ED Treatment Options

Medical treatment begins with addressing your heart and vascular health, both of which have a significant impact on erectile dysfunction. Heart disease care, diabetes management (diet and medication), endocrine normalization and other medical practices may be the only treatment you need to cure your erectile dysfunction. For example, if it's found that the medications you've been prescribed are the underlying cause, your primary care physician may shift you to prescriptions less likely to cause ED or simply lower the dosage.

Perhaps the best-known treatments for erectile dysfunction are oral medications, such as tadalafil, avanafil, vardenafil and sildenafil (better known by their brand names: Cialis, Stendra, Levitra and Viagra) which relax the muscles in your penis to increase blood flow. These medications are usually taken just before you plan to engage in sexual activity. When you are sexually aroused, improved blood flow will get and keep your penis erect.

The most common side effects of oral medications for erectile dysfunction are headache, runny nose, flushing, blurred vision, back pain, light sensitivity and indigestion. 

However, you may suffer serious side effects from ED oral medications if you are taking medications for the following:

• Advanced liver disease
• Kidney disease, especially if you're on dialysis 
• Angina, if you're taking nitrate drugs such as nitroglycerin 
• Severe hypertension or hypotension

Another type of treatment for erectile dysfunction is penile injection therapy, which involves using a needle to inject medication (such as Trimix, Papaverine or Bimix) into your penis to improve blood flow. For maximum effectiveness, you should inject within 15 minutes of planned sexual activity; you will be given training on how to perform the injection properly.

Penile injection therapy should not be carried out at the same time as taking oral medications for erectile dysfunction. The guidelines for using oral medications in conjunction with penile injections are as follows:

• Within 18 hours (before or after, for a total of 36 hours) of injection, do not take:
  • Viagra (20-100 milligrams)
  • Stendra (50-200 milligrams)
  • Levitra (10-20 milligrams)
• Do not use the penile injection within 72 hours of taking a 10-20 milligram dose of Cialis
• Consult with your urologist on how to use the penile injection if you are taking up to 5 milligrams of Cialis every day

Wearable, medical-grade devices, such as constriction devices or vacuum pumps can effectively help men address the issue noninvasively. These devices—Eddie by GiddyⓇ, is an FDA-registered Class II example—are placed around the base of the penis to constrict blood flow during sex and help maintain an erection. They are available without a prescription and come without the side effects of ED medications or the risks of injections or surgery.

You may also consider intraurethral suppositories. With this treatment, you insert a pellet (approximately the size of a rice grain) with medication into the urethra of your penis. As the pellet dissolves, blood flow increases so you can achieve an erection.

Consider a visit with a physical therapist to learn Kegel exercises. Weakened pelvic floor muscles due to diabetes, prostate surgery or an overactive bladder could affect your ability to get and maintain an erection. Kegel exercises can strengthen your pelvic floor muscles in just a few weeks, but they shouldn't be a primary or sole modality.

Your physical and medical condition will dictate your surgical options. Surgery may be the only option for men whose ED is due to past surgical procedures in the pelvis or past physical trauma. There are several options your surgeon will discuss with you to identify what best fits your lifestyle and medical conditions.

Penile prosthesis

A more permanent solution, penile prostheses allow for more spontaneity than medication or a vacuum device. Neither the malleable nor inflatable implant changes the sensation on the skin or the ability to orgasm and ejaculate. The malleable implant is a semi-rigid rod surgically placed in the penis. It provides permanent firmness you can conceal by manually bending the penis downward. Inflatable implants come in two-piece and three-piece varieties and are surgically placed. You inflate them before sex and deflate them after intercourse.

Microsurgical penile revascularization

This procedure is also called microvascular arterial bypass surgery and works in the same way as a cardiac bypass. It's used in men younger than 50 who may have had a blunt trauma injury with a localized arterial lesion. The surgeon uses a donor artery from the leg to bypass the arterial lesion that is slowing blood supply to the penis.

In addition to the medical and surgical options, there are some natural or alternative treatments you could consider, but be sure to have a full physical exam before trying any of them. Erectile dysfunction may be the first symptom of a more serious underlying medical condition such as heart disease, vascular disease or type 2 diabetes, so it's important to consult a doctor. If you receive a clear medical examination, you may wish to try an alternative treatment first.

One study in 2017 found people with erectile dysfunction also had low levels of L-arginine, an amino acid that is a vasodilator, which means it helps open blood vessels and increases the blood supply to the penis. More research is necessary to determine the safety and effectiveness of this remedy. (Keep in mind that almost no supplements are tested or approved by the U.S. Food and Drug Administration, so caution is always encouraged.) If you are taking drugs such as Viagra, avoid using L-arginine because the combination can cause your blood pressure to drop too low.

Ginkgo biloba and ginseng, or Panax ginseng, are both popular home remedies that may help to increase blood flow to the penis and combat ED. To date, the National Center for Complementary and Integrative Health indicates there's not enough evidence to support the use of Ginkgo biloba. Preliminary studies have suggested ginseng may be useful, but more research is necessary to confirm the effects.

Physical and mental health conditions may trigger erectile dysfunction and offer insight into possible lifestyle changes that could help manage or prevent sexual dysfunction. Choosing healthy lifestyle options helps manage vascular conditions—type 2 diabetes, cardiovascular disease and high blood pressure are among them—and reduces symptoms.

Eating a healthy diet low in sugars and simple carbohydrates and high in omega-3 fatty acids can help support your cardiovascular system. Exercise helps you manage stress and maintain a healthy weight. Because tobacco damages your blood vessels, seek a program that will help you successfully quit smoking if you're a smoker. Excessive alcohol or recreational drugs can reduce your sex drive and erectile function, too.

The outlook for ED is quite positive. If lifestyle factors are the cause of your erection issues, then adopting positive lifestyle habits should solve the problem.

If psychological issues such as stress and anxiety are causing your erectile dysfunction, there are personal steps you can take to reduce or get rid of them. If your own efforts are not enough, you should seek professional counseling to learn techniques for managing stress and anxiety so they do not negatively affect your sexual performance. 

If abnormal hormonal levels are causing your erectile dysfunction, then an endocrinologist can help get your hormones back into a normal range, which can restore full sexual function.

Even if your erectile dysfunction is related to a medical condition, there are many treatments available to help restore your ability to get and maintain an erection.