Treating erectile dysfunction (ED)

Erectile dysfunction (ED) is the condition of not being able to get or keep an erection that’s firm enough for sexual intercourse. It’s often caused by an underlying health problem.

The Urology Care Foundation estimates that this condition affects 30 million men in the United States. For some men, treatment with drugs may resolve their ED.

If you’re looking for options to treat your ED, check out the list below. Information such as how to take these drugs and what the side effects are can help you discuss drug treatment options with your doctor.

There are many types of drugs used to treat ED. Each drug works differently, but they all improve sexual activity by stimulating blood flow to the penis.

The most common ED drugs belong to a group known as phosphodiesterase type 5 (PDE5) inhibitors. They block certain enzyme activity that leads to ED.

If you have certain health conditions, it may not be safe for you to take ED drugs. For instance, if you have heart disease, your heart may not be healthy enough for sex.

Make sure you tell your doctor about all of the health issues you have and the medications you’re taking. This information can help your doctor decide which drug is best for you.

Alprostadil

Alprostadil (Caverject, Edex, MUSE) comes as an injectable solution and as a penile suppository.

You’ll inject the solution directly into your penis 5 to 20 minutes before having sex. You can use it as needed up to three times per week. You should let at least 24 hours lapse between injections.

With MUSE (or Medicated Urethral System for Erections), the suppository should be administered 5 to 10 minutes before sex. It should not be used more than twice in a 24-hour period.

The more common side effects of this drug include pain in the penis and testicles, as well as burning in the urethra.

Avanafil

Avanafil (Stendra) is an oral drug and a PDE5 inhibitor. You should take it about 15 minutes before having sex. Do not take it more than once per day.

You should not use any PDE5 inhibitors if you’re also taking nitrates to treat heart disease. Examples of nitrates include isosorbide mononitrate (Monoket) and nitroglycerin (Nitrostat). Taking nitrates with avanafil can cause severely low blood pressure and even death.

The more common side effects of this drug include:

Sildenafil

Sildenafil (Viagra) is also a PDE5 inhibitor. Viagra is only available as an oral tablet. You should take it only once per day, about 30 minutes to an hour before sex.

The more common side effects of this drug include:

  • headache
  • flushing
  • stuffy or runny nose
  • back pain
  • upset stomach
  • muscle aches
  • vision changes, such as blurry vision and changes in how certain colors look

Tadalafil

Tadalafil (Cialis) is an oral drug that increases blood flow throughout your body. You take this PDE5 inhibitor about 30 minutes before sex, no more than once per day. It may work for up to 36 hours.

The more common side effects of this drug include:

  • headache
  • flushing
  • stuffy or runny nose
  • back pain
  • upset stomach
  • pain in the limbs

Testosterone

Testosterone is the main sex hormone in the male body. It plays many roles in overall health.

Testosterone levels naturally drop with age. This change can lead to ED and other issues, such as:

Doctors sometimes prescribe testosterone to treat ED. In fact, PDE5 inhibitors are most effective when used alongside testosterone therapy in men with a testosterone deficiency. However, the drug does come with risks.

Testosterone can increase your chance for a heart attack or stroke. Because of these risks, the Food and Drug Administration (FDA) says that only men who have low testosterone due to certain health issues should use testosterone.

Your doctor will watch you closely if they prescribe testosterone. They’ll test the levels of testosterone in your body before and during your treatment with this drug. If your testosterone levels are too high, your doctor will stop your treatment or lower your dosage.

Side effects of testosterone may include:

Testosterone for ED comes in many forms. The table below lists the forms of testosterone and their brand-name versions. Some forms may also be available as generic drugs.

Testosterone formBrand names
Transdermal creamFirst Testosterone Cream 2%
Transdermal gelAndroGel, Fortesta, Testim, and Vogelxo
Transdermal patchAndroderm
Transdermal solutionNone (only available as generic)
Topical gelAndroGel and Natesto
Nasal gelNatesto
Oral capsuleTestred
Oral tabletAndroid 25
Mucoadhesive film that dissolves under your gumsStriant
Pellet implantTestopel
Solution for intramuscular injectionDepo-Testosterone and Aveed

Vardenafil

Vardenafil (Levitra, Staxyn) is an oral drug and a PDE5 inhibitor. You take it as needed 60 minutes before sex. You can take this drug up to once per day, your doctor’s recommendation.

The more common side effects of this drug include:

  • headache
  • flushing
  • stuffy or runny nose
  • back pain
  • upset stomach
  • dizziness

Vitamins and supplements for ED

There are many vitamins and supplements on the market that claim to help ED. Some promise better sexual function as well as increased energy and vitality. However, these supplements usually do not work. They may also be unsafe.

Some supplements that are marketed as “natural” may even contain drugs. ED supplements can still interact with other medications you’re taking. They may also cause side effects.

Talk with your doctor before using any vitamins or supplements for ED.

Not everyone with ED needs to take medications. If you think you have ED, see your primary care doctor. They’ll do a physical exam and request certain lab tests, as well as a complete medical and psychosocial history.

They may also refer you to a mental health professional, who can help you manage performance anxiety or relationship issues related to your ED.

ED caused by underlying conditions

Your ED may be caused by untreated diabetes, high blood pressure, or another issue. Treating that condition first may improve your ED symptoms.

ED caused by medications

Other medications you’re taking may cause ED. These may include drugs used to treat:

Your doctor can review the drugs you’re currently taking. They may make some changes that could improve your ED.

ED caused by lifestyle choices

Sometimes lifestyle choices can contribute to ED. Adopting habits that promote overall health and well-being may help improve your symptoms. Try limiting or avoiding smoking, if you smoke, maintaining a moderate weight, getting regular exercise as often as possible, and consuming alcohol on a limited basis.

The best place to get medications for ED is from your doctor or a licensed medical professional. Although there are some online pharmacies that may sell or deliver ED medications, these are often unregulated and may contain ineffective or harmful ingredients.

If you have signs of ED, keep in mind that the condition is often caused by another medication you’re taking or a health condition. Getting treatment for the underlying health issue or having your doctor adjust your drug regimen may be all that’s needed to ease your symptoms.

If you do need ED medications, there are many options. They come in different forms and work in unique ways. They also can cause side effects that are specific to the medication.

Together, you and your doctor can find the best ED medication for you.