Treatment for Erectile Dysfunction
Lifestyle factors can often lead to ED or make its symptoms worse. Sometimes, changing a daily habit could help prevent or improve your ED. If you smoke cigarettes, one of the best things you can do for your ED and your overall health is to quit smoking. Smoking cigarettes is linked to heart and blood vessel disease, which can lead to ED. Eating well helps to maintain erectile function. Consider working with a registered dietitian, if possible, to create an eating plan for your individual needs.
| Contraindication | Explanation | Usually applies to | Alternative approach |
|---|---|---|---|
| Use of Nitrates | Can cause severe hypotension | Heart patients on nitrate therapy | Psychological counseling, vacuum devices |
| Severe Liver Impairment | Reduced drug metabolism increases risk | Patients with hepatic failure | Dose adjustment, alternative therapies |
| Severe Cardiac Conditions | Risk of heart attack or arrhythmias | Unstable angina, recent MI | Medical evaluation, lifestyle changes |
| Hypotension | May worsen low blood pressure | Systolic BP <90 mm Hg | Non-pharmacological options |
You can find a registered dietitian online through the Academy of Nutrition and Dietetics or through your health care professional. A dietitian can create a custom meal plan for you.
| Brand Name | Generic Name | Dosage Forms | Mode of Action | Typical Dosage |
|---|---|---|---|---|
| Viagra | Sildenafil Citrate | Tablets | Vasodilation via PDE5 inhibition | 50-100 mg as needed |
| Cialis | Tadalafil | Tablets | Long-lasting PDE5 inhibitor | 10-20 mg as needed |
| Levitra | Vardenafil | Tablets | PDE5 inhibition | 10-20 mg as needed |
| Stendra | Avanafil | Tablets | Rapid onset PDE5 inhibitor | 50-200 mg as needed |
A healthy weight can improve testosterone levels and self-esteem, which may help prevent ED.
- Urologist: A specialist who often diagnoses and treats ED.
- Endocrinologist: Specializes in hormonal causes like low testosterone.
- Cardiologist: Important for cardiac risk assessment before prescribing.
- Primary Care Physician: Often the first point of contact and management.
- Mental Health Professional: Treats psychological causes like anxiety or depression.
- Certified Sex Therapist: Can provide specialized counseling for sexual issues.
- Team Approach: Often requires collaboration between different specialists.
Maintaining a healthy weight can also prevent diabetes and high blood pressure, which can cause ED. Physical activity increases blood flow through your body, including the penis, and can help keep you at a healthy weight.
- Natural Nitric Oxide Boosters: Foods like beets, leafy greens, and dark chocolate.
- L-arginine: An amino acid precursor to nitric oxide, found in supplements.
- Panax Ginseng: An herbal supplement with some evidence for improving ED.
- L-citrulline: Another amino acid that may improve blood flow.
- DHEA: A hormone precursor, but evidence for ED treatment is limited.
- Yohimbine: An alkaloid with historical use, but significant side effects.
- Warning: Supplements are not FDA-regulated and can interact with medications.
The Physical Activity Guidelines for Americans, 2nd edition, recommends at least 150 minutes, or 2 hours and 30 minutes, of moderate-intensity physical activity, such as brisk walking, each week.2 Taking care of your mental and emotional health can help prevent ED. If you feel stressed, try relaxation techniques and other activities that might soothe you. A simple way to relax is deep breathing, which you can do anywhere. You can help prevent ED by avoiding recreational and illicit drugs and limiting how much alcohol you drink. Some drugs can prevent arousal or other sensations that are important for getting and keeping an erection. Sometimes, illicit drugs and too much alcohol may mask other mental health, emotional, or physical factors that cause ED. This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.
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Your counselor may ask you to bring your partner to sessions for more support. Your health care professional may review any medicines you are taking to see if a medicine you need for another health condition is causing ED. They may suggest taking a different dose of medicine or switching to another medicine. Do not stop taking any medicines on your own. Talk with your health care professional first.
5. Penile implant
Health care professionals may also prescribe other types of medicines for your ED. Phosphodiesterase type 5 (PDE5) inhibitors are oral medicines that improve blood flow to the penis. These medicines may help you get and keep an erection. If you have ED and low testosterone, health care professionals may prescribe testosterone with PDE5 inhibitors. You may be given testosterone as an man up pills oral medicine, a patch, or a gel.
This Really Happened
Injectable medicines and suppositories can enhance erections. An injectable medicine causes a quick, automatic erection by increasing blood flow to the penis. Some people with ED prefer a suppository, a solid piece of medicine that you insert into the urethra. Your health care professional will teach you how to give yourself an injection or insert a suppository. Some people say certain alternative medicines help their ED symptoms. Some men with erectile dysfunction, or ED, find they can return to an active sex life by treating an underlying condition, such as high blood pressure or diabetes, or with counseling and lifestyle changes.
| Product | Dosage | Quantity + Bonus | Price | |
|---|---|---|---|---|
| Viagra Generic | 200mg | 10 Pills | 40.96€ 39.01€ | |
| Priligy Generic Dapoxetine | 60mg | 20 + 4 Pills | 77.31€ 73.63€ | |
| Kamagra Soft Tabs | 100 mg | 180 + 8 Pills | 425.45€ 405.19€ | |
| Viagra Professional | 100mg | 30 Pills | 88.92€ 84.69€ | |
| Kamagra Soft Tabs | 100mg | 32 Pills | 120.11€ 114.39€ | |
| Viagra Generic | 200mg | 20 Pills | 61.69€ 58.75€ | |
| Cialis Generic | 5mg | 20 Pills | 41.99€ 39.99€ | |
| Priligy Generic Dapoxetine | 60mg | 60 + 8 Pills | 183.06€ 174.34€ | |
| Viagra Original | 100mg | 4 Pills | 40.94€ 38.99€ | |
| Cialis Soft Tabs | 20mg | 20 + 2 Pills | 66.98€ 63.79€ |
But others find they may need medication to get and keep an erection.
- Vascular Health: ED can be an early warning sign of heart disease.
- Diabetes: A leading cause of ED due to nerve and blood vessel damage.
- Neurological Disorders: MS, Parkinson's, and spinal injuries can cause ED.
- Metabolic Syndrome: A cluster of conditions that increases ED risk.
- Prostate Cancer Treatment: Surgery and radiation often cause temporary or permanent ED.
- Depression: Both a cause and a consequence of erectile dysfunction.
- Medications: Antidepressants, antihypertensives can cause ED as a side effect.
The FDA has approved several prescription drugs you take orally to treat ED.
- PDE5 inhibitors prevent the breakdown of cGMP.
- ED medications are often taken on an as-needed basis.
- Tadalafil's longer duration allows daily low-dose use.
- Viagra's active ingredient is sildenafil citrate.
- Medical evaluation is necessary before starting treatment.
- Not all men respond to ED medications; alternatives exist.
- Rare side effects include priapism and sudden vision loss.
- Some ED drugs are available in generic form.
- Patients should follow dosing instructions carefully.
- Medication efficacy can be enhanced by reducing alcohol intake.
All of these work by relaxing your muscles and boosting blood flow to your penis, making erections easier to get and maintain.
Seeing Dr. Engel about erectile dysfunction
Sildenafil and vardenafil take effect in 30 minutes to an hour and last four to five hours. Tadalafil kicks in after 30 to 45 minutes and can last 24 to 36 hours. "Many doctors first prescribe sildenafil because it has been around the longest and has a high success rate," says Dr. O'Leary. Men who want a longer-lasting effect might opt for tadalafil.
What medications are available for erectile dysfunction?
Tadalafil is also available as a low-dose daily drug, so you have a constant amount of the drug in your bloodstream, which helps with spontaneous sex. (This version is also used to treat benign prostatic hyperplasia, or an enlarged prostate.) The maximum dosages for ED drugs vary from 20 milligrams (mg) for tadalafil and vardenafil to 100 mg for sildenafil and 200 mg for avanafil. Your doctor usually begins with a low dose and increases it as needed. "Once you reach the maximum dose, and the drug still doesn't work, taking more won't help," says Dr. O'Leary.
Be physically active
"Also, switching to another ED drug usually won't make a difference." The most common side effects of ED drugs are headaches, upset stomach, nasal congestion, muscle pain, and facial flushing. But most of these are relatively mild and disappear after a few hours. "ED drugs can make blood pressure temporarily drop, so don't use them if you take nitrates for angina (chest pain) or other heart problems," says Dr. O'Leary. However, there's no problem with nitrates found in food - for example, leafy green vegetables (spinach, kale) and root vegetables (beets, carrots). Caution: Do not use these ED medications if you take nitrates, such as nitroglycerin or a similar medicine, for chest pain. The combination can cause dangerously low blood pressure. These medications all work similarly to each other. However, there are subtle differences in how long they stay effective and how quickly they begin to work. Levitra takes about 30 minutes to start working and the effects last a little longer than Viagra, about 5 hours.
The Need for More ED Care Options
You also need to be careful if you take alpha blockers such as tamsulosin (Flomax) and alfuzosin (Uroxatral), used to treat an enlarged prostate. "Make sure to take these medications at least four hours apart from an ED drug," says Dr. O'Leary. It's also best not to take sildenafil or vardenafil soon after eating, as food can block their absorption. (Tadalafil and avanafil don't interact with food in this manner.) Matthew Solan, Former Executive Editor, Harvard Men's Health Watch Howard E.
Quit smoking
LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Health care professionals treat the underlying cause of erectile dysfunction (ED) when possible. Sometimes, the exact cause of ED is not known.
Conditions We Treat
Health care professionals will then focus on improving sexual function. Choosing an ED treatment is a personal decision. If you have a partner, you may want to talk together about treatments that work for you as a couple. Your health care professional may suggest lifestyle changes to help improve your ED symptoms, including Health care professionals may suggest counseling if mental health or emotional issues are affecting your ED. Counselors can help you lower anxiety and stress about sex. It contains the same active ingredient as Levitra and can begin working in about 15 minutes.
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Bruises are usually painless and will disappear in a few days. VEDs may weaken ejaculation but this doesn’t affect the pleasure of climax or orgasm. Most people with ED do not need surgery. If you have tried all other options and your ED does not improve, you and your health care professional may consider surgery to implant a device—called a prosthesis—to make the penis erect, either using a pump in the scrotum or a rod that you can control on your own repair arteries to increase blood flow to the penis, a procedure that works best for younger men Your health care professional will describe the benefits and possible side effects of surgery. ED medicines that you take by mouth, through an injection, or as a suppository can have side effects, including erections that last longer than 4 hours, known as priapism vision or hearing loss after taking oral ED medicines Call your health care professional right away if you develop these problems. Viagra takes around 30 minutes to become effective and lasts about 4 hours. Cialis lasts much longer -- up to 36 hours in some cases.
Alternative Names
For safety reasons, talk with your health care professional before using dietary supplements, such as vitamin or mineral supplements, or any complementary or alternative medicines or medical practices. Vacuum erectile devices (VEDs) pull blood into the penis for an erection. a plastic tube to put around your penis an elastic ring that helps you to keep an erection You may need to practice with or adjust your VED. Sometimes, VEDs can make your penis feel cold or numb. Your penis could look purple or bruised. Stendra can start doing its thing in as little as 15 minutes, and its effects last up to 6 hours. You may find that one works better for your schedule or that there are differences in the side effects for you. But these medications work the same basic way, so you’re likely to have similar results. Again, do not use these ED medications if you take nitrates, such as nitroglycerin or a similar medicine, for chest pain. But there are other situations that may make these medications unsafe as well. Before you take Viagra or one of the others, tell your doctor: If you are allergic to any medications, including other ED medications About any prescription or nonprescription medications you take, as well as any herbal and dietary supplements If you are scheduled for surgery, even dental surgery If you take alpha-blockers for blood pressure or prostate problems. These can lower your blood pressure when taken with ED pills.