Treatment and Prevention
There are a wide range of treatments for erectile difficulties. Some are
pills, and others are injections or devices that should be used just before
sex. There are also treatments involving surgery.
Medications for erectile dysfunction include phosphodiesterase inhibitors,
prostaglandins, yohimbine, and testosterone.
Phosphodiesterase inhibitors: This class of medications includes sildenafil,
tadalafil, and vardenafil.* They work by inhibiting an enzyme called phosphodiesterase
type 5. This enzyme normally breaks down a molecule called cGMP.
Inhibiting the enzyme makes more cGMP available, which leads to relaxation of
smooth muscles in the penis, allowing more blood to enter and helping to produce
an erection. These medications are taken before sex and will cause an erection
only when the man is sexually stimulated.
The time the dose should be taken and how long the effects last depend on the
medication used. The most common side effect of these medications is a headache.
However, there is a potential for certain dangerous drug interactions. Anyone
taking this medication must let his doctor know about any medications he's on,
and especially if he's taking nitrates (e.g., nitroglycerin spray or nitroglycerin
patch) for heart problems.
Prostaglandins (alprostadil): Alprostadil can be injected into the penis
or inserted as a pellet through the urethra. It causes an erection that usually
lasts about 60 minutes. The danger with this method is that too high a dose
can cause priapism, an erection that won't go away. This condition can
cause serious bruising, bleeding, and extreme pain. Once the doctor is sure
of the right dose, the man can self-inject at home.
Some doctors may prescribe a combination of alprostadil with additional ingredients
such as phentolamine to help the medication work more effectively. This mixture
is prepared by the pharmacy according to the directions of the prescribing doctor.
It is injected into the penis before sex.
Yohimbine: Yohimbine is derived from a natural source. While it's somewhat
controversial, it's been shown to be useful in psychogenic erectile difficulties,
such as performance anxiety problems. It may raise blood pressure or interfere
with liver function.
Testosterone: This is only useful for people with specific disorders
like hypogonadism (small testicles at birth) that result in lower than
normal amounts of testosterone in the blood stream. Testosterone increases interest
in sex, as well as erections.
Common non-medication ways of treating erectile difficulties include vacuum
devices and penile implants.
Vacuum devices: This involves placing a tube over the penis, forming
an airtight seal around the base. By pumping air out of the tube, blood can
be drawn into the penis. Placing a ring around the base of the penis will maintain
the erection.
Penile implants: This treatment involves permanent implantation of flexible
rods or similar devices into the penis. Simple versions have the disadvantage
of giving the user a permanent erection. The latest (and most expensive) device
consists of inflatable rods activated by a tiny pump and switch in the scrotum.
Squeezing the scrotum stiffens the penis, whether the person is aroused or not.
The penis itself remains flaccid, however, so the diameter and length are usually
less than a natural erection, and hardness is lacking, although it's sufficient
for intercourse.
*All medications have both common (generic) and brand names. The brand name
is what a specific manufacturer calls the product (e.g., Tylenol®).
The common name is the medical name for the medication (e.g., acetaminophen).
A medication may have many brand names, but only one common name. This article
lists medications by their common names. For more information on brand names,
speak with your doctor or pharmacist.