Erectile dysfunction

The first thing your doctor will do is to make sure you're getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner's preferences also might play a role in your treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra, Staxyn)
• Avanafil (Stendra)

All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing men to function normally. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in men who get normal erections.

The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.

Your doctor will consider your particular situation to determine which medication might work best. These medications might not fix your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor's OK. Medications for erectile dysfunction might not work or might be dangerous if you:

• Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Minitran, Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil)
• Have very low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension)
• Have severe liver disease
• Have kidney disease that requires dialysis

Other medications

Other medications for erectile dysfunction include:

• Self-injections. Several medications are commonly injected directly into the penis to achieve an erection. The most often used medications include alprostadil, papaverine, and phentolamine. With this method, you use a fine needle to inject the medications into the base or side of your penis.
  The goal of injection therapies is to produce an erection that lasts about 20 to 40 minutes. If an erection lasts longer than one hour, you will need to have the medication or dose adjusted to avoid potentially long-term complications. Because the needle used is very fine, pain from the injection site is usually minor.
  Side effects can include bleeding from the injection, prolonged erection (priapism) and formation of fibrous tissue within the penis or at the injection site.
• Alprostadil urethral suppository. Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.
  The erection usually starts within 10 minutes and lasts between 30 and 60 minutes. Side effects can include pain, minor bleeding in the urethra and formation of fibrous tissue inside your penis.
• Testosterone replacement.Some men have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step.
  Testosterone replacement therapy can be delivered via injection, patch, gel, gum and cheek (buccal cavity), intranasal, subcutaneous pellet, or oral medication. Talk to your doctor about your personal preference and the possible side effects.

Penis pumps, surgery and implants

If medications aren't effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include:

• Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.
  Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.
  The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.
  If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model.
• Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or semirigid rods. Inflatable devices allow you to control when and how long you have an erection. The semirigid rods keep your penis firm but bendable.
  Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among men who have tried and failed more-conservative therapies. As with any surgery, there's a risk of complications, such as infection.
• Blood vessel surgery.Rarely, erectile dysfunction is treated by bypassing obstructed penile arteries. This is uncommon, however, and is only recommended in a small percentage of men.