Medically reviewed by: Thomas Fischer (Pharmacist). This article has been written according to strict guidelines and medical standards. More InfoThis content is based on the current state of medical knowledge. All information has been carefully researched and sources are listed at the end of the article. Our articles meet a high quality standard. Our goal is to present medical topics in a comprehensible language.
Medically reviewed by: Thomas Fischer (Pharmacist) More InfoThis content is based on the current state of medical knowledge. All information has been carefully researched and sources are listed at the end of the article. Our articles meet a high quality standard. Our goal is to present medical topics in a comprehensible language.
Erectile dysfunction (ED) is a condition for which many people are seeking treatment. Fortunately, there are a vast number of treatment options.
To help you understand more about each type of treatment, we are providing information on the impotence treatments available. Read on to learn all you need to know about erectile dysfunction treatments.
Erectile Dysfunction: Causes
Erectile dysfunction can have many causes. Some of these are:
- Side effects of medication
- Recreational drugs and nicotine
- Obesity
- Hormone imbalances
- Sleep apnea
- Psychological and emotional causes
- High cholesterol
- Biking
- Nerve Problems
- Kidney Disease
- Prostate Surgery and Radiation Therapy
- Problems with the Penis
Side Effects of Medications
At least one-fourth of ED cases can be attributed to the side effects of drugs taken for other conditions. The following classes of medications can sometimes cause impotence as a side effect:
- Diuretics
- Antidepressants (especially SSRIs and SNRIs)
- Medicines for indigestion
- Antihistamines
- Opiod pain meds
Some medications for Parkinson’s disease and prostate cancer can cause ED, as can some chemotherapies. However, these medications do not produce as significant an effect as those in the bulleted list above.
If the side effects of medication are causing your ED, your doctor may be able to prescribe a different medication that will enable you to avoid this side effect. Alternatively, they might prescribe a lower dose that will not cause this side effect.
Recreational Drugs and Nicotine
Substances such as alcohol, marijuana, heroin, cocaine, amphetamines, methadone, and barbiturates can contribute to erectile dysfunction. Nicotine use, whether smoked or vaped, can also be a cause of ED.
If you have erectile dysfunction and smoke, drink alcohol, or use recreational drugs, you may need to take a look at those habits. Reducing your use or stopping altogether could solve your ED problems.
Obesity
Obesity puts you at risk for type II diabetes, high cholesterol, and high blood pressure. All of these are causes of ED. Obesity also lowers testosterone levels, which affect erectile function. So, by treating obesity, you will likely be addressing your ED issues as well. Consider eating healthier and exercising to lose weight. Improved erectile function may be one of the many health benefits.
Hormone imbalances
Several hormonal imbalances can lead to ED:
- Abnormal cortisol levels
- Low testosterone levels
- High levels of prolactin
- Thyroid hormone imbalance
If a hormone imbalance is the cause of your erectile dysfunction, treating the hormonal problems will likely improve erectile function for you.
Sleep Apnea
Men with obstructive sleep apnea (OSA) have a higher risk of ED than others. While researchers haven’t determined exactly why this is true, it may be related to lower blood oxygen levels caused by OSA. This problem can be treated using an overnight breathing mask (also called a CPAP). As blood oxygen levels improve, sexual function typically improves as well.
Psychological or Emotional Causes
The brain is the body’s control center and, as such, is vital in the physical process of getting an erection. Because of this, ED can stem from performance anxiety, relationship difficulties, anxiety, trauma, stress, and depression. Sometimes ED has both emotional and physical causes.
Some possible treatments for these problems that may, in turn, improve ED symptoms are:
- Counseling
- Psychotherapy
- Treatments for anxiety, stress, and depression
High Cholesterol
High cholesterol can cause damage to blood vessels. Damage to blood vessels in the penis can lead to ED. So, lowering your cholesterol may improve your ED symptoms.
Biking
Men who spend a lot of time in the bike seat can sometimes experience numbness due to the pressure on nerves and blood vessels in the groin. This can then lead to erectile dysfunction.
If you have ED and spend extended periods biking, you may be able to change your bike saddle to alleviate pressure. Researchers found that wider seats helped preserve blood flow to the penis, but padding did not seem to make a difference.
Other recommendations for bike seats are:
- Consider a saddle without a nose
- Keep your bike seat at the correct height.
- Make sure your saddle is not tilted upwards.
Nerve Problems
If you have a problem that affects nerves in your body, it can also interfere in the communication between the brain and the penis. Some examples are brain or spinal cord injuries, Alzheimer’s, strokes, Parkinson’s, and MS.
There are no known cures for these conditions. The most common treatment for ED that results from these conditions is medication.
The most-prescribed drugs for this treatment are Sildenafil (Viagra), Tadalafil (Cialis, Adcirca), and Vardenafil (Levitra, Staxyn). Avanafil (Stendra) is also an option.
Chronic Kidney Disease
People who are on dialysis for chronic kidney disease very commonly have erectile dysfunction. This can be due to blood vessel damage, nerve damage, depression, low testosterone, or side effects from medication (mostly antidepressants and blood pressure medication).
Maintaining a regular schedule of dialysis can help lessen the effects of ED. However, the most effective treatment for ED in these cases is a kidney transplant.
Prostate Surgery and Radiation Therapy
Any surgery or radiotherapy to the pelvic area can lead to blood vessel and nerve damage that affects the penis. Examples are prostate removal and radiotherapy to the prostate. This damage is often permanent, and the most common treatment is medication.
Problems with the Penis
Issues like the curvature of the penis, tissue scarring (cavernous fibrosis), or fracture of the penis can lead to ED. In most such cases, treatment involves corrective surgery or an implant.
Is There a Cure for Erectile Dysfunction?
As seen above, there are many different causes of erectile dysfunction. Some can be reversed (“cured”), while others cannot.
The following causes of ED are reversible (“curable”):
- Side effects of medication
- Cigarettes, drugs, and alcohol
- Obesity
- Sleep apnea
- Relationship difficulties
- Biking
Others are considered treatable, but not curable:
- Hormone imbalances
- Depression
- Anxiety
- High cholestrol
- Blood vessel and nerve damage
- Problems with the penis
In general, if your ED has just one cause that is treatable or reversible, you may be able to treat the cause and thus provide a cure for your ED symptoms. However, this is not the case for everyone.
For many men, ED is the result of multiple physical and psychological factors. This makes a cure harder to obtain.
Treatment Options for Erectile Dysfunction
Treatment options for ED are many and varied. It is essential to consider all the options before choosing. Your doctor can help you, and you may want to see a prosthetic urologist, as well. Prosthetic urologists specialize in erectile dysfunction and incontinence. They can help you understand the risks and benefits of each type of treatment.
Physical Therapy
A physical therapist can suggest exercises that may help with your ED. One possible example is Kegel exercises. If you would like to try these exercises on your own, you can research the benefits of Kegel exercises for men.
Oral Medications
There are several prescription medications available to treat ED by improving blood flow to the penis. The most common are Viagra (sildenafil), Cialis/Adcirca (tadalafil), and Levitra/Staxyn (vardenafil). Stendra (avanafil) is also an option.
Injection Therapy
In this treatment option, a needle is used to inject medicine directly into the penis. This injection, applied at the base or side of the penis, improves blood flow to produce an erection.
Vacuum Devices
A vacuum erection device is a plastic cylinder that is placed over the penis. It is equipped with a manual or battery-operated pump that creates suction inside the cylinder. The action of the pump draws blood into the penis to produce an erection. After the erection is attained, it can be maintained using a tension band placed at the base of the penis.
Suppositories
Intraurethral suppositories or pellets are inserted into the urethra through the tip of the penis using an applicator. Each pellet is approximately the size of a grain and dissolves in the urethra. It then acts to increase blood flow, allowing an erection to occur.
Penile Implants
A penile implant is a mechanism that is implanted into the penis. It consists of a pump that fills two cylinders to create an erection. This erection can be maintained for as long as desired.
This type of implant requires surgery, usually done by a urologist who has training in penile prosthetics. There are three types of implants:
- One-piece malleable (bendable) implant
- Two-piece inflatable implant
- Three-piece inflatable implant
It is essential to talk with your doctor about which option might be best for you. Each type offers specific benefits and risks that need to be understood before you make a choice.
Vascular Surgery
In some cases, vascular surgery can be performed to reconstruct the arteries inside the penis. This can enhance blood flow to the penis. Increased blood flow improves the ability to get and maintain an erection.
What Should I Do to Treat Erectile Dysfunction?
When you identify that you are having problems with ED, the first step is to visit your doctor. He will make sure you are getting the correct treatment for health problems that may be causing or aggravating your ED.
There will likely be various treatment options available to you. Ask your doctor to explain the pros and cons of each treatment. Take into consideration your partner’s preferences, as well.
Oral medications
Medicines taken orally can successfully treat erectile dysfunction in many men. These drugs include avanafil (Stendra), sildenafil (Viagra), vardenafil (Levitra, Staxyn), and tadalafil (Adcirca, Cialis).
All of these drugs improve the effects of nitric oxide to relax penis muscles. They increase the blood flow and help produce an erection.
Consult with your doctor before you take any medicine for ED. This includes any OTC remedies or herbal supplements. Medications do not work for everyone and may also be risky to take for people who:
- Have very low blood pressure
- Have heart problems
- Take drugs containing nitrates, like nitroglycerin, isosorbide mononitrate, and isosorbide dinitrate.
Additional medications to treat impotence
Other medications for erectile dysfunction include:
- Alprostadil for self-injection - With this option, you use a tiny needle to inject alprostadil (Caverject, Edex) into the side or base of your penis.
- Alprostadil in intraurethral suppository - This treatment involves placing a tiny alprostadil (Muse) suppository inside the opening of your penis. A special applicator is necessary to insert the suppository into the urethra.
- Testosterone replacement - Some patients experience ED that is related to low levels of testosterone. In such cases, testosterone replacement therapy could be recommended alone or in combination with other treatments.
Exercise
Several studies have shown that moderate and vigorous aerobic exercise can improve erectile function. Even regular exercise that is less strenuous may reduce the risk of ED. Talk to your doctor about the benefits of Increasing your activity level.
Counseling
Visiting a psychologist or counselor could help with ED in some situations. If your condition is related to anxiety, depression, or stress, you could benefit from this therapy. It can also be helpful if your ED is causing tension in your relationship.
Alternative medicine
Check with your doctor before using any medication or supplement. He can help you understand if it’s safe for you. This is especially true for patients with chronic health issues.
Some alternative medicine options include:
- Acupuncture - Both manual and electroacupuncture have been used to treat patients in whom ED medications did not function.
- Korean red ginseng (Panax ginseng) - Red ginseng has long been used in Chinese traditional medicine to treat ED, but studies on its effectiveness are just now being conducted.
- Pomegranate juice - This remedy is being researched and is thought to improve erectile function by increasing nitric oxide levels.
- Yohimbe - This supplement has its origin in West African traditional medicine and is believed to block the receptors that prevent an erection.
What New Treatments for Erectile Dysfunction Are Being Researched?
In addition to the medications currently available for ED, other treatments are being researched. These treatments may provide solutions that work more quickly and have fewer side effects. Some examples are gene therapy, melanocortin activators, Topiglan, and Uprima.
Gene Therapy
This new type of therapy would provide genes that can produce proteins or products that are not functioning correctly in men with ED. Replacing these substances may improve erectile function. So far, this therapy has shown potential in testing done with animals.
Testing with humans may also be successful. However, this type of therapy may take a long time to be approved. It may also take time to be accepted by the general public.
Melanocortin Activators
Melanocortin activators are medications that appear to act through the central nervous system (brain and spinal cord). In animal testing, they have shown potential in leading to an erection. More studies are needed to confirm the safety and effectiveness of these drugs.
Topiglan
Topiglan is a cream applied to the penis that uses alprostadil. This is the same active ingredient used in injections and suppositories. Its effectiveness and safety have yet to be determined.
Uprima
Uprima, whose active ingredient is apomorphine, is a tablet that dissolves under the tongue. It functions by stimulating the production of dopamine, which increases sexual interest and sensations.
While it is available in Europe, the release of Uprima for use in the US is on hold because of its side effects. It can cause nausea and vomiting. Some people who took it also passed out as a result.
Additional clinical trials are being carried out with a version of this drug in nasal spray. It is thought that this form may cause less nausea.
What is the Best Treatment for Erectile Dysfunction?
The best treatment for erectile dysfunction depends on your specific situation. You will need to talk with your doctor about your health and lifestyle to determine the cause of your ED. Armed with that understanding, the doctor can help you find the treatment that is best for you.
Treatments for Impotence Compared
Impotence means a consistent difficulty in getting an erection, maintaining it, or ejaculating. It is considered a synonym for erectile dysfunction. Thus, the treatments are the same as those already explained in this article:
Medications
- Oral medication
- Injectables
- Intraurethral suppositories
Alternative remedies
- Acupuncture
- Korean red ginseng (Panax ginseng)
- Pomegranate juice
- Yohimbe
Penis Pumps
- Vacuum pumps
- Implants
Surgical interventions
- Penile implants
- Vascular surgery
See previous sections of this article for more details on each of the above treatments.
- Feldman HA1, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB.: Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. In: National Center for Biotechnology Information, U.S. National Library of Medicine. URL: ncbi.nlm.nih.gov.
- One Patient out of four with newly diagnosed erectile dysfunction is a young man. Paolo Capogrosso MD et al (2013). URL: onlinelibrary.wiley.com.
- Stief CG, Hartmann U, Höfner K, Jonas U: Erektile Dysfunktion und Therapie. Berlin: Springer-Verlag, 1997.
- Montorsi F, Deho F, Salonia A, Cestari a, Guazzoni G, Rigatti P, Stief CG: Pharmacological management of erectile dysfunction. BJU Int 2003; 91: 446–454.
- Anele UA, Morrison BF, Burnett AL. Molecular pathophysiology of priapism: emerging targets. Curr Drug Targets. 2015;16(5):474-83. doi:10.2174/1389450115666141111111842.
- Yafi FA, Jenkins L, Albersen M, et al. Erectile dysfunction. Nat Rev Dis Primers. 2016;2:16003. doi:10.1038/nrdp.2016.3. URL: https://www.nature.com/articles/nrdp20163
- Delgado PL, Brannan SK, Mallinckrodt CH, Tran PV, McNamara RK, Wang F, Watkin JG, Detke MJ (2005). “Sexual functioning assessed in 4 double-blind placebo- and paroxetine-controlled trials of duloxetine for major depressive disorder”. The Journal of Clinical Psychiatry.
- Rao AR, Thwaini A, Ahmed HU, Shergill IS, Minhas S (July 2007). “The phosphodiesterase inhibitors and non-arteritic anterior ischaemic optic neuropathy: increased vigilance is necessary”. BJU International. 100 (1): 3–4.
- Kloner, RA (26 December 2005). “Pharmacology and Drug Interaction Effects of the Phosphodiesterase 5 Inhibitors: Focus on α-Blocker Interactions”. The American Journal of Cardiology. 96 (12 (Suppl. 2)): 42–46.