Erectile dysfunction (ED) occurs when a person can’t achieve or maintain an erection that stays hard enough for sex. A variety of treatment options are available for people with ED to treat both physical and emotional triggers.
For instance, issues with your blood circulation can affect how blood fills the vessels of the penis. Nervous system problems can affect how electrical impulses from the brain reach the nerves that trigger an erection. Problems with sex hormones like testosterone can also impact how the blood vessels of the penis dilate. Treatment for other conditions, like prostate cancer, can also make achieving an erection difficult or impossible without medical or surgical assistance. And medication side effects, alcohol and drug use, and mental health conditions can affect your ability to get and maintain an erection.
Once your doctor has determined what’s causing your ED, you can discuss ways to help your symptoms. Your treatment choices will depend on how severe the ED is and what other health conditions you have. Each therapy has pros and cons, so you and your doctor will have to weigh the benefits and risks when deciding which suits you. You and your partner may benefit from coming to a decision together, as well.
Several types of oral and injectable medications may help ED.
PDE5 Inhibitors
These medications, which you take by mouth, can boost the effects of nitric oxide — a chemical in your body that allows the blood vessels to dilate. This helps the penile tissues fill with blood, which supports getting an erection. Medications in this class include:
sildenafil (Viagra)
vardenafil (Levitra)
tadalafil (Cialis)
avanafil (Stendra)
Depending on the medication, you may need to take it with or without food, daily or as needed, and at different times before sex. These medications may not be safe if you also takes nitrate drugs, alpha-blockers, or drugs that block an enzyme called CYP3A4, including itraconazole (Sporanox, Tolsura), ketoconazole (Extina, Ketozole, others), and ritonavir.
Common side effects of PDE5 inhibitors include:
Headaches
Flushing
Blocked or runny nose
Indigestion
Rarely, a prolonged erection (called priapism) might occur, which may cause permanent penile damage. Seek immediate medical attention if you have any erection that lasts for four hours or longer after taking a PDE5 inhibitor.
Injectable Combination Drugs
Other drugs can be delivered by injection or as a pellet inside your penis to help create an erection. Drugs in this category include:
Trimix, which combines alprostadil (Muse), papaverine, and phentolamine, which are drugs from different classes that combine to relax smooth muscle and blood vessels in the penis
Bimix, which combines phentolamine and papaverine
Papaverine, which a doctor may prescribe on its own
A rare side effect of injections is Peyronie’s disease, which is a painful curvature of the penis. Incorrect injection technique can lead to scar tissue that affects how the penis curves, so be sure to talk to your healthcare provider about how to do the injections properly before moving forward. A medical professional will offer training on how to give yourself these injections at home, which often takes two consultations.
If you also take a PDE5 inhibitor medication, you should avoid taking a dose of it within 18 to 72 hours of an injection, depending on your medication and dosage. Talk to your doctor about these safety precautions.
Hormone Therapy
If your ED is linked to a low testosterone diagnosis, a doctor might recommend testosterone replacement therapy. Testosterone supplements (Androderm, AndroGel, or Fortesta) are available as pills, capsules, patches, gels, nasal gels, injections, or implantable pellets. The brand, dosage, and schedule will vary depending on which form you take.
Side effects are rare but might include acne, sleep apnea, swollen or tender breast tissue, or ankle swelling. Testosterone therapy also comes with risks if you overuse it, so talk to your doctor for any warnings and use only as directed.
A doctor may recommend surgery if medications or other conservative measures, like penis pumps, don’t help you get and keep erections.
Penile Implant Surgery
A surgeon may place an inflatable or non-inflatable implant in the penis. The implant surgery usually takes one or two hours under general anesthesia, after which you can generally return home.
Most men can use their implants about one month after having the procedure. After an implant procedure, medication will no longer work for ED, and you’ll always need the implant to achieve an erection. Your penis won’t look any different after it heals, and most people report that it feels similar during sex and that they’re still able to orgasm and feel pleasure.
Risks from implant surgery include infection and device malfunctions or breakages. The surgery or implant itself may also lead to excessive scar tissue, damage the urethra, or wear down layers of skin. It also risks giving the penis a shorter appearance than before, as it doesn’t extend to and harden the head of the penis. However, Cleveland Clinic suggests that more than 90 percent of people experience satisfaction with the results of a penis implant and that they last for around 20 years.
Inflatable Implant
The most common type of inflatable implant contains a pair of inflatable cylinders that a surgeon inserts into the erection chambers of the penis. They connect these cylinders to a small fluid container under the lower abdominal muscles and a pump inside the scrotal sac.
To inflate the device, simply squeeze the pump to transfer fluid. When you deflate the pump, the penis returns to being flaccid, or soft. Because the pump is inside your body, other people won’t know you have it.
Non-Inflatable Implant
This implant contains two bendable rods, often made of silicone. The rods help make the penis firm to enable sex. This type of implant allows you to manually adjust the position of your penis.
Penile Artery Bypass Surgery
Sometimes, surgery can help reroute blood vessels in the penis to restore erections in some people without needing implants or medications.This option is typically only suitable for younger people who have ED due to trauma like a fracture, excessive cycling, or penis injury that has blocked an artery. People with other risk factors like underlying diabetes, hypertension, or tobacco use disorder aren’t generally candidates for this procedure.
In the lead-up to surgery, the surgeon identifies a blocked artery as well as an artery from elsewhere in the body that’s long enough to be a suitable replacement. You’ll be able to return home the next day after surgery, but you’ll need to avoid having sex for about six weeks.
Some people experience side effects like swelling in the scrotum and occasional numbness on the surface of the penis.
Various lifestyle factors, like smoking or not getting enough physical activity, can interfere with your ability to get and maintain an erection. Making daily adjustments may help you manage ED without needing treatment.
Exercise
According to Cleveland Clinic, moving more might help. For some people, participating in three, 45-minute cardio sessions every week can reverse mild ED. ED has close links to the way blood moves through your veins, so engaging in workouts like jogging, fast walking, cycling, or swimming might help improve your circulation.
Stress Management
Working more relaxation into your day may help ED symptoms that are due to stress. According to a 2023 review, stress management helped support the effects of PDE5 inhibitors in some research. Relaxation techniques like deep breathing, yoga, or meditation may be unlikely to make much of a difference if ED has an underlying physical cause, however.
Avoiding Smoking
Quitting smoking is a powerful decision for your overall health that can also reverse ED a few months after your last cigarette.Talk to your doctor and support networks if you need help quitting.
Vacuum Constriction Device
A vacuum constriction device, also known as a “penis pump,” can help you get an erection immediately by pulling blood into the penis.
The device looks like a hollow tube with a battery-powered or hand-powered pump. You place the tube over your penis and use the pump to suck out the air inside the tube. This action helps pull blood into your penis, which leads to an erection.
Once you get an erection, you put a tension ring around the base of your penis to hold in the blood and keep your penis firm. Then, you can remove the vacuum.
The elastic ring stays in place for up to 30 minutes. Most of the time, a vacuum device allows for an erection that lasts long enough to have sex with your partner. You should remove the ring after intercourse.
Some possible side effects include bruising of the penis, skin irritation, and trouble ejaculating or weak ejaculation.
If your doctor suspects stress, anxiety, or depression are causing ED or resulting from it, they may refer you to counseling or sex therapy. While addressing a psychological cause of ED can help you reach an erection, also know that ED of any cause can lead to misplaced feelings of shame, embarrassment, or body image issues that can also impact relationships, so mental health care is still important.
A psychologist or counselor can help you learn coping techniques and address underlying stressors and anxieties. If you get a referral for a sex therapist or choose to see one, they can help you talk openly about sex with a partner, make sex feel more comfortable, and help you adjust behaviors and thought patterns that might be disrupting your sex life. Your partner might also want to attend these sessions and learn ways to support you.
While treating depression can potentially address a cause of ED, antidepressant medications carry a risk of ED as a side effect, especially those that interact with a brain chemical called serotonin. Treating depression is crucial, and medications are sometimes the most effective option. However, you can speak to your prescribing doctor or mental health professional about choosing an option with a lower risk of sexual side effects. These might include:
Atypical antidepressants like bupropion (Wellbutrin SR, Wellbutrin XL, others), mirtazapine (Remeron), vilazodone (Viibryd), and vortioxetine (Trintellix)
Serotonin and norepinephrine reuptake inhibitors (SNRIs) like desvenlafaxine (Pristiq), duloxetine (Cymbalta, Drizalma Sprinkle), and levomilnacipran (Fetzima)
Monoamine oxidase inhibitor (MAOI) like selegiline (Emsam)
Your doctor can balance your mental health needs with the risk of sexual side effects.
Most people with ED find that the symptoms, sexual impact, and mental health effects of their condition are treatable through medications, penis pumps, surgery, or psychological support.
Simple lifestyle changes can also help support better sexual function.
ED has a range of physical causes, so speak to a doctor if lifestyle changes don’t seem to have the effect you need.
