Erectile dysfunction (ED) is a condition in which a man is unable to get or sustain an erection firm enough for satisfactory sexual intercourse all the way through to orgasm. Many men are too embarrassed to talk about this problem, but health care professionals, such as primary healthcare providers and urologists are able to treat ED. Although ED is very common, it is not a normal part of aging. 

ED used sometimes to be called impotence, but healthcare professionals prefer to use the term less now because it carries negative nonmedical meanings of the word. ED is in fact very common, and affects about thirty million men in the United States.

There are several options for treatment of ED. In the short list below, we are summarizing the main options that you have. Don’t forget to talk to your healthcare provider to see which one of these can best work for you.

Oral medications – phosphodiesterase 5 (PDE5) inhibitors work by relaxing the blood vessels connected to the penis. This allows more blood to flow into the chambers and helps sustain an erection. All PDE5 drugs only work when you are sexually aroused. It is necessary to take the pill between 30 minutes and one hour but not more than 3-4 hours before starting sexual arousal. All PDE5 drugs share common side effects such as facial flushing, headaches, stomach upset/diarrhea/nausea, flu-like symptoms.

Cialis (tadalafil)Available as a tablet in 4 different doses. Known as the weekend pill because it can sustain the erection for up to 36 hours, so more than one dose each day is not needed.
Pros: Works longer than all other PDE5 drugs, which means multiple dosing is not needed. Wider dosing range makes it easier to get the right dose after trials.
Cons: Unusual side effects are abnormal ejaculation and prolonged painful erections (priapism lasting more than 6 hours)
Viagra (sildenafil)Available as a tablet in 3 strengths (20mg, 10mg, 5mg, 2.5mg). 

Pros: Works quickly, to promote erection within one hour
Cons: Erections only last 1-4 hours. 
Levitra (vardenafil)Available in only one dosage – 20mg.

Pros: Works slightly longer than Viagra, and is not affected by food.
Cons: Smaller dose (20mg) than Viagra makes getting the right timing more difficult.

Testosterone Replacement – Low testosterone can contribute to issues with forming and maintaining an erection. As you age, your testosterone levels fall off by about ten percent each decade after the age of forty.

Creams
AndroForte® – AndroForte testosterone cream is a bioidentical, pharmaceutical grade hormone cream designed to target low testosterone levels in men. It comes in 5% and 2% strengths.

Injectable medications – Can be injected into the penis or as a urethral suppository pellet inserted into the urinary opening of the penis

Caverject (alprostadil urogenital) –
Pros: Fast acting, gives an erection within 20-30 minutes
Cons: For injections – minor pain or bleeding at the injection site. Prolonged erection (priapism) after sex. Danger of the formation of scar tissue within the deeper tissues of the penis, mainly for long-term users.
Cons: For insertables – pain when inserting. Damage to the urethra. Prolonged erection (priapism) after sex.

Physical devices

Vacuum Erection DevicesAlso called a penile pump, it works by manually pulling blood into the penis using suction. 
Pros: Useful mainly when all other remedies have fails, or where there are allergies to oral meds
Cons: Side effects of using a penile pump include mild bruising, restricted ejaculation
Penile Prosthesis  implantA penile prosthesis is a water chamber inserted into the erection chambers of the penis. This involves a 30- to 45-minute surgical procedure. 

Pros: It enables reliable control exactly when and how long an erection lasts
Cons: Expensive ($15,000 – $20,000). Risks of surgical accidents, and the device can rupture or break.

Lifestyle changes

– Quit smoking
– Limit or stop drinking alcohol, especially just before sex
– Increase physical activity and maintain a healthy body weight
– Stop recreational drug use
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