Erectile dysfunction (ED) is a medical condition in which men consistently have problems either achieving or maintaining erections. While this issue can occur from time to time, it’s more than just an occasional issue with arousal. It can be an ongoing health concern. According to the Cleveland Clinic, ED affects about 52 percent of all men, and the prevalence increases with age.

Men who experience ED can have other related health issues. These may include:

Men may become even more nervous and anxious when engaging in sexual relations. They may experience more failures that lead to depression. Ignoring ED can even be dangerous. A 2010 study published in the Journal of Sexual Medicine reported that men who fail to seek help for ED could have undetected heart disease. In fact, erectile dysfunction is a risk factor for cardiovascular disease.

Fortunately, there are a number of pills that help treat ED. Surprisingly though, most men are not taking advantage of them. The American Urological Association reports that only about a quarter of men affected by ED seek treatment for it. The other three quarters go without treatment. To prevent these issues and improve overall quality of life, find out which ED pills — if any — may work the best.

Treating the underlying cause of ED is often the most important step. Doctors are also likely to suggest specific treatments for the symptoms themselves. The most commonly recommended medications are called PDE5 inhibitors. These include the brand names Cialis, Levitra, and Viagra. The drugs work by protecting a certain enzyme called “cyclic GMP.” 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 should not take PDE5 inhibitors.

In addition, men who go to the emergency department for chest pain should tell their doctors if they’ve taken a PDE5 inhibitor recently, as it may cause their blood pressure to drop suddenly if they are given nitroglycerin.

Testosterone naturally decreases in 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 published in BMC Surgery noted that age-associated testosterone deficiency is characterized by symptoms such as ED. Testosterone replacement therapy helps restore blood levels of testosterone in men. However, it’s still unclear if it helps improve ED. It likely depends on what’s causing ED in the first place.

Some medications that are administered via an injection are also available as pill suppositories. Alprostadil (MUSE) is one of these. It 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 researchers at the Cleveland Clinic, 73 percent of men were able to go through successful intercourse after using MUSE.

Prescription yohimbe (yohimbine hydrochloride) is derived from yohimbe bark. Yohimbe bark comes from a native African evergreen tree and was historically used as an aphrodisiac. It was approved by the FDA as a prescription treatment for ED in the late 1980s. Scientists believe it works by stimulating blood flow to the penis.

Studies on yohimbe have shown 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.

Yohimbe can also cause dangerous side effects, such as:

You should not use yohimbe if you have a heart disease, a mental health disorder, or kidney disease.

The efficacy of ED pills is promising, but the results vary. PDE5 inhibitors continue to be the first line of treatment. Your doctor might recommend another option if such medications fail to help or cause side effects. ED can be uncomfortable to discuss with your doctor at first, but know that this is a common medical issue.

Never self-treat ED with over-the-counter herbs and supplements. Not only are these not regulated for safety by the FDA, there is also no proof that they actually work.

It’s best to get a complete checkup, since ED is often related to other health issues. Treating any underlying cause will often help improve the ED as well. The Massachusetts Male Aging Study, for instance, found that depression and ED are often related. The following may also be associated with ED:

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