Sexual Health Q&A

Erectile Dysfunction
What can men do if oral drugs for erectile dysfunction (ED) aren’t an option?

Oral medications like Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil) are considered the first-line treatment for erectile dysfunction (ED). However, some men cannot take these medications because they also take nitrates for heart conditions. Also, these drugs do not work for every man. In fact, recent research suggests that about 40% to 50% of patients do not have success. Fortunately, there are other treatments they can consider.

Self-injections. Injecting a drug called alprostadil directly into the penis before sex can improve blood flow and induce an erection. Many men feel uneasy about this process, but once a urologist teaches them to do it, they become more confident.

Vacuum erection devices (VEDs). This treatment does not involve the use of medications. Instead, a man places a clear plastic cylinder over his penis when he desires an erection. Next, he uses a special pump to create a vacuum, allowing the penis to fill with blood. A constriction ring is placed at the base of the penis to keep the erection firm.

Suppositories (transurethral agents). Alprostadil can also be administered as a suppository. To do so, a man uses an applicator to insert a pellet of medication into the tip of his urethra (the tube used to pass urine and ejaculate semen). Like self-injections, the suppository procedure should be taught by a urologist. [This approach is sometimes called the medicated urethral system for erection (MUSE).]

Penile implants. When the previous options don’t work or aren’t feasible, the surgical implantation of a penile prosthesis is another path to consider. With this treatment, spongy tissue in the shaft of the penis, which normally fills with blood during an erection, is removed. The tissue is replaced with cylinders that can be manipulated to produce an erection. Nowadays, penile implants are usually inflatable devices. The man presses on a pump placed in the scrotum, which allows fluid to travel from a reservoir to the cylinders, filling them and causing an erection. When he no longer wants an erection, he presses the pump again and the fluid returns to the reservoir. (To learn more about penile implants, see the Penile Prostheses section of the ISSM Q & A page.)

If you feel that ED medications are not working for you, talk to your urologist. Sometimes, changing to another medication helps. Or, you might try one of these alternative treatments. Your urologist can help you decide which option is best for you and your partner.

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