Oral Sildenafil in the Treatment of Erectile Dysfunction

But it’s important to be honest with the provider in order to quickly determine the cause. Are you currently taking any medications, including prescription drugs, over-the-counter drugs, herbal supplements, dietary supplements and nonmedical drugs? Has a healthcare provider ever diagnosed you with depression or anxiety?

Should I Get Surgery for Erectile Dysfunction?

But it’s normal to sometimes have erection issues. Erection problems can occur if you feel nervous, anxious, frustrated or tired. Drinking alcohol and/or using substances can also have an effect. It can also result from other conditions or as a side effect of certain medications or cancer treatments. If you’re having difficulty getting or maintaining an erection, it’s a good idea to schedule an appointment with a healthcare provider for further discussion.

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In many cases, ED can be the first symptom of another underlying problem, including heart disease. It’s important to talk to a healthcare provider if you have problems getting and maintaining an erection. Healthcare providers separate ED into several categories: Vascular ED includes causes that affect the blood vessels that send blood to the tissues in your penis that allow you to get and maintain an erection, or the valves in the penis that normally hold blood inside. Vascular ED is the most common type of ED. Neurogenic ED occurs as a result of nerve problems, which prevent signals from traveling from your brain to your penis to create an erection.

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This can happen because of trauma, pelvic surgery, radiation therapy or neurologic conditions like stroke, spinal stenosis and multiple sclerosis (MS). Hormonal ED refers to ED that happens as a result of testosterone deficiency, or in some cases as a result of thyroid issues. Psychogenic ED involves psychological conditions (conditions that affect your thoughts, feelings or behavior) that can cause ED. Erectile dysfunction is the most common sex-related condition that males report to healthcare providers, especially as they age and develop other health issues. Providers and medical researchers estimate that erectile dysfunction affects over 50% of males between the ages of 40 and 70. How often are you able to get erections? How long are you able to maintain an erection? Do you lose your erection because you ejaculate sooner than you would like?

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When did you first sex tablet women notice symptoms of erectile dysfunction? What exactly happened when you first had erectile dysfunction symptoms? Do or did you experience erections at night or during the morning?

What Treatments Might Not Work for Erectile Dysfunction?

Erectile dysfunction is a common side effect of many prescription drugs. Common medications that list ED as a potential side effect include: Substances that have addiction potential may cause ED, including: These substances can affect and suppress your central nervous system. They can also cause severe damage to your blood vessels, which may lead to permanent erectile dysfunction. Fear of sexual intercourse or intimacy (genophobia). Conditions that affect your body’s ability to deliver blood to your penis are the most common cause of ED. What sexual positions do you regularly engage in? The provider may also ask to talk with your sexual partner. Your partner may be able to offer additional insight on potential causes. The provider may order tests to confirm their diagnosis and determine the cause of your ED. It depends on what your healthcare provider suspects is causing erectile dysfunction. Tests that measure if the nerves in your penis respond to vibrations (penile biothesiometry). Drugs that temporarily make your penis erect (vasoactive injection). Before testing, your provider will explain what’s involved with a test and answer any questions you have. If you don’t feel comfortable, you can decide not to do the test at any time. The first step in treating erectile dysfunction is identifying the underlying cause. A healthcare provider will help determine the best treatment for you.

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And those numbers may be higher — many don’t seek help for the condition due to embarrassment or shame. Only sometimes being able to get an erection before sexual intercourse. Being able to get an erection before sexual intercourse but not being able to maintain it during sexual intercourse. Requiring a lot of stimulation to maintain an erection. There are many possible causes of ED, including conditions that affect your: Your circulatory system includes the blood vessels that carry blood throughout your body.

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Your penis needs adequate blood flow to become erect and maintain an erection. Your penis also relies on a series of valves to close when it fills with blood — in some cases, these valves stop working as they should. Your nervous system includes your brain, spinal cord and nerves. They work together to send electrical impulses that help your body move and feel, including your penis. Your endocrine system includes the glands that create and release hormones.

Make an informed decision about your Erectile Dysfunction Treatment

Hormones help tell your body to perform certain functions. Testosterone may help open up (vasodilate) your blood vessels, which helps blood flow to your penis. Injuries (trauma) to your penis and surrounding areas can also cause ED. Injuries to your pelvis bones (hip bones, sacrum and tailbone), bladder, prostate and spinal cord. Pelvic surgery, including prostate, colon or bladder cancer surgery. Vigorous cardiovascular exercise for at least 45 minutes three times per week may help reverse some cases of mild ED. Cardiovascular exercises may include brisk walking, jogging, swimming, bicycling and jumping rope. For men with mild ED, quitting smoking can lead to improvement after several months. Oral medications that help increase blood flow to your penis, including sildenafil (Viagra®), vardenafil (Levitra®), tadalafil (Cialis®) or avanafil (Stendra®). Oral medications start to work within an hour. Penile low-intensity focused shockwave therapy (LiSWT). This noninvasive treatment improves blood flow by using sound waves.

• Sildenafil (Viagra): A popular PDE5 inhibitor to treat erectile dysfunction.
• Tadalafil (Cialis): Offers longer-lasting effects for up to 36 hours.
• Vardenafil (Levitra): Acts quickly and lasts several hours.
• Stendra (Avanafil): Provides rapid onset of action within 15 minutes.
• Alprostadil (injection): Penetrates directly into the penis to induce an erection.
• Erectile dysfunction patches: Topical patches delivering medication for quicker absorption.

It can take two months to see improvement. Medications you inject directly into your penis to create an erection, including alprostadil (Caverject®), papaverine (Papacon®), phentolamine (Regitine®) or a combination of multiple medications. Injectable medications start to work within 10 minutes. Penis pumps start to work almost immediately. Testosterone replacement therapy, which is available as a gel, injection, patches and pellets. Testosterone replacement therapy starts to work within four weeks. A penile implant is a procedure in which a surgeon places a device into your penis to make it hard.

Drug Type	Mechanism of Action	Target Enzyme/Pathway	Typical Use Cases
PDE5 Inhibitors	Inhibit phosphodiesterase type 5 enzyme	PDE5 enzyme	Relaxation of penile arteries
Testosterone Replacement	Increase testosterone levels	Hormonal pathway	Hormonal deficiency cases
Vasodilators	Directly relax smooth muscle	Nitric oxide pathway	Severe cases of ED
Melanocortin Agonists	Stimulate melanocortin receptors	Central nervous system	Experimental, limited availability

The device doesn’t affect sensation, peeing or orgasm.

Premature Ejaculation (PE)

The dose is the amount of medicine you take. Don't be fooled into buying "herbal viagra." Never take any medicines that claim to be the "herbal" or nonprescription version of an oral medicine for ED. These aren't an effective option, and some contain harmful substances. Our caring team of Mayo Clinic experts can help you with your health concerns. Visit Mayo Clinic Men's Health to get started.

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Erectile dysfunction (ED) is the inability to get or maintain an erection long enough to have sexual intercourse. There are many different causes, which may include conditions that affect your blood vessels, neurological conditions, mental health conditions and injuries. A healthcare provider can diagnose and treat erectile dysfunction. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission.

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We do not endorse non-Cleveland Clinic products or services. Erectile dysfunction (ED) is a type of penile disorder. It affects your ability to get and maintain an erection firm enough for sexual intercourse. Your feelings play a major role in getting and maintaining an erection. Feeling relaxed, confident and aroused is essential. ED will not likely go away on its own without changes to your lifestyle or some kind of treatment.

Can Vacuum Devices Help With Erectile Dysfunction?

You may have a greater risk of getting ED if you: Have a body mass index (BMI) over 25. A healthcare provider can diagnose ED and determine its cause. They’ll review your medical history and perform a physical exam. They’ll also ask you questions about your personal and sexual history. These questions may make you feel embarrassed or awkward. The outlook for ED is good and it’s a very treatable condition. Though there aren’t cures for some causes of ED, many treatment options can help you get and maintain an erection hard enough for sexual intercourse. Certain lifestyle changes can help lower your risk of developing erectile dysfunction, including: Being more physically active, especially doing cardiovascular exercises like running, jogging or bicycling. Eating healthy foods with low saturated fats, such as fruits, vegetables and whole grains. Talk to a primary care physician or a urologist if you suspect you have erectile dysfunction. They can help diagnose ED, identify its cause and recommend the best treatment option for you.

• Medications for ED should be used strictly as prescribed.
• Overuse or misuse of drugs can lead to complications.
• Not all men will respond to the same medication.
• Combining treatments might provide better results.
• Keep medication away from children and pets.
• Always inform your doctor about other health conditions.

A urologist is a healthcare provider who specializes in diagnosing and treating conditions that affect your reproductive system and urinary system. Go to your nearest emergency room if you’re taking medication for erectile dysfunction and have a painful erection that lasts longer than two to four hours. This may be a sign of priapism, which can cause permanent damage to your penis without treatment. Is it normal to have erectile dysfunction?

• PDE5 inhibitors require sexual arousal to work effectively.
• They are contraindicated with nitrates for chest pain.
• Possible side effects include headaches and flushing.
• These medications do not cause an erection without stimulation.
• Effectiveness varies among individuals tested during clinical trials.
• Consult a doctor before starting any ED medication.

How do you know I have erectile dysfunction? What ED treatment option do you recommend? Can erectile dysfunction cause other conditions that affect my sexual health? Can you recommend a support group for people who have erectile dysfunction? Am I a candidate for a penile implant procedure? Erectile dysfunction can cause you to feel many different emotions. You may feel embarrassed, frustrated, guilty, ashamed, angry or “less than.” This can lead to more serious long-term emotions, like anxiety and depression. But you don’t have to live with these feelings. ED is common, and it doesn’t reflect your worth as a person. Erectile dysfunction is a sensitive topic for many people.