Erectile Dysfunction: AUA Guideline (2018)

In fact, more than 70% of men have ED by the age of 70.

The good news is that lifestyle changes and medical treatments can improve the symptoms of ED.

PHOSPHODIESTERASE TYPE 5 INHIBITORS

The main differences between ED drugs are how quickly they act and how long the effect lasts. Avanafil takes about 15 to 30 minutes to work and lasts six to 12 hours. Sildenafil and vardenafil take effect in 30 minutes to an hour and last four to five hours. Tadalafil kicks in after 30 to 45 minutes and can last 24 to 36 hours. "Many doctors first prescribe sildenafil because it has been around the longest and has a high success rate," says Dr.

Nausea and Vomiting

O'Leary. Men who want a longer-lasting effect might opt for tadalafil. Tadalafil is also available as a low-dose daily drug, so you have a constant amount of the drug in your bloodstream, which helps with spontaneous sex. (This version is also used to treat benign prostatic hyperplasia, or an enlarged prostate.) The maximum dosages for ED drugs vary from 20 milligrams (mg) for tadalafil and vardenafil to 100 mg for sildenafil and 200 mg for avanafil. Your doctor usually begins with a low dose and increases it as needed.

Table 6. Phosphodiesterase Type 5 Inhibitors for Erectile Dysfunction

"Once you reach the maximum dose, and the drug still doesn't work, taking more won't help," says Dr. O'Leary. "Also, switching to another ED drug usually won't make a difference." The most common side effects of ED drugs are headaches, upset stomach, nasal congestion, muscle pain, and facial flushing. But most of these are relatively mild and disappear after a few hours. "ED drugs can make blood pressure temporarily drop, so don't use them if you take nitrates for angina (chest pain) or other heart problems," says Dr. Let’s take a look at the different treatment options and help you find which ones might be right for you.

Researchers are spending time and resources to develop new treatments for erectile dysfunction. Several new treatments are being studied and may offer fewer side effects and better results than current treatments.

Why Choose University of Utah Health?

Michael O'Leary, a urologist and former director of men's health at Harvard-affiliated Brigham and Women's Hospital's Department of Urology. There are four main FDA-approved ED drugs: sildenafil (Viagra), tadalafil (Cialis), vardenafil, and avanafil (Stendra). All of these come as pills; vardenafil also is made in a dissolvable version you place under your tongue. Chewable ED drugs are available that contain the same active ingredients of sildenafil, tadalafil, and vardenafil. However, they are made to order in compounding pharmacies and may include other ingredients.

Executive Summary

Dr. O'Leary advises against using these custom-made products since they are not regulated or approved by the FDA. The four ED drugs - known medically as PDE5 inhibitors - work similarly to increase blood flow into the penis, which helps men reach and maintain an erection. They do this by inhibiting phosphodiesterase type 5 (PDE5), an enzyme in blood vessel walls that controls blood flow. When a man is aroused, his body releases molecules that relax the smooth muscles in the blood vessels, allowing more blood to flow in.

Evaluation and Diagnosis

ED drugs prevent PDE5 from breaking down these substances, thus keeping the blood flowing. ED drugs are effective in about 70% of men, according to Dr. O'Leary, but the results can vary. "A man with nerves or arteries damaged by prostate surgery, diabetes, or cardiovascular disease will not respond as strongly to ED drugs," he says. Also, while ED drugs can help men achieve and maintain an erection, they don't help with other sexual issues, such as low libido, premature ejaculation, or the inability to reach orgasm. Here are some of the promising therapies under investigation: Stem cell therapy: Stem cells are a special type of cell that can turn into any other type of cell and help repair tissues.

The bottom line

Most men have trouble getting or keeping an erection at some point in their lifetime. But if this problem happens often or lasts long enough to interfere with satisfying sex, it may be a sign of erectile dysfunction (ED). Between 30 and 50 million men in the U.S. have ED. As many as 5% of men under the age of 20 have ED, and the rate increases with age. Stem cells taken from umbilical cords or fat tissue show promise for improving ED when injected into the erectile tissue of the penis. Stem cell therapy: Stem cells are a special type of cell that can turn into any other type of cell and help repair tissues. Low-intensity shock wave therapy (LISW): Shockwave therapy isn’t yet FDA-approved for ED, but some healthcare professionals are using it.

This treatment uses sound waves to help grow new blood vessels in your penis.

• Counseling may help if emotional or psychological factors cause ED.
• Psychotherapy can address performance anxiety.
• Relationship counseling improves communication.
• Stress, depression, and anxiety can affect erections.
• Mental health support can enhance treatment outcomes.
• Combining therapy with medication often yields better results.

New blood vessels help supply your penis with enough blood to get an erection. Low-intensity pulsed ultrasound (LIPUS): LIPUS is similar to shock wave therapy. It uses sound waves applied to the penis over several sessions. Studies show that both LIPUS and LISW therapy may offer a non-invasive treatment for ED. Melanocortin receptor activator: This treatment option has been studied as an injection or nasal spray. It has shown promise by increasing sexual desire and improving erection, even without sexual stimulation, in men who have failed typical treatments. One form, Vyleesi (bremelanotide), is FDA approved for women with hypoactive sexual disorder. Guanylate cyclase activator: In animal studies, this treatment relaxed smooth muscle in the penis, allowing more blood flow and stronger erections in mice. Human studies are needed to see if they’re effective for men with ED. Nitric oxide (NO) donors: NO donors, like L-arginine, have been shown to improve erections, especially in combination with medications like Cialis or Viagra. These treatments increase nitric oxide levels, which help improve blood flow and stronger erections. There are many FDA-cleared and FDA-approved treatment options for ED. These include oral, topical, and injectable medications.

• PDE5 inhibitors require sexual arousal to work effectively.
• They are contraindicated with nitrates for chest pain.
• Possible side effects include headaches and flushing.
• These medications do not cause an erection without stimulation.
• Effectiveness varies among individuals tested during clinical trials.
• Consult a doctor before starting any ED medication.

There are also handheld devices and surgical interventions. All PDE5 inhibitors are equally safe and effective.

• Medications for ED should be used strictly as prescribed.
• Overuse or misuse of drugs can lead to complications.
• Not all men will respond to the same medication.
• Combining treatments might provide better results.
• Keep medication away from children and pets.
• Always inform your doctor about other health conditions.

Depending on your personal circumstances and cost, one option may be a better fit for you. Eroxon gel: Eroxon gel is an over-the-counter (OTC) topical product for ED. It’s applied to the head of your penis and works by stimulating nerves to help create an erection.

Diagnosis and Tests

A healthy weight can improve testosterone levels and self-esteem, which may help prevent ED. Maintaining a healthy weight can also prevent diabetes and high blood pressure, which can cause ED. Physical activity increases blood flow through your body, including the penis, and can help keep you at a healthy weight. The Physical Activity Guidelines for Americans, 2nd edition, recommends at least 150 minutes, or 2 hours and 30 minutes, of moderate-intensity physical activity, such as brisk walking, each week.2 Taking care of your mental and emotional health can help prevent ED. If you feel stressed, try relaxation techniques and other activities that might soothe you.

Which Medication Will Work Best for My ED?

A simple way to relax is deep breathing, which you can do anywhere. You can help prevent ED by avoiding recreational and illicit drugs and limiting how much alcohol you drink. Some drugs can prevent arousal or other sensations that are important for getting and keeping an erection. Sometimes, illicit drugs and too much alcohol may mask other mental health, emotional, or physical factors that cause ED. This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health.

4. Penile injections

NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts. Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing Since the 1990s, erectile dysfunction (ED) drugs have helped millions of men continue to enjoy an active sex life. "While not much has changed in how they work or the types of drugs available, there still are things men should consider when choosing which one to try," says Dr. It’s the first OTC gel to get FDA clearance for ED.

Vacuum Erection Device (VED)

O'Leary. However, there's no problem with nitrates found in food - for example, leafy green vegetables (spinach, kale) and root vegetables (beets, carrots). You also need to be careful if you take alpha blockers such as tamsulosin (Flomax) and alfuzosin (Uroxatral), used to treat blue 100 pill an enlarged prostate. "Make sure to take these medications at least four hours apart from an ED drug," says Dr. O'Leary.

How do I know if erectile dysfunction medication is right for me?

It's also best not to take sildenafil or vardenafil soon after eating, as food can block their absorption. (Tadalafil and avanafil don't interact with food in this manner.) Matthew Solan, Former Executive Editor, Harvard Men's Health Watch Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

See, Play and Learn

Erectile dysfunction (ED) is a common issue, and it becomes more common with age. About 70% of men have some degree of ED by age 70. Researchers are exploring new ways to treat ED, including stem cell therapy, shock wave and ultrasound therapy, and new pharmacologic medications. Common ED treatments include medications like Cialis and Viagra, injections, topical treatments, and vacuum devices. If those options don’t work, penile implants offer long-term function and satisfaction. Intracavernous injection: Medications like alprostadil (Caverject, Edex) and Trimix (a compound medication that usually has alprostadil, phentolamine, and papaverine) are injected into your penis just before intercourse.

• Sildenafil (Viagra): A popular PDE5 inhibitor to treat erectile dysfunction.
• Tadalafil (Cialis): Offers longer-lasting effects for up to 36 hours.
• Vardenafil (Levitra): Acts quickly and lasts several hours.
• Stendra (Avanafil): Provides rapid onset of action within 15 minutes.
• Alprostadil (injection): Penetrates directly into the penis to induce an erection.
• Erectile dysfunction patches: Topical patches delivering medication for quicker absorption.