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Erectile dysfunction (ED) is a medical condition when you consistently have problems 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 problems as a result, leading to depression. Ignoring 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.

Phosphodiesterase type 5 (PDE5) inhibitors

The most commonly recommended medications are called phosphodiesterase type 5 (PDE5) inhibitors. There are four PDE5 inhibitors on the market:

They work by protecting a certain enzyme called cyclic guanosine monophosphate (cGMP). This enzyme helps trap blood in the penile tissue during sexual stimulation, encouraging an erection.

Those taking nitrate drugs for angina or using alpha-blockers to treat high blood pressure shouldn’t take PDE5 inhibitors.

In addition, if you go to the hospital emergency room for chest pain, you should 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.

Some common side effects of these medications include:

Comparison chart

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 20 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

daily dose is 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.

An older 2012 study published in BMC Surgery 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 suppository (known as MUSE).

MUSE (or Medicated Urethral System for Erections) works by causing blood vessels to expand, allowing more blood flow into the penis. You simply place the pill into the opening at the tip of 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:

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

Though ED is relatively common, if you’re bothered by the quality, firmness, or duration of your erection, you should see 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 come up with a proper treatment.

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.

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 of these factors or by several of them. 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 are 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. Avanafil (Stendra) only works if you’re sexually stimulated.

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 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).

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 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.