and replaced with a constriction ring. Separate constriction rings and external support devices are also available.
  • Implant. You can also have a pump device with a penile prosthesis surgically implanted into your body to produce erections. Your best bet is to visit an urologist with experience if you are interested in this type of implant. Be sure to ask about the risks, which can include infection and the need for further surgery in case the device doesn’t work correctly.
  • Testosterone. Testosterone injections or patches can be prescribed if a low hormone level is the problem. The injections are usually given every 3–4 weeks. Men should not take testosterone unless they have abnormally low levels and have been evaluated for prostate cancer.
  • Psychotherapy. It may also help for you and your partner to work with a therapist who knows how to deal with sexual issues.

All of the treatments for ED have risks or drawbacks. You may decide to seek no treatment. Some men and their partners choose to express their sexuality in ways that do not involve intercourse. If you do want to consider treatment, you need to tell your provider, even if you are not asked about your sexual life. Your provider can only help you if you let him or her know about your concerns.

There are three treatment options for erectile dysfunction (ED):

  • Medication. Both oral and injectable medications are available for the treatment of ED. Some injectable and many oral medications help treat ED by improving blood flow to the penis. Other oral medications, such as testosterone replacement, help minimize ED caused by low testosterone, a fairly uncommon but highly treatable cause.
  • Devices. Pumps and implants can help restore erectile function in some men.
  • Surgery. Surgery is a last resort and not commonly performed to treat ED. If other treatments have not been effective, devices that help achieve erections can sometimes be surgically implanted. Also, vascular surgery can sometimes be done to repair damaged blood vessels interfering with blood flow to or from the penis.

Regardless of the cause, ED can be managed and treated. And it's in your best interest to do so. A healthy, satisfying sex life is good for you.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.