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Erectile dysfunction (ED) is a health condition when you consistently have issues either achieving or maintaining erections. While these problems can occur in anyone from time to time, ED is more than just an occasional issue with arousal. It can be an ongoing health concern.

ED affects about 30 million men in the United States. Prevalence increases with age.

Those who experience ED can have other related health issues, including anxiety and depression. They might also experience low self-esteem and decreased quality of life.

People with ED may become even more nervous and anxious when engaging in sexual activity. They may experience continued erection issues as a result, which can lead to depression. If untreated, ED can even be dangerous, since it can be a sign of other health conditions.

Treating the underlying cause of ED is often the most important step. Doctors are also likely to suggest specific treatments for the symptoms themselves. Find out which ED pills — if any — may work best.

ED pills are oral medications taken by mouth. Available by prescription, these medications are designed to help relax smooth muscles and increase blood flow in your penis during sex. While not a cure for ED, oral medications may help you better manage the symptoms of ED.

Sildenafil (Viagra) was the first ED pill introduced in the United States, and was approved by the Food and Drug Administration (FDA) in 1998. Since then, three other types of ED pills of the same class have been approved as first-line treatments for ED.

Depending on the type, ED pills are designed to be taken as needed or on a daily basis to help promote an erection during sexual stimulation. Not all of these medications work the same for everyone, so a doctor may suggest that you start with one and try another type if you’re not getting the results you want.

ED pills also aren’t safe for everyone, especially if you take certain heart or blood pressure medications. Nitrates, for example, widen your blood vessels. When combined with ED pills, this may lead to a potentially serious drop in blood pressure (hypotension). Taking alpha-blockers with ED medication may also lead to sudden hypotension.

The most common type of ED oral medication is a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors, which includes Viagra and Cialis, among others. This is also the only class of oral medications approved for ED in the United States.

PDE5 inhibitors work by protecting a certain compound called cyclic guanosine monophosphate (cGMP). This compound helps hold blood in the penile tissue during sexual stimulation, encouraging an erection. Also, by inhibiting PDE5 in penile tissues, blood vessels are better able to dilate, further promoting blood flow.

Additionally, PDE5 inhibitors decrease vascular pressure, which is why they may lead to hypotension when combined with nitrates and alpha-blockers.

While there are four types of PDE5 inhibitors used in the treatment of ED, they all work similarly via slight structural differences. This is why some men may find that certain ED pills may work better than others. The results are highly individual.

The cost of your ED treatment will depend on which pill you’re taking, the dosage, where you’re purchasing it from, and how much you purchase at once. Branded Viagra tends to be much more expensive than generic sildenafil.

Prices start at about $2 per 20mg pill of generic sildenafil from services like Roman and Hims and can go up to around $70 per pill of branded Viagra through your local pharmacy.

One of the best ways to save money on ED pills is to use services like Roman, Hims, and Lemonaid, which offer multiple-month subscription services for a discounted price and provide both brand name and generic. In general, most insurance companies won’t cover name-brand Viagra, but they might cover the generic, sildenafil.

The most commonly recommended medications for ED are PDE5 inhibitors. There are four PDE5 inhibitors on the market:

  • Sildenafil (Viagra): available in 25 to 100 milligram (mg) doses taken once daily only as needed 30 minutes to 4 hours before sex
  • Tadalafil (Cialis): a lower dose medication available in 2.5 to 20 mg doses that are taken daily, so you don’t have to worry about timing of sexual activities; this may also be a better fit for younger people who don’t take medications for other health conditions
  • Vardenafil (Staxyn, Levitra): also designed for daily use, this medication is available in 2.5 to 20 mg doses and may pose fewer side effects
  • Avanafil (Stendra): available in higher doses at 50, 100, and 200 mg and is taken once a day as needed 15 minutes before sexual activity, which is a shorter time frame than Viagra

Some common side effects of these medications include:

If you’re taking nitrate drugs for angina, avoid taking PDE5 inhibitors. It’s also not recommended if you’re using alpha-blockers to treat high blood pressure to take PDE5 inhibitors due to the blood pressure lowering effects of the combination. However, it’s possible if you’re monitored.

In addition, if you go to the hospital emergency room for chest pain, tell your doctor if you’ve recently taken a PDE5 inhibitor. If you’re given nitroglycerin (Nitrostat, Nitro-Dur), it may cause your blood pressure to drop suddenly. It’s a type of nitrate drug.

How to take itHow fast it worksTypical dose
Sildenafil (Viagra)1–2 hours after eating, don’t consume with fatty foodscan start in about 10 minutes, can take 1 hour for maximum effecttypical starting dose is 50 mg, can be increased to 100 mg
Tadalafil (Cialis)when you need it, or regularly every daycan start working in about 15 minutes, can take 2 hours for maximum effect

remains effective for up to 17 hours.
10–20 mg for occasional use

typical daily dose is 2.5 mg
Vardenafil (Levitra)shouldn’t be taken with food, wait 1–2 hours after eatingcan start working in about 15 minutes, can take 45 minutes to reach maximum effecttypical starting dose is 10 mg, can be decreased to 5 mg or increased to 20 mg
Avanafil (Stendra)can be taken with or without food, shouldn’t be taken more than once a dayfastest acting, starts working in as little as 15 minutestypical starting dose is 100 mg, can go up to 200 mg

Hormone replacement therapy

Your testosterone levels naturally decrease by small amounts as you age. However, you may be a candidate for hormone replacement therapy if your testosterone levels are too low.

A 2012 study noted that age-associated testosterone deficiency is characterized by symptoms such as ED.

Testosterone replacement therapy (TRT) helps restore testosterone blood levels, but it’s still unclear if it helps improve ED. It likely depends on what’s causing ED in the first place.

Side effects of TRT may include:

Penile suppositories

The medication alprostadil is available as both an injection (known as Caverject or Edex) and as a pill that you place into the opening at the tip of the penis (known as MUSE). MUSE, or Medicated Urethral System for Erections, works by causing blood vessels to expand, allowing more blood flow into the penis.

However, the medication is less effective when it’s delivered this way than when it’s delivered via injection.

According to findings from multi-center, placebo-controlled, double-blind, parallel-group studies, 7 out of 10 men were able to go through successful intercourse after using MUSE.

Side effects may include pain and burning in the genital region.

Yohimbine hydrochloride

Yohimbine hydrochloride is derived from yohimbe bark. Yohimbe bark comes from an African evergreen tree and was historically used as an aphrodisiac.

Yohimbine hydrochloride was approved by the Food and Drug Administration (FDA) as a prescription treatment for ED in the late 1980s. It’s also available over the counter.

Yohimbe herbal supplements are available over the counter as well. They’re different from yohimbine hydrochloride, chemically speaking.

Scientists believe yohimbe works by stimulating blood flow to the penis. Studies on yohimbe have seen mixed results. It isn’t known whether the supplemental extract form of yohimbe is safe or effective due to a lack of clinical trials on the substance.

That being said, there aren’t enough studies to support the claim that yohimbe works, and some experts are adamant that it doesn’t.

Yohimbine hydrochloride can also cause dangerous side effects, such as:

Don’t use it if you have a heart disease, a mental health condition, or kidney disease.

ED can be uncomfortable to discuss with your doctor at first, but keep in mind that it’s a common medical issue.

Since ED is often related to other health issues, it’s best to get a complete checkup as well as laboratory tests and a psychological exam. Treating any underlying cause will often help improve the ED as well.

The landmark Massachusetts Male Aging Study found that depression and ED are often related.

ED may also be associated with the following:

The better your overall health, the lower the risk of ED. Discuss any of these issues with your doctor thoroughly, as well as any medications you may be taking.

In some cases, ED may be related to an underlying health condition that requires specific treatment. However, if your ED is not caused by a medical issue, a doctor may recommend preventive measures to complement oral medications. Keep in mind that ED may not be entirely preventable, but medications and lifestyle changes may help you manage it.

Talk with a doctor about the following nutrition and lifestyle changes:

  • Stop smoking, if you currently smoke: Smoking adversely affects your blood vessels and heart, which can also increase your risk of developing ED. If you need help stopping, talk with your doctor. They may be able to recommend smoking cessation programs or medications to help you.
  • Exercise to promote blood flow: Regular exercise of at least 30 minutes each day can help increase blood flow throughout your body, including penile blood flow. If you’re new to exercise, start off slow with moderate activities, such as walking. Talk with a doctor about how you can gradually increase physical activity.
  • Limit alcohol: According to a 2021 meta-analysis of 46 studies, regular alcohol consumption was found to increase ED and possibly damage blood vessels. Try to limit the amount of alcohol you drink, and talk with a doctor if you need help.
  • Eat a healthy diet: A diet that focuses on lean meats, low fat dairy products, whole grains, fruits, and vegetables may also help prevent ED. Some studies suggest that following a plant-based diet may promote overall cardiovascular health while also decreasing your risk of ED.
  • Maintain a moderate weight: Having more weight may also increase your risk of ED due to increased inflammation and lower testosterone levels. In addition, some cases of ED are caused by stress, relationship issues, and low self-esteem. By losing or moderating your weight, you may boost your testosterone levels and increase your overall self-esteem — two factors that can influence ED symptoms.

For people with more weight, losing weight may help prevent high blood pressure and diabetes, which are two conditions that may cause ED.

If you’re considering setting a weight goal for yourself, talk with your doctor before getting started. They can help determine if that goal is right for you, as well as strategies to help you safely achieve it.

Though ED is relatively common, if you’re bothered by the quality, firmness, or duration of your erection, talk with a doctor.

At the end of the day, ED can be pointing to signs of a more serious health condition, such as high blood pressure, diabetes, or heart disease.

Depending on the cause, your doctor will analyze your symptoms and determine a proper treatment.

What causes ED?

There are many possible causes of ED, and they can include both emotional and physical conditions. Common causes include:

ED can be caused by one or several of these factors. That’s why it’s important to work with your doctor so that they can rule out or treat any underlying medical conditions. Learn more about the causes of ED.

What ED pill is best for me?

There are a few different options: Viagra, Cialis, Levitra, and more. The truth is the best ED pill is the one that works best for you.

They’re all equally safe and effective, but the main differences between them are how they’re taken, how long they last, their side effects, and cost.

For occasional use, most people start with sildenafil (Viagra). For regular use, tadalafil (Cialis) can be a better fit.

Some people prefer to alternate between medications, depending on their lifestyle and relationship status.

How effective are ED pills?

Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) all have studies that back how well they work.

Currently, there are no studies that directly compare them against each other, but a 2009 meta-analysis of a few hundred studies found that all three medications result in successful penetrative sex in 65 percent to 80 percent of users with ED, compared with 30 percent with a placebo.

How quickly do ED pills work?

How quickly an ED pill begins to work will depend on the medication. Usually, ED pills begin to work in as little as 10–15 minutes. Some may take up to 1–2 hours to take full effect.

How long do ED pills last?

How long your ED pill lasts will depend on the medication, dosage, and your body’s metabolism.

On average, branded and generic Viagra will last between 2 and 3 hours before its effects start to diminish, but can last up to 5 hours depending on your dosage, metabolism, and other factors. Avanafil has a similar duration, lasting between up to 6 hours. Sildenafil and Vardenafil can remain effective for up to 12 hours.

Tadalafil has the longest duration of these common ED pills. It can remain effective for up to 36 hours.

ED pills are promising, but the results vary. PDE5 inhibitors continue to be the first line of treatment, and they enjoy high rates of patient satisfaction. Your doctor might recommend another option if such medications don’t help you or if they cause side effects.

If you’re interested in natural ED remedies, consult your doctor first. Never self-treat ED with over-the-counter herbs and supplements.