How Erectile Dysfunction Is Treated

Erectile dysfunction (ED) is a common sexual disorder for which there are several treatment options. These range from taking medication or using a device, to counseling, lifestyle changes, and natural remedies.

After a careful assessment of the pluses and minuses of each therapy (and often, a trial and error process), you and your doctor can choose the treatment or combination of treatments that is uniquely right for you.

Lifestyle Changes

A variety of personal habits and lifestyle choices have been linked to ED. In some ways, this is a good thing, since habits can be altered and choices reconsidered.

What's more, many of the lifestyle factors that contribute to sexual problems are ones that affect overall health and well-being, both physical and mental. Addressing these factors, therefore, can have benefits beyond improving erectile dysfunction.

Get More Exercise

Regular physical activity improves blood circulation and decreases the risk of heart disease, diabetes, and obesity, all of which can have an impact on sexual function.

In fact, research shows that men who exercise more in midlife have a 70% lower risk of erectile dysfunction than sedentary men. In addition to preventing ED, physical activity has been found to improve ED.

Shed Extra Weight

Excess body fat may play a role in erectile dysfunction by promoting inflammation and converting testosterone to estrogen. According to one study, a third of obese men with erectile dysfunction regained sexual function after participating in a two-year weight loss program.

Stopping Smoking

Smoking affects circulation in ways that can inhibit blood flow to the penis and affect the ability to achieve or sustain an erection. This is why male smokers are at an increased risk of developing ED, regardless of their age or underlying medical conditions.

That said, it remains unclear whether stopping smoking once a person has started will necessarily improve ED. Research suggests this may be only true in younger men who have a limited smoking history.

Regardless, smoking cessation has many other health benefits, such as reducing heart disease and diabetes—two major causes of ED.

Eat Well

People who eat diets rich in whole-grain foods, vegetables, and fruits and low in red meat, full-fat dairy products, and sugary foods and drinks have a reduced risk of ED.

Similar to smoking, adopting healthy eating habits has other health benefits too, especially with regards to improving your heart health.

Take Care of Your Teeth

Perhaps a less obvious lifestyle strategy is to see your dentist for regular teeth care. This is because, according to a review article of five studies involving more than 200,000 men, chronic gum disease (periodontitis) might be associated with a more than twofold increase in the risk of erectile dysfunction.

Prescription Medications

The oral medications for erectile dysfunction—phosphodiesterase-5 (PDE5) inhibitors—work by enhancing the effects of nitric oxide, a naturally-occurring substance that relaxes blood vessels to allow blood to flow into the penis. With this effect in place, it's possible to get an erection in response to sexual stimulation and to sustain it.

• Viagra (sildenafil): May be effective within 30 to 60 minutes can last up to 12 hours
• Cialis (tadalafil): May be effective within 60 to 120 minutes and may last up to 36 hours
• Levitra or Staxyn (vardenafil): May be effective within 30 to 60 minutes and can last up to 10 hours
• Stendra (avanafil): May be effective within 15 to 30 minutes and can last up to 12 hours

Keep in mind—for Viagra, Levitra, and Stendra—eating a high-fat meal may delay the absorption of the drug, which can prolong the time it takes to get an erection and diminish the drug's overall effectiveness.

If a PDE5 inhibitor is ineffective or contraindicated, your physician may suggest you try penile injections. This is where a liquid medication such as Caverject (alprostadil for injection) or TriMix (papaverine, phentolamine and alprostadil [PGE]) is injected into your penis with a fine needle. 

Another treatment option includes penile suppositories like Muse (alprostadil urogenital) that are inserted into the urethra.

Both of these methods will bring on an erection within five to 15 minutes without a need for major sexual stimulation.

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Testosterone Replacement Therapy

A doctor may prescribe testosterone replacement therapy if a man is found to have a low testosterone level, along with other symptoms, such as low libido and ED.

That said, testosterone deficiency is uncommonly the primary cause of ED. Before you take testosterone, your doctor will have you tested to make sure that you do indeed have a deficiency.

Reviewing Current Medications

Taking a step back, besides taking a prescription, it's equally if not more important to first review your current list of medications with your doctor. It is very possible that one or more of them may be causing or contributing to your erectile dysfunction.

While you may not necessarily be able to stop that medication, recognizing it as a potential culprit may at least help you and your doctor understand the "why" behind your erectile dysfunction.

Medications that classically cause erectile dysfunction as a side effect are antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), such as Zoloft (sertraline).

Other potential medications linked to erectile dysfunction include certain blood pressure medications and pain medications.

Pumps and Implants

A mechanical device may be worth trying if medication and other interventions don't work.

One option is a vacuum pump, a plastic tube that is placed over the penis. When air is sucked out of the tube it creates pressure that causes blood to be forced into the penis. A ring can then be temporarily placed at the base of the penis to stop the blood from draining away too quickly.

A penile implant is another option, of which there are two types. One type, called a semi-rigid penis implant, keeps the penis erect all the time, though it can be bent downward when you aren't having sex. The other type, an inflatable two- or three-piece penis implant, includes a pump that's implanted in the scrotum and can be squeezed in order to make the penis erect.

Low-Intensity Shock Wave Therapy

While not a conventional therapy, an emerging treatment for erectile dysfunction is low-intensity shockwave therapy. This treatment is still in the research phase, but entails delivering sound waves to the penis, which is believed to ultimately increase blood flow and, thus, improve erectile dysfunction.

Counseling

Research suggests that combining a psychological intervention with medication improves sexual satisfaction and symptoms of erectile dysfunction better than either therapy alone.

This makes sense considering that even though ED is most often caused by a medical condition (e.g., heart disease or high blood pressure), stress and mental health problems, such as anxiety and depression, can exacerbate it.

Moreover, suffering from ED often has emotional consequences, which may negatively impact relationships or a person's self-esteem.

If you are considering therapy for ED, consider seeing a certified sexual therapist or joining group psychotherapy, both of which have been shown to be beneficial for the patient and their partner.

Natural Remedies

Research has found that, to some extent, acupuncture can improve ED. While the precise mechanism remains unclear, experts suspect that acupuncture may help regulate nerve sensitivity and improve blood flow to the penis.

There are lots of herbs and nutritional supplements claiming to improve sexual function in general and to treat ED in particular. However, there's very little research to prove that any of them actually work.

Options like red Korean ginseng, horny goat weed, L-arginine, L-carnitine, zinc, and niacin all have potential side effects when taken in high doses.

In addition, when research has shown a nutrient such as zinc or niacin to improve sexual function, it's usually in people who are deficient in it. So before you stock up on over-the-counter supplements for ED, speak with your doctor. They can test you for deficiencies and steer you toward the most effective and safest way to treat your erectile dysfunction.

Frequently Asked Questions

How is erectile dysfunction treated?

The most common treatment for erectile dysfunction (ED) is phosphodiesterase-5 (PDE5) inhibitors. There are five PDE5 inhibitors approved for the treatment of ED:

• Viagra (sildenafil)
• Cialis (tadalafil)
• Levitra or Staxyn (vardenafil)
• Stendra (avanafil)

Who should not take erectile dysfunction drugs?

PDE5 inhibitors are avoided in certain groups. For people with these conditions or characteristics, the decision to use the drugs should weigh the potential benefits and risks:

• Heart attack, stroke, or life-threatening arrhythmia within the past six months
• Resting hypertension or hypotension
• History of heart failure or unstable angina
• Current use of alpha-blocker drugs

What other drugs besides PDE5 inhibitors treat erectile dysfunction?

If you cannot take PDE5 inhibitors or the drugs fail to improve your symptoms, speak with your doctor about a vasodilator called alprostadil that increases penile blood flow and promotes erections. These are injected into the penis and are marketed under the brand names Caverject, Muse, Edex, and others. There are also topical alprostadil formulations.

Are there home remedies for erectile dysfunction?

There aren’t home remedies per se, but there are lifestyle choices that may counter some of the physiological causes of ED. This includes routine exercise and weight loss to improve circulation and reverse the ill effects of obesity. Smoking cessation and a reduction in heavy alcohol use can also help as both are independent risk factors for ED.

Are there non-medical treatments for erectile dysfunction?

Vacuum pumps are devices placed over the penis that suction blood into the penis to facilitate erection. A penile ring ("cock ring") can then be placed behind the testicles at the base of the penis to keep the blood contained.

Does "herbal Viagra" work?

"Herbal Viagra" is a generic term used by manufacturers to describe any number of herbs or substances thought to treat ED (such as horny goat weed or ginseng). There is no proof that the treatments work and no guarantees that the herbal remedies are inherently safe. Speak with your doctor before using any natural remedy for ED.

Is sound wave therapy effective for erectile dysfunction?

Low-intensity shock wave therapy (LISWT) is an emerging treatment thought to increase blood flow to the penis and, in turn, promote erections. A 2021 study involving 40 people in whom PDE5 inhibitors were ineffective concluded that LISWT was "modestly" effective with no adverse effects.

Is surgery an option for erectile dysfunction?

Penile microvascular surgery may restore blood flow to the penis and improve erections but is mainly used for people under 40 who have had a traumatic penis injury. Other options include penile prosthetic surgery (involving implants) performed under anesthesia in a hospital.

A Word From Verywell

There are obviously a lot of treatment options available for ED, which in no small part is due to the fact that a healthy sex life is important for many people's sense of well-being. That said, try not to get overwhelmed with all the different choices. It may take a bit of time and patience on your part, but under the guidance of your doctor, you can find the treatment that works best for you.