Health Education

Erectile dysfunction treatments and medications

Cropped SingleCare logo By | August 19, 2019
Medically reviewed by Raymond Zakhari, DNP, EdM, NP-BC

Erectile dysfunction (ED), sometimes called impotence, is the inability to achieve or maintain an erection. Every year, more than 3 million people in the United States experience ED. In other words, it’s an extremely common condition—one that is easily treatable, and often curable. Standard erectile dysfunction treatments include oral medications such as:

They all work slightly differently, but each prescription improves blood flow to the penis, which can boost sexual performance. Other ED treatments include: injections, testosterone replacement, vacuum pumps, and penile implants.

What age do men stop getting erections? 

It’s a common myth that aging causes ED. Erection problems may be more common in older men, but it’s more commonly caused by an underlying health problem or condition, such as:

  • Heart disease
  • Diabetes
  • Obesity
  • Low testosterone
  • Stroke
  • Penis, spinal cord, prostate, bladder, or pelvis injury
  • High blood pressure (hypertension)
  • Hyperlipidemia
  • Multiple sclerosis
  •  Liver or kidney disease
  • Pituitary gland conditions
  • Peyronie’s disease
  • Surgery for bladder cancer 
  • Nerve damage
  • Injury from treatments for prostate cancer, including radiation therapy and prostate surgery

Lifestyle factors like smoking, excessive alcohol consumption, or extreme stress can also contribute to ED. Or, certain medications like antidepressants, antihistamines, or opiates. ThIt’s not just a normal part of getting older that you have to live with. No matter your age, ED can be diagnosed and treated at any stage of life.

How can I improve my erectile dysfunction?

Given erectile dysfunction is often self-diagnosed without the need for invasive or expensive lab tests, many men first try alleviate their symptoms by using a range of natural and over-the-counter treatment options like: 

  • Therapies, including acupuncture and talk therapy
  • Vitamins, dietary supplements, and herbal remedies
  • C-rings
  • Prostate massage
  • Food and diet changes
  • Meditation
  • Exercise

The majority of erectile dysfunction cases are curable, as long as the underlying cause is established. For example, if a medication you’re taking is causing impotence, your doctor may suggest an alternative drug or timing of the drug. Or perhaps smoking is the culprit of your symptoms, in which case kicking the habit may be all you need. One study shows an improvement in erectile quality in 25 percent of men who quit the habit, compared to zero improvement in men who continued smoking.

For the cases where it’s not curable, such as when a chronic disease like diabetes is the primary cause, many treatment options are available so you can get back to enjoying a healthy sex life.

Because there are so many contributing factors to erectile dysfunction, it’s always a good idea to speak with your doctor and discuss all of your erectile dysfunction treatment options, like prescription medication.

Conversations about your sexual health can be awkward. But it’s important to be open and transparent when speaking to your doctor. It’ll make it much easier to diagnose and treat your condition, so you can get back to having healthy erectile function.

If you have preexisting health conditions, certain treatment options may not be safe. Be sure to disclose all medical issues and any supplements or prescription drugs you take. Depending on your specific medical condition and history, your primary care doctor may refer you to a specialist in urology or endocrinology. 

What medicine can cure erectile dysfunction?

Here are some treatments that your doctor, urologist, or endocrinologist may recommend for your erectile dysfunction:

The basics of ED medications

The most common medications used to treat erectile dysfunction are a type of drug called phosphodiesterase type 5 inhibitors (PDE-5 inhibitors or PDE5i). These include sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). FDA-approved, they are widely accepted as first-line therapy for various forms of ED, with each using a similar mechanism to treat erectile dysfunction. First introduced in 1998, these PDE5i revolutionized how doctors and urologists treat ED, thanks to their effectiveness and safety profile.

PDE5i work by inhibiting the breakdown of cyclic guanosine monophosphate (cGMP) by the phosphodiesterase type 5 enzyme (PDE5) in the smooth muscle of the corpora cavernosa. These smooth muscles of the penis contain most of the blood during an erection, so when relaxed using PDE5i, the result is increased erection hardness and duration.

It’s important to note these erectile dysfunction medications are not aphrodisiacs, will not cause sexual desire and are not needed in men who get normal erections. In other words, even with these medications, sexual stimulation is still needed to achieve an erection.  However, the assurance of an erection may relieve performance anxiety—which as a result could increase desire.

According to the 2018 American Urological Association Erectile Dysfunction Guideline, PDE5i medications, particularly sildenafil, tadalafil, and vardenafil, appear to have similar effectiveness in the general erectile dysfunction population. The comparison to avanafil, another popular PDE5i, is less clear as published research is limited. PDE5i medications vary in dosage, how long they work, and side effects. 

In addition to PDE5i drugs, there are other medications that treat erectile dysfunction, like alprostadil.

Sildenafil (Viagra)

Sildenafil was the first oral PDE5i to hit the market in 1998. Viagra, one of the most recognizable drug names in the world, is a brand name of sildenafil. Like other PDE5i, it works by relaxing the blood vessels in your penis when you are sexually excited, allowing blood to flow to your penis so you can get an erection.

A common misconception is that sildenafil will increase your sex drive, however it does not. As the production of cGMP requires the release of nitric oxide in response to sexual arousal. Meaning, sildenafil will only work if you are sexually excited.

The recommended dose of Viagra is 25-100 mg taken 30 minutes to four hours before sexual activity. Generally it takes 30-60 minutes to be absorbed into your system and take effect, lasting four to five hours.

Before taking sildenafil, be sure to tell your healthcare provider of any other medications and supplements you use as it may interact with other drugs, including those that treat high blood pressure, antibiotics, and antidepressants.

Fortunately, there is no evidence that sildenafil is addictive, however there is the risk of some serious side effects.

Although rare, these side effects include:

  • Dizziness
  • Loss of hearing or ringing in the ears
  • Stomach pain and nausea
  • Headaches
  • Warmth or redness in the face, neck, or chest
  • Stuffy nose
  • Diarrhea
  • Back pain
  • Memory problems
  • An inability to differentiate between the colors green and blue

Tadalafil (Adcirca, Cialis)

Tadalafil is an oral PDE5i drug. It has a different structure to sildenafil, although it acts in the same way with similar side effects. It, too, helps to maintain the smooth muscle relaxation in the corpus cavernosum of the penis, which increases blood flow and produces an erection.

However, tadalafil is more slowly absorbed than sildenafil. It takes about two hours to reach maximum concentration compared to one hour. It can still be effective up to 36 hours after a dose, and is mainly eliminated by metabolism.

Dosage varies depending if you take it as needed or on a daily basis. As needed doses vary from 5 to 20mg, taken orally prior to sexual activity. Daily dosage often starts with an initial 2.5 mg taken once a day at the same time. Then, moves to a maintenance dose of 2.5 to 5 mg once a day depending on the individual.

Vardenafil (Levitra, Staxyn)

Vardenafil is an oral PDE5i drug. Much like sildenafil and tadalafil, it raises concentrations of cyclic guanosine monophosphate in the corpus cavernosum of the penis, increasing the likelihood of an erection in response to sexual arousal.

Doctors generally advise patients take vardenafil 25 to 60 minutes before attempting intercourse. The normal starting dose of vardenafil is 10 mg, however it’s available as an oral medication in 2.5 mg, 5 mg, 10 mg, and 20 mg doses. 

Vardenafil has a similar half-life to sildenafil—approximately four hours. As with other PDE5i, it has the potential to interact with other drugs, and should not be prescribed for patients taking potent CYP3A4 inhibitors such as ketoconazole and ritonavir, and patients with severe cardiovascular disease and disorders, especially if you’re taking nitrates.

Avanafil (Stendra)

Avandafil was the last of the most popular PDE5i drugs approved by the Food and Drug Administration in 2012. It too enables the inflow of blood to the penis, resulting in erection, by creating smooth muscle relaxation in the corpus cavernosum.

Rapidly absorbed, avanafil can reach maximum concentrations after only 30-45 minutes. Some men are able to achieve an erection just 20 minutes after a 200 mg dose, however absorption can be delayed by food. Avanafil can last for 6-12 hours.

Avanafil should not be used by people with severe liver disease. Like other PDE5i, it could interact with many other drugs, including nitrates.

The main adverse effects of avanafil include headache, flushing and nasal congestion, as well as loss of hearing or vision.  

A bar graph comparison of different erectile dysfunction treatments and medications

Alprostadil (Caverject, Viridal, Muse)

Alprostadil is a second-line therapy for erectile dysfunction that comes as an injectable solution or a suppository. It is the same chemical produced by an erect penis. When injected into the shaft of the penis with a thin needle, it helps increase blood flow, facilitating an erection. Erections achieved through injections usually last no longer than one hour.

One downside to this injectable treatment is that is can be very painful, and in some cases cause scarring to the penis. Side effects can include mild bleeding from the injection site, prolonged erection (priapism) and, rarely, formation of fibrous tissue at the injection site.

If you’re not into needles, Alprostadil you can place the suppository the urethra using a special applicator. The erection usually starts within 10 minutes, however it’s not as effective as its injectable form. When effective, erections can last between 30 and 60 minutes.

Side effects of an alprostadil urethral suppository (Muse) can include pain and discomfort, minor bleeding in the urethra, and formation of fibrous tissue inside your penis.

Testosterone replacement 

Some people experience low levels of the hormone testosterone, which can cause sexual dysfunction. If you have low testosterone, your doctor may suggest testosterone replacement therapy used alone, or used in combination with other medications and therapies.

Testosterone is a male sex hormone, essential for a normal erection. If testosterone levels are too low, you may suffer from erectile dysfunction, however research shows that high levels of the hormone have no major impact on ED.

Not sure if you have low testosterone? Ask your doctor for a simple blood test, and look out of symptoms, such as: 

  • Reduced sex drive
  • Breast growth
  • Loss of body hair
  • Drop in muscle strength and size

Aging doesn’t cause ED, but after age 50, men’s levels of testosterone slowly decrease, affecting sexual function and increasing the likelihood of erectile dysfunction.

Testosterone treatments are generally more expensive than other treatments, and can be administered with an injection, a gel, or a patch placed on the skin. You must keep taking testosterone indefinitely to maintain the benefits of the treatment. 

Like all treatments, hormone therapy has a number of potential side effects like: 

  • Fluid retention
  • Acne
  • Enlarged breasts and prostate
  • Decreased fertility
  • Increase in red blood cells
  • Worsened sleep apnea symptoms

What other treatments can cure erectile dysfunction?

Many people prefer to start by trying the range of natural treatment options that people with ED report as fast and effective. Natural cures for erectile dysfunction include:

  • Therapies (c-rings, penis pumps, prostate massage, acoustic shockwave therapy) results vary greatly and not all are evidence based
  • Sex Therapy
  • Vitamins, dietary supplements, and herbal remedies
  • Food and diet changes
  • Lifestyle changes (medication, stress reduction, reducing exposure to pornography)
  • Physical activity

RELATED: Natural cures for erectile dysfunction

You can also try the following medical interventions.

Penis pumps

If can’t—or don’t want to—take medications to manage ED, your doctor may recommend trying a either a hand-powered or battery-powered penis pump (vacuum device). This involves placing a hollow tube over your penis, then gently using the pump to remove any air, thereby creating a vacuum. This vacuum effect pulls blood into your penis, leading to erection.

Once you achieve an erection, you place a tension ring around the base of the penis to hold in the blood and keep it hard. The tension ring is removed after intercourse.

Erections achieved through this method tend to last long enough to enjoy intercourse, however side effects include possible bruising of the penis and restricted ejaculation due to the ring.

Penile implants

Penile implants (or penile prosthesis) are a surgical option to treat erectile dysfunction. A physician places either inflatable or bendable rods on each side of the penis or scrotum.

Penile implants are not usually recommended until you’ve exhausted all other options without success. As with any surgery, there are risks and potential complications involved, including infection.

What is the latest treatment for erectile dysfunction?

There are limited advancements erectile dysfunction medications since the development of the popular and effective PDE5i drugs. However, MED2005 is currently in development as an alternative treatment for erectile dysfunction.

 MED2005 is a glyceryl trinitrate topical gel, designed to be used on demand. It’s an exciting new option that has signs of potential, but a recent study calls for additional research to determine its effectiveness, including clinical trials that monitor high doses.

If you have erectile dysfunction, there are many treatment options available to improve your sex life. Whether it be suggesting lifestyle changes, like doing more exercise or reducing your alcohol consumption, or recommending one of the many effective men’s health medications available, your doctor will be able to guide you through the best and most appropriate treatment.