ED Treatments

ED treatments - Viagra

What Are Your Erectile Dysfunction Treatment Options?

A referral to a specialist is sometimes needed for assessment and treatment of erectile dysfunction (ED). However, GPs are now treating more cases of ED than previously, as ED treatments have improved in recent years. Your GP is more likely to suggest referral for erectile dysfunction treatment if you have been found to have a hormonal problem, if the cause is related to another condition like circulatory problems, or if you are young and the condition started after an injury.

The following gives a brief summary of recognised and genuine ED treatments. Once you find the right treatment there is a good chance of success. Shockwave therapy for erectile dysfunction is a painless, side-effect free and most effective treatment alternative to those listed below. One of the latest ED treatments, shockwave therapy has also proven to have complimentary beneficial effects when used in conjunction with many other treatments.

Have You Considered Your Other Medication?

As mentioned, some medicines can cause ED. Check the leaflet that comes with any medication that you take to see if ED is a possible side-effect. Do not stop any prescribed medication but see your doctor if you suspect this to be the cause. A switch to a different medicine may be possible, depending on what the medicine is for.

Oral Medication ED Treatments

The first tablet to treat ED that could be taken by mouth was launched in 1998. Prior to this, the first line treatment was a self-adminstered injection of a drug to the penis. So, a tablet that could simply be swallowed made a huge impact. There are now four different pills licensed in the UK for the treatment of ED:

  • sildenafil (Viagra®);
  • tadalafil (Cialis®);
  • vardenafil (Levitra®);
  • avanafil (Spedra®).

All of these drugs work by increasing the blood flow to your penis. So, even if the nerves or blood vessels in or going to your penis are not correctly functioning, these tablets can cause an erection. Fortunately, none of these tablets will cause an erection if you are not sexually aroused.

All four drugs work by affecting the same chemical pathway. The drugs inhibit the cGMP which is the chemical that dilates (widens) the blood vessels when you are sexually aroused. Because of this, these medicines are all part of a group of drugs called phosphodiesterase type 5 (PDE-5) inhibitors.

Rather than taking the tablets each day, you take a dose before you plan to have sex. Som one criticism of these treatments is the removal of spontaneity from your sex life.

Although PDE-5 inhibitors can treat ED caused by a range of underlying conditions, they treat the symptoms of ED and not the cause. So, ED tablets are not a cure for erectile dysfunction. However, the medicine works well in most (about 8 in 10) cases. But they do not work in every case. In addition, they may work better when combined with additional treatments. One such treatment is shockwave therapy for ED.

Where the tablets differ is how long before sex they need to be taken and how long they are active for. Also, there are differences in the side-effects of the various drugs.


Other medication that you are taking may rule out some of the tablets. And the same applies if you have certain other medical conditions. If may be that you are not able to take any of the PDE-5 inhibitors. For example, if you suffer from angina and are taking a nitrate medicine such as glyceryl trinitrate (GTN). Also, if you are taking an alpha-blocker such as doxazosin, indoramin, terazosin or prazosin for high blood pressure then you must be on a stable dose before taking a PDE-5 inhibitor. This is because the combination of drugs can cause a sudden drop in blood pressure.

Cream Or Gel Applied To The Penis

Topical creams or gels are sometimes used to treat ED. Your doctor may prescribe alprostadil cream. This cream is applied to the tip of the penis and the surrounding skin. You need to do this between 5 and 30 minutes before you have sex. So, as with tablets, your sex life may lose a little spotaneity. Recently, a promising trial with a new gel has been reported. Would you believe that the gel is based on gunpowder? It’s early days and more studies are needed but this gel could truly lead to fireworks in the bedroom!

Injection Treatment

As mentioned above, penile injection was the most common treatment before oral tablets became available. Although these injections usually work very well, many men baulk at the idea of sticking a needle into the base of the penis. However, if you are taught properly, it’s not that painful. The injected drug increases blood flow to the penis and you usually develop an erection within 15 minutes. It is worth mentioning that, unlike tablets, the erection occurs whether of not you are sexually aroused. So, unplanned interruptions can be rather inconvenient.

Urethral Medication ED Treatments

The urethra is the tube that carries urine from your bladder to the end of your penis. You can place a small pellet into the end of the urethra which contains a similar medicine to that used for injection treatments. The medicine is quickly absorbed into the penis. Most often you will get an erection, usually within 10-15 minutes.

Vacuum Devices

Several different brands and designs of device are available. However, they all work in basically the same way. Firstly, you put your penis into a plastic container. Then you use a pump to suck out the air from the container to create a vacuum. This vacuum causes blood to be drawn into the penis, causing an erection. Once you have got an erection you place a rubber band at the base of the penis to stop the blood flowing out. This should maintain your erection. You then take the plastic container off the penis. The penis should remain erect until the rubber band is removed. But it’s important to take the rubber band of within 30 minutes to avoid any complications.

Penile Implant Treatment for Erectile Dysfunction

Surgery is, perhaps, a treatment of last resort. A surgeon can perform an operation to premanently insert a rod into your penis. Essentially there are two types of rod. The basic type is a rod that has to be straightend by hand. The more sophisticated type is inflated with an inbuilt pump to cause an erection. Of course the more sophisticated penile implant is considerably more expensive.

Treat Underlying Causes

For some men, treatments that address one or more of the underlying causes of ED solve their erectile problems too. For example, successfully treating depression and anxiety can often result in a return to normal bedroom function. As mentioned above a change medication can often help. Similarly lifestyle changes mentioned below such as cutting back on drinking too much alcohol can work. Also, treating certain hormonal conditions such low testosterone may cure the associated ED.

Lifestyle And Other Advice

As discussed at length elsewhere on this website, ED is often a an early warning sign that you may soon develop heart disease or other cardiovascular diseases. Consequently, if you experience ED, you should review your lifestyle. And, wherever possible, you should make changes to minimise the risk of developing these problems. Also your doctor may, depending on your circumstances, help you avoid heart disease by prescribing statins to lower your blood cholesterol level.

Counselling and Sex Therapy

If your ED is at least partly due to mental health issues or psychological problems then individual cognitive behaviour therapy (CBT), couple counselling, or sex therapy may help. This may be in addtion to another treatment option, depending on whether or not you have a physical problem too. These treatments can also help if you develop psychological issues as a result of ED.

Erectile Dysfunction Treatment on the NHS

In England, Scotland and Wales the generic equivalent of Viagra®, the drug sildenafil, is available on NHS prescription from your GP as well as specialists for any man who has ED. In Northern Ireland, you have to have a specialist assume responsibility for prescribing sildenafil.

Viagra has recently become available for purchase over the counter at pharmacies. However, we would urge anyone intending to do this to consult with their doctor first.

Mostly for reasons of cost, tadalafil, vardenafil and avanafil are only available to men who have one of these specified medical conditions:

The specified medical conditions are:

  • Diabetes
  • Multiple sclerosis
  • Parkinson’s disease
  • Poliomyelitis
  • Prostate cancer
  • Following an operation to remove the prostate gland (prostatectomy)
  • Having had radical pelvic surgery
  • Chronic kidney disease treated by dialysis or transplant
  • Following severe pelvic injury
  • Single gene neurological diseases
  • Spinal cord injury
  • Spina bifida

A specialist, usually a urologist,  can also prescribe these alternatives to sildenafil on the NHS if your condition causes severe distress in your life. Examples include relationship breakdown, social problems and effects on mood or behaviour.

As mentioned above, tadalafil, vardenafil and avanafil are all licenced in the UK for treatment of ED. So, other men can receive a private prescription from their GP at their own cost.