The following is informational only and does not constitute medical advice. Always talk to your doctor about the risks and benefits of any treatment.
Erectile dysfunction is a problem that has always existed but only since the 1990s has come to the forefront of health education. Since then, numerous medications for the treatment of erectile issues have been released and millions of prescriptions have been filled
The term erectile dysfunction refers to an inability to develop or maintain an erection firm enough for sex, though there are no diagnostic criteria for how consistent the problem must be or for the length of duration.
According to the Massachusetts Male Aging Study conducted in 1994, the prevalence of ED is around 52%, but the study also revealed that its prevalence increases with age. As more men experience erectile issues, newer and better treatments are being developed with prescription medications among the most common.
Before you head to your doctor’s office to get a prescription for an oral ED drug, you should consider all of the options available to you. Ask yourself and your doctor whether ED drugs are really the best choice or if an alternative form of treatment might be safer or more effective.
Keep reading to learn about the best questions to ask and, if you do decide to go the route of ED drugs, which options are available.
Erectile dysfunction aside, prescription drugs always come with risks. Just because something is prescribed by a doctor doesn’t necessarily mean that it is inherently safe for everyone—it is impossible to predict exactly how an individual’s body will respond to a particular drug.
Even the most common erectile dysfunction drugs that have been prescribed millions of times come with the risk of side effects, and there may be complications with long-term use.
Though side effects are a risk with any medication, it is important to take a look at the side effects specifically linked to ED drugs. A 2007 study published in the journal Therapeutics and Clinical Risk Management involving 979 men with erectile dysfunction tested the long-term safety of sildenafil (Also known as Viagra).
Over a four-year period, roughly 3.8% of participants experienced one or more adverse events (side effects) which led to either a change in dosage or temporary or permanent discontinuation of the drug.
Statistics vary for different drugs, but some of the most common side effects reported for erectile dysfunction medications include the following:
Though side effects of ED drugs are typically minor and temporary, there are some reports of serious side effects including sudden changes in hearing, loss of vision, and priapism or an erection lasting longer than four hours. Your risk of side effects depends on numerous factors, most notably any underlying medical conditions as well as medications you may be taking for those conditions.
Because ED drugs come with risks, it is always a good idea to consider all of your options before taking them. Sure, it might seem like popping a pill is the easy way to solve your erectile issues, but it may not be quite as simple as that.
ED drugs may help you achieve or maintain an erection, but they could mask underlying health problems or cause side effects and complications. So, before you start taking ED drugs, there are some important questions you need to ask yourself and discuss with your doctor:
When you experience erectile dysfunction, your primary focus is probably going to be on the problem itself, not the cause. In order to properly treat this condition, however, you have to know what is causing it.
Occasional erectile dysfunction is often caused by stress, excessive alcohol consumption, fatigue, certain medications and personal or relationship problems. In cases like this, the problem usually resolves on its own without medical treatment. If your erectile dysfunction becomes chronic, however, you may want to consider treatment.
When it comes to causes of erectile dysfunction, they can be broken into two main categories—medical and psychological. Medical conditions that may contribute to chronic erectile dysfunction include the following:
If your doctor determines that one or more of these conditions may be to blame for your ED, the first step is to treat that condition. In addition to treating those conditions, your doctor may also recommend erectile dysfunction drugs.
In cases where erectile dysfunction is caused by psychological issues, ED drugs may not be effective. According to the University of Cambridge, as many as 20% of men experience psychological impotence at some point in their lives, often triggered by periods of extreme stress or anxiety, depression, relationship problems, personal problems, performance anxiety and even pornography dependence or addiction.
Because these causes for ED are not biological in nature, taking an oral medication will not work—psychotherapy is the best way to overcome psychological causes for ED.
Before taking any prescription drug, you need to make sure that it is safe for you to do so. Erectile dysfunction drugs belong to a class of medications known as vasodilators or, to be more specific, they are phosphodiesterase type 5 (PDE5) inhibitors which provide the benefit of vasodilation.
PDE5 inhibitors increase the amount of nitric oxide in the body which works along with other substances to relax and open (dilate) the blood vessels, allowing blood to flow freely into the penis to create an erection firm enough for sex.
PDE5 inhibitors are generally well tolerated but may cause side effects including headache, nasal congestion or runny nose, back pain or muscle aches, flushing, indigestion and dizziness. Though these side effects are typically mild, taking PDE5 inhibitors with certain other medications may produce more serious and dangerous side effects.
For example, nitrates prescribed for chest pain and blood pressure medications may interact poorly with ED drugs. ED drugs are also not recommended for patients with heart disease or heart failure, severe liver disease, or kidney disease that requires dialysis.
Even if your doctor determines that your erectile dysfunction is related to medical causes and that prescription drugs are safe for you, you should still consider all of your options—this includes alternative forms of treatment.
The most effective alternative treatment for erectile dysfunction consists of diet and lifestyle changes that remedy underlying factors contributing to ED such as obesity, diabetes and high blood pressure. Improving your diet, losing weight, quitting smoking and limiting your alcohol intake are all excellent ways to improve your health and your ED.
In addition to diet and lifestyle changes, certain supplements and other natural remedies have shown potential in treating ED. Panax ginseng, for example, has been shown to improve ED symptoms in men with high cholesterol and metabolic syndrome.
DHEA, a hormone produced by the adrenal glands, is also available in supplement form and may provide benefits for men with low testosterone levels as well as men with diabetes.
Another option is L-arginine, an amino acid that helps the body produce nitric oxide. One study showed a significant improvement in sexual function among 31% of men taking 5 grams of the supplement daily.
If you’ve asked yourself the questions above and your doctor agrees that erectile dysfunction drugs are the best course of treatment, your next step is to consider the options. While you’re probably familiar with some of the most common ED drugs like Viagra and Cialis, there are more choices out there. Not only should you consider prescription drugs, but there are also over-the-counter options as well as non-oral medications. Here is an overview of the different types of ED drugs available:
Sildenafil (brand name Viagra) was the first erectile dysfunction drug to hit the market in the United States. The drug was originally developed to treat high blood pressure and angina associated with coronary artery disease. When its benefits for erectile dysfunction were discovered, the drug was rebranded and in 1998 approved by the FDA.
In August of 2003, the FDA approved vardenafil hydrochloride, sold under the brand name Levitra. Tadalafil or Cialis was approved and released later that same year. And in 2012, the FDA approved avanafil or Stendra.
Viagra, Cialis, Levitra and Stendra are all prescription oral medications for the treatment of erectile dysfunction. These four drugs work by improving blood supply to the penis and, when combined with sexual stimulation, help produce an erection firm enough for sex.
Though the results vary from one man to another, ED drugs produce an erection firm enough for sex in about 70% of the men who take them. They are available in different dosages – usually 2.5 mg or 5 mg – and they typically begin working within 15 to 60 minutes of ingestion.
If you don’t like the idea of taking an oral medication for your erectile dysfunction, there are other options. Alprostadil (Muse), for example, is available in the form of a suppository which is inserted directly into the urethra.
This treatment typically begins to work within 5 to 10 minutes and lasts for 30 to 60 minutes. This makes it a much more direct—and often quicker—daily treatment for ED than oral medications. Though Alprostadil is generally well tolerated, minor side effects such as penile pain or burning with urination have been reported.
In addition to a suppository, Alprostadil is also available in the form of an injectable and sold under the brand name Caverject Impulse. This medication comes in the shape of a disposable, single-use prefilled injector that can be self-administered with proper training from a healthcare provider.
Caverject Impulse typically begins working 5 to 20 minutes after injection and your erection can be expected to last for up to an hour. You should wait at least 24 hours between doses and use no more than three injections per week. The most common side effects of this medication include penile pain, bruising at the injection site, rash, swelling, changes in sensation and an erection lasting more than four hours.
Single-drug injection therapy for erectile dysfunction typically uses alprostadil, but there are also bi-mix and tri-mix injections available as well. These are combination therapies which use either two or three drug mixtures, typically alprostadil combined with either papaverine or phentolamine.
Both papaverine and phentolamine belong to a class of medications known as vasodilators that work by relaxing the smooth muscle tissue in the penis, allowing the arteries to open which increases blood flow to the area. Success rates for injectable ED drugs like these are roughly 85 percent.
If you suffer from occasional erectile dysfunction, taking a prescription medication may help you achieve and maintain an erection firm enough for sex. When erectile issues become chronic, however, it is worth examining those problems in greater depth to determine and treat the underlying cause.
Regardless of your current health situation, it is always a good idea to consider all your options before choosing drugs, prescription or otherwise.