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Erectile dysfunction treatments
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Most of the tablets you take for erectile dysfunction are known as phosphodiesterase type 5 (PDE5) inhibitors. These help to increase blood flow to the penis. This increase in blood flow is what makes a penis erect. The tablets also increase the amount of nitric oxide in your body. This helps to relax and open the blood vessels in your penis so that blood can flow more easily.
There is also a different type of medication for erectile dysfunction known as prostaglandin E1 (PGE1), which is used directly on the penis, rather than as a tablet. This comes as a cream and an injection. This also helps to relax and open the blood vessels in your penis so that blood can flow more easily.
Taking erectile dysfunction tablets alone will not give you an erection. You must have some form of sexual stimulation (something that turns you on) too. The tablets will allow you to get an erection when you are stimulated.
There are 6 different types of licensed PDE5 inhibitors in England. They all work in similar ways but each one has a slightly different chemical makeup.
Viagra and Sildenafil
The active ingredient in Viagra is sildenafil citrate. Viagra is the brand name for the generic drug sildenafil. They can be taken up to 4 hours before you have sex and can have an effect for up to 5 hours. They work best when taken on an empty stomach 1 hour before sex.
Viagra Connect is available over the counter at a pharmacy, so you do not need a prescription. You will have to fill out a questionnaire at the pharmacy, which will be reviewed by the pharmacist before you are given Viagra Connect.
Cialis and Tadalafil
Cialis is a licensed medication for the treatment of erectile dysfunction. The effects last a lot longer than Viagra, with a duration of up to 36 hours. Tadalafil is a generic (unbranded) version of Cialis, which means it works exactly the same but costs less. Cialis and tadalafil can also be used at a lower dose that’s taken every day so you do not have to plan when you have sex.
Levitra contains the active ingredient vardenafil. The effects can last for 5 to 8 hours, and the tablets should be taken around 30 minutes before having sex. There is also another form of this treatment that dissolves on the tongue, which may work faster.
The active ingredient in Spedra is avanafil. It should be taken around 30 minutes before having sex and the effects can last up to 6 hours.
We also provide a different kind of treatment to the PDE5 inhibitor tablets. Vitaros is a cream that is applied directly onto the penis. It contains a synthetic (man made) version of PGE1.
In normal circumstances erectile dysfunction treatments are perfectly safe. As with any medication though, there can be some side effects.
Common side effects
Some common side effects of PDE5 inhibitors include:
- tummy problems
- aches and pains
- changes in vision
- hot flushes
- a runny nose
Rare and uncommon side effects
Severe but rare side effects of PDE5 inhibitors include:
- priapism (where your erection lasts longer than 4 hours and is painful)
- changes in your hearing
- loss of vision
Common side effects around the penis area when using PGE1 treatment (like Vitaros cream) are:
- pain, itching or tenderness
- throbbing or tingling
- inflammation or irritation around the head of the penis
Your partner may also have mild burning or itching symptoms in their genitals during or after sex.
You should tell your doctor if you are taking any other medication before being prescribed erectile dysfunction treatment. They will make sure it is safe for you to do so.
If you are taking medicine that contains nitrates, or have a GTN spray for angina, you must not take PDE5 inhibitors. Taking the 2 drugs together can cause a dangerous or fatal drop in your blood pressure. This is also the case for recreational drugs like amyl nitrates ( ‘poppers’). .
Other medications that can interact with erectile dysfunction treatments include some forms of high blood pressure treatment and certain antibiotics, antivirals or antifungal treatments. You should also avoid grapefruit or grapefruit juice for 24 hours before using erectile dysfunction treatments.
Unless your doctor says it is okay, you should not take PDE5 inhibitors if you have:
- low blood pressure (hypotension)
- had a stroke or heart attack recently
- unstable angina
- a history of non arteritic anterior ischaemic optic neuropathy (this condition causes a sudden loss of vision)
- been told not to have sex for medical reasons
Unless your doctor says it is okay, you should not use PGE1 treatment (like Vitaros cream) if you:
- have a penile implant, a deformity of the penis or a current infection or inflammation of the penis
- have been told not to have sex for medical reasons
- are using other erectile dysfunction treatments
- are prone to prolonged erections (erections that stay erect for a long time and are painful)
- are using medications that thin the blood
- want to have a child or your partner is pregnant as the effects in pregnancy are unclear
There are lots of other options if you need help getting and keeping an erection. Some are medical treatments and others are non medical treatments that you may want to try first before anything else.
Vacuum erection devices
When you put one of these on, it creates a vacuum around your penis. You then use a small hand pump to draw air from the vacuum, which draws blood into the penis and makes it erect. A band then fits around the base of the penis to maintain the erection for no more than 30 minutes for safety.
If low testosterone (male hormone) is detected in your blood, you may use injections, patches, or gels to replace it. This may improve your mood and sex drive, but it is not proven to improve erectile dysfunction.
These can be used if your erectile dysfunction is not improving with usual erectile dysfunction treatments, like Viagra or Cialis. A synthetic (man made) hormone is injected into the penis to increase blood flow. It is perfectly safe and you can be trained to do it yourself.
There are two types of penile implant, semi rigid and inflatable. Semirigid implants are always hard but can be turned away from the body for sex, or towards the body to cover it. Inflatable implants mean you can inflate or deflate the implant and get an erection as and when needed.
There are some lifestyle changes you can make yourself that may improve your erectile dysfunction symptoms over time.
Changes you can make yourself include:
- quitting smoking
- exercising regularly
- avoiding too much alcohol
- avoiding taking drugs
- lowering your stress levels
Erectile dysfunction (ED) is when you have trouble getting or keeping an erection. It affects around 30 million men worldwide and there are lots of different things that can cause it. The most common causes of ED are either psychological (in the mind) or physical (in the body).
Psychological causes of erectile dysfunction can include:
- relationship troubles
Physical causes of erectile dysfunction can include:
- issues with your blood circulation
- high blood pressure
- high cholesterol
- an injury
- changes in hormone levels
Common risk factors include:
- being over 50 years old
- smoking, alcohol, or drugs
- being overweight
- poor diet
- lack of exercise
- high blood pressure or sugar levels (diabetes)
- cardiovascular disease
- high cholesterol
Yes, erectile dysfunction is common and can happen to you at any age, although most of the time it is temporary.
Erectile dysfunction is seen in around 55% of men between the age of 40 to 70 years old, and becomes more common as you get older.
Whilst erectile dysfunction is common, you should discuss it with your doctor if it keeps happening as it could be a sign of a different health problem.
No, erectile dysfunction is not permanent. Most of the time it will go away on its own if it’s linked to stress or anxiety.
Whilst there are treatments available to help reverse erectile dysfunction, completely curing it depends on the underlying condition. Treatments help by increasing blood flow to the penis. You should speak with your doctor to find out which erectile dysfunction medication is best for you.
Yes, stress can cause erectile dysfunction. If you find stress is affecting your sexual performance in general, this may need to be treated separately.
Your doctor may refer you to a therapist or offer medication to improve your mental health, and see if erectile dysfunction happens less often as a result.
No, erectile dysfunction does not affect fertility as your sperm are not affected by it.
If you are having a problem getting an erection, you may have trouble getting your partner pregnant since you need to be hard and ejaculate so your sperm can enter their womb.
The health of your sperm is what can affect your fertility, so if you are having problems conceiving, speak to your doctor about your options.
Dr Kathryn Basford
Dr Kathryn Basford is a qualified GP who works as a GP in London, as well as with ZAVA. She graduated from the University of Manchester and completed her GP training through Whipps Cross Hospital in London.Meet our doctors
Article created: 20 Aug 2021
Last reviewed: 04 Nov 2021
How do pills for erectile dysfunction work? International Society for Sexual Medicine (Accessed 8 July 2021)
What is Erectile Dysfunction? (June 2018) Urology Care Foundation (Accessed 8 July 2021)
Erectile dysfunction (impotence) (August 2020) NHS (Accessed 8 July 2021)
7 Common Side Effects of Erectile Dysfunction Medication (January 2019) Healthline Media (Accessed 8 July 2021)
Predictors of Sexual Dysfunction Incidence and Remission in Men (May 2014) The Journal of Sexual Medicine (Accessed 8 July 2021)
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(Reviews are for ZAVA UK)