The treatment for ED depends on what is causing it.
Your health care provider may ask you to change certain habits, stop smoking, or using drugs or alcohol. He or she may suggest treatment for emotional problems, relationship conflicts, depression, or performance anxiety. Or you may be asked to change the way you take other medicines. (Never stop or change any drug without first talking to your health care provider.)
Testosterone Replacement Therapy
If a blood test shows low testosterone levels (low T), testosterone replacement therapy (TRT) may help. However, adding TRT will not help your erection problems if you have normal testosterone levels.
Dietary supplements (often called "herbal remedies") for ED are popular but may not be safe or even work. Unlike prescription drugs, they do not have to be proven to work to be sold. Check with your health care provider before you take any supplements or drugs to treat your ED.
Most of the best-known treatments for ED work well and are safe. But in making your choice, ask your health care provider about any possible problems that could result with each option:
- Vacuum erection device
- Oral drugs
- Drugs in the penis
Vacuum Erection Device
Vacuum Erection Device
National Institute of Diabetes and Digestive and Kidney Diseases,
National Institutes of Health
A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body. A pump at the other end of the tube creates a low-pressure vacuum around the erectile tissue, which results in an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. With proper training, 75 out of 100 men can get a working erection using a vacuum erection device.
Drugs known as PDE-5 inhibitors relax muscle cells in the penis and increase blood flow. (These are the drugs you often see on TV and in Internet ads.)
- Viagra® (sildenafil citrate)
- Levitra® (vardenafil HCl)
- Cialis® (tadalafil)
Men with ED take these pills before having sex. The drugs boost the natural signals that are generated during sex to help you have a better erection that lasts longer. The drug works by relaxing the muscle cells in the penis, letting the blood flow better to give a firm erection. These drugs often work well, and nearly 80 out 100 men show improvement once they start using them.
The side effects of PDE-5 inhibitors are mild and often last just a short time. The side effects also get weaker the longer you use the drug. The most common side effects are:
- Stuffy nose
- Muscle aches
In rare cases, sildenafil can cause blue-green shading of vision that lasts for a short time. There is no long-term risk and the problem goes away as the amount of the drug in the body lowers. It is important to follow the instructions for taking this drug to get the best results.
If you are taking nitrates for your heart, you should speak with your health care provider before using a PDE-5 inhibitor to learn how it might affect your health.
Drugs in the Penis
If oral drugs don't work, another drug, alprostadil, is approved for use in men with ED. This drug comes in two forms, depending on how it is to be used:
Medical Injections for Impotence
The drug is injected into the side of penis with a very fine needle. The success rate for getting an erection firm enough to have sex is as high as 85%.
Transurethral Therapy for Impotence
A tiny medicated pellet of the drug is placed in the urethra (the tube that carries urine out of your body). Using the drug this way avoids having to give yourself a shot, but makes it less likely to work.
The most common side effects of alprostadil are a burning feeling in the penis, and an erection that can last for over four hours and need medical attention to make it go down.
When other treatments do not improve ED, your health care provider may offer you surgery. Surgeries that help treat ED are penile implant surgery and surgeries to fix problems with blood vessels in the penis. Fixing blood vessels only helps in very specific cases.
Penile implants (also called penile prostheses) are devices that are placed completely inside your body. They produce a stiff penis that lets you have normal sex. Penile implants are a good treatment choice for some men. There are two types of penile implants.
The simplest kind of implant consists of 2 easy-to-bend rods that are most often made of silicone. These silicone rods give the man's penis the firmness needed to have sex. The implant can be bent downward for peeing or upward for sex.
Penile Pump Implant - Inflatable
Image © 2003 Fairman Studios, LLC.
With an inflatable implant, fluid-filled cylinders are placed lengthwise in the penis. Tubing connects these rods to a pump that is placed inside the scrotum (the sac that holds the testicles). When the pump pushes fluid into the cylinders, they make the penis hard. Inflatable implants are the most natural feeling of the penile implants, as they let you control firmness and size.
In the simplest inflatable implants, the pump moves a small amount of fluid into the cylinders for erection then out again when erection is no longer needed. These devices are often called 2-part (or 2-component) penile implants. One part is the paired cylinders and the second part is the scrotal pump.
A 3-part inflatable penile implant has paired cylinders, a scrotal pump, and a fluid reservoir in the belly. With these three-part devices, a larger volume of fluid is pumped into the cylinders for erection and out of the cylinders when erection is no longer needed.
What is the Surgery Like?
Penile implants are usually placed under anesthesia, during a 1-hour surgery. Usually 1 small surgical cut is made either above the penis where it joins the abdomen or under the penis where it joins the scrotum. No tissue is removed, blood loss is small and blood transfusion is almost never needed. A patient will usually spend 1 night in the hospital for observation.
Most men have pain after the surgery for about 4 weeks. During this time, oral pain medicine is needed and you are not allowed to drive. If men limit their physical activity while pain is present, the pain usually ends sooner. Men can often be taught how to use the prosthesis for sex 1 month after surgery, but if there is still pain and soreness this may be delayed for another month.
If there is an infection, or the implant fails to work, it will usually have to be removed. On rare occasions, the device can cause pain or reduced feeling. It is important to know that after an implant is placed, other non-surgical treatments will no longer work if that prosthesis is removed. Fortunately, most men with penile implants and their partners say that they're satisfied with the results.
Penile Arterial Revascularization
Young men (under 45) who have had injuries to the pelvis or penis are most likely to be helped by this treatment. This surgery fixes problems with blocked or injured blood vessels in the penis. It may help in rare cases. It is mostly considered for men with no known risk factors for hardened arteries. When an accident leaves a penile vessel too injured or blocked to carry blood, the surgeon may connect to a nearby artery to get around the site. This can clear a pathway so enough blood can be supplied to the penis to cause an erection.
Venous Ligation Surgery
This procedure binds leaky penile vessels that cause the penis to soften during an erection. Because proper firmness depends on blood flow through the arteries and relaxation of the spongy tissue in the penis, blocking off leaky veins makes sure there is enough blood trapped in the penis to create a good erection. Since long-term success rates are less than 5%, this technique is rarely a choice for correcting ED.
Vascular surgeries are still thought of as experimental by some, and may not be covered by your health plan.
Neither the penile arterial revascularization or venous ligation surgeries are recommended if you use tobacco or have:
- insulin-dependent high blood sugar
- widespread hardened arteries
- high blood serum cholesterol levels
- injured nerves
- diseased and/or wide-spread damaged blood vessels