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Erectile dysfunction treatments

A range of treatments is available for erectile dysfunction (ED), or impotence. These include oral medications (given by mouth) such as Viagra, Cialis or Levitra or injections into the penis. Other treatments include vacuum devices, counselling or implants (penile prosthesis).

Treatments are sometimes used in combination. Hormone therapy and vascular surgery are other available alternatives but are rarely used.

Most cases of erectile dysfunction are caused by physical illness, with only one in ten cases caused by psychological problems.

When to see a doctor
Occasional erectile dysfunction is normal and may be a result of too much alcohol, stress or anxiety, or a lack of sleep. However, ongoing impotence can sometimes be a symptom of a serious physical illness. Some of these illnesses include heart and blood vessel diseases (atherosclerosis), diabetes and multiple sclerosis.

Ongoing erection problems should always be fully investigated by a doctor to check for any underlying medical cause that may also require treatment.

Treatments are varied
There are many treatments for erectile dysfunction. Treatments can be grouped according to their level of invasiveness.

  • Non-invasive treatments – include oral medications, counselling and external devices such as vacuum pumps. Hormone therapy is another non-invasive treatment that is rarely used.
  • Minimally invasive treatments – include penile injections.
  • Surgical treatments – include penile prosthesis (implants) and vascular surgery.
It is usual to start with the least invasive treatment, such as tablets, and to recommend more complicated injection treatments or surgery if the tablets fail.

Medications
Medication is effective in about 70 per cent of men with erectile dysfunction. This is usually taken in the form of tablets – brand names include Viagra, Cialis and Levitra. These drugs, known as PDE5 inhibitors, inhibit a particular enzyme in the penis, enhancing the erectile response to normal sexual stimulation.

It is usually recommended that tablets be taken at least one hour before sexual contact is planned. Fatty meals and large amounts of alcohol can interfere with the body’s absorption of some of these drugs. Some side effects of these medications may include facial flushing, nasal congestion, headaches and indigestion. Although these drugs act in a similar way, there are important differences between them – for example, the period of time for which they are active. Your doctor will advise you about which is the most appropriate for you. Medication treatment may not be suitable for all men.

Patients taking heart medication should always consult their doctor, as erectile dysfunction medications may interact with some medications for heart disease.

Psychotherapy and counselling
Psychosocial issues may be a single cause of erectile dysfunction or may combine with a physical cause. Psychotherapy and counselling can help if the underlying cause of erectile dysfunction is psychological. Counselling can also benefit the man who has lost sexual confidence, even though his erectile dysfunction is caused by physical factors.

Counselling may be provided by a GP, a psychologist or a psychiatrist. The man’s partner may also be involved.

Vacuum and other devices
A vacuum device is a pump placed over the penis to create blood flow. It draws blood into specific tissues of the penis (the two copora cavernosa), mimicking a normal erection.

A rubber ring can sometimes be used around the base of the penis to help make it rigid enough for intercourse. This is used when a man is able to get an erection but has difficulty maintaining it.

Devices such as vacuums and rings are not always successful. These devices need to be properly explained and appropriately fitted, and are best used after consultation with a doctor.

Injections
Some medications can increase blood flow when they are injected into the penis. A penile injection can create an erection within five to 10 minutes and last for up to one hour. Men must be taught how use the penile injections properly and should have several supervised injections in a doctor’s surgery.

One possible side effect is a painful erection lasting for hours, known as priapism. This occurs if the medication dose is too high. If an erection lasts for four hours or longer, the penis may be permanently damaged. Immediate medical attention should be sought in this situation.

Hormone therapy
Hormone therapy is rarely used and is only suitable for men whose levels of sex hormones, such as testosterone, are too low.

Penile prosthetic implants
A penile prosthesis is a device that is surgically implanted into the penis. It can enable erections through a mechanism of squeezing on a specific part of the device. Penile prosthetic implants are expensive and are generally used only as a last resort if other treatments have not worked.

Vascular surgery
Vascular surgery targets the veins and arteries that supply blood to the penis. It is a major surgical procedure and is rarely used. Surgery may be considered for men who have vascular damage due to trauma in the area around the penis – for example, after a car accident or fall.

Other products
Many other products claim to treat or even cure erectile dysfunction. These products are often expensive and usually have not been adequately tested for either their side effects or results. Treat such products with caution and use only under the supervision of a doctor.

Where to get help Things to remember
  • Most cases of erectile dysfunction are caused by physical factors.
  • Treatments include oral medications, penile injections, vacuum devices, counselling and implants.
  • Ongoing erection problems may have a medical cause that needs specific treatment and should be fully investigated by a doctor.
    Better Health Channel - Related Quiz.

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Diabetes and erectile dysfunction.
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Article publication date: 10/02/2000
Last reviewed: 31/01/2009

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This article, like all health articles on the Disability Online, is sourced from Better Health Channel and has passed through a rigorous and exhaustive approval process. It is also regularly updated. For more information see Better Health Channel quality assurance page.


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