Erectile dysfunction (ED) medications include phosphodiesterase inhibitors like sildenafil, tadalafil, or vardenafil, which improve blood flow to the penis. Doctors may also recommend testosterone supplements or alprostadil to help boost libido and support better erectile function.
Erectile dysfunction, commonly known as sexual impotence, primarily affects men between the ages of 50 and 80. This condition involves difficulty or an inability to achieve and maintain an erection firm enough for sexual intercourse.
Treatment for sexual impotence should always be managed by a urologist to ensure individualized dosing after a physical exam. Identifying the underlying cause of ED is essential for determining the most effective medical approach.
Types of ED medications
Some medications your doctor can prescribe include:
1. Phosphodiesterase-5 inhibitors
Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are oral tablets and typically serve as the first-line treatment for erectile dysfunction. These drugs belong to the phosphodiesterase-5 (PDE-5) inhibitor class and work by increasing local blood flow to help achieve or sustain an erection during sexual stimulation.
The most common side effects that can occur during treatment with these medications are headache, back pain and muscle pain, dizziness, visual disturbances, hot flashes, facial flushing, nasal congestion, nausea, and indigestion.
2. Injectable alprostadil
Alprostadil, sold under the brand name Caverject, is an injectable medication administered directly into the penis. It is often recommended when ED is caused by nerve or blood vessel issues, psychological factors, or when oral PDE-5 inhibitors fail to work.
This medication helps relax the smooth muscles of the corpora cavernosa and stimulates vasodilation. An erection usually develops within 5 to 20 minutes following the injection.
The most common side effects are penile pain, redness, penile fibrosis, penile curvature, fibrotic nodules, prolonged erection, and hematoma at the injection site.
3. Testosterone therapy
Urologists may prescribe testosterone in the form of gels, patches, or injections for patients with low libido or ED caused by low hormone levels. This is frequently used to treat conditions like hypogonadism.
In many cases, hormone replacement therapy is suggested if PDE-5 inhibitors are unsuccessful. It can also be used in combination with other ED treatments to improve overall results.
Some of the side effects that can occur with testosterone replacement therapy are headache, hair loss, tension, breast enlargement and pain, prostate changes, diarrhea, dizziness, increased blood pressure, mood changes and alterations in laboratory test results, skin hypersensitivity and burning, and memory loss.
4. Avanafil
Avanafil (Stendra) is an oral medication that a urologist may prescribe for ED stemming from vascular or psychological causes. This medication is known for its rapid onset of action compared to other oral options.
It works by increasing blood flow to the penis to facilitate an erection during sexual arousal. The side effects of avanafil include headache, flushing, nasal congestion, back pain, or sore throat.
5. Alprostadil urethral suppositories
The alprostadil urethral suppository (MUSE) is a small pellet inserted into the urethra to relax penile muscles and promote blood flow. This alternative is used to improve the quality of an erection without the need for a needle injection.
The side effects that may occur during treatment with the alprostadil urethral suppository include penile pain, minor urethral bleeding, dizziness, and swelling of the leg veins.
Other medical treatments for erectile dysfunction
While the medications listed above are the primary treatments for ED, urologists may consider other options depending on the patient's specific health profile.
One such option is the use of compounded medications, often referred to as Bimix or Trimix. These are customized injectable liquids that combine two or three vasodilators, such as alprostadil, papaverine, and phentolamine. These are often used when single-agent injections or oral medications are not effective.
Additionally, while not a "medication" in the traditional sense, some doctors may prescribe the use of a vacuum erection device (VED) in conjunction with medications to improve results. In cases where ED is linked to specific cardiovascular issues, a doctor might also focus on optimizing medications for blood pressure or cholesterol, which can indirectly improve erectile function over time.