There's a wide range of treatments for erectile dysfunction. Some are pills, and others are injections or devices that should be used just before sex. There are also treatments involving surgery.
Medications for erectile dysfunction include phosphodiesterase inhibitors, prostaglandins, and testosterone.
Phosphodiesterase inhibitors: This class of medications includes sildenafil,* tadalafil, and vardenafil. They work by inhibiting an enzyme called phosphodiesterase type 5 (PDE-5). This enzyme normally breaks down a molecule called cGMP. Inhibiting the enzyme makes more cGMP available, which leads to relaxation of smooth muscles in the penis, allowing more blood to enter and helping to produce an erection. These medications are taken before sex and will cause an erection only when the man is sexually stimulated.
The time the dose should be taken and how long the effects last depend on the medication used. The most common side effect of these medications is a headache. However, there is a potential for certain dangerous drug interactions. Anyone taking this medication must let his doctor know about any medications he's on, and especially if he's taking nitrates (e.g., nitroglycerin spray, nitroglycerin pills, or nitroglycerin patch) for heart problems.
Prostaglandins (alprostadil): Alprostadil can be injected into the penis or inserted as a pellet through the urethra. It causes an erection that usually lasts about 60 minutes. The danger with this method is that too high a dose can cause priapism, an erection that won't go away. This condition can cause serious bruising, bleeding, and pain. Once the doctor is sure of the right dose, the man can self-inject at home.
Some doctors may prescribe a combination of alprostadil with additional ingredients such as phentolamine to help the medication work more effectively. This mixture is prepared by the pharmacy according to the directions of the prescribing doctor. It is injected into the penis before sex.
Testosterone: This is only useful for people with specific disorders like hypogonadism (small testicles) that result in lower than normal amounts of testosterone in the blood stream. Testosterone increases interest in sex, as well as erections.
Common non-medication ways of treating erectile dysfunction include vacuum devices and penile implants.
Vacuum devices: This involves placing a tube over the penis, forming an airtight seal around the base. By pumping air out of the tube, blood can be drawn into the penis. Placing a ring around the base of the penis will maintain the erection.
Penile implants: This treatment involves permanent implantation of flexible rods or similar devices into the penis. Simple versions have the disadvantage of giving the user a permanent erection. The latest (and most expensive) device consists of inflatable rods activated by a tiny pump and switch in the scrotum. Squeezing the scrotum stiffens the penis, whether the person is aroused or not. The penis itself remains flaccid, however, so the diameter and length are usually less than a natural erection, and hardness is lacking, although it's sufficient for intercourse.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
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