Erectile Dysfunction FAQs (cont.)
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How is erectile dysfunction treated?
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Treatment options include sexual counseling, medications, external vacuum devices, hormonal therapy, penile injections, or intraurethral suppositories (see Impotence/Erectile Dysfunction for treatment options). In highly selected cases under the supervision of a urology specialist in ED, combination therapy using several of these methods together can be used. If none of these therapies is satisfactory, penile implants through surgery can be considered.
Illustration of two rigid cylinders placed into the penis.
Illustration of two balloon cylinders placed into the penis.
Most patients start with Viagra and other similar drugs. No one could miss all of the consumer advertising for drugs to aid in ED. You see advertising for these drugs in magazines and on TV. Certainly there are plenty of jokes about Viagra and similar drugs, but ED is not funny if you are experiencing it.
How do drugs like Viagra work?
Viagra (sildenafil citrate), a prescription medication for the treatment of erectile dysfunction, is the first pill available that's been proven to improve erections in most men with impotence.
Since its introduction in March 1998, no other therapy for ED has achieved such wide public recognition. Viagra doesn't improve erections in normal men, only in those with difficulty in achieving or maintaining erections sufficient for sexual intercourse due to a true medical problem. It is not an aphrodisiac (sexual stimulant) and will not increase sexual desire. Unlike other treatments for erectile dysfunction, Viagra requires sexual stimulation to function. Without this stimulation, Viagra won't have any effect.
Viagra works by blocking an enzyme found mainly in the penis that breaks down chemicals produced during sexual stimulation that normally produce erections. Viagra allows these chemicals of arousal to survive longer and improves erectile function. That is also why sexual stimulation is necessary for Viagra to work.
In general, Viagra works successfully in about 65-70% of all impotent men.
Viagra works best if taken about 30 to 60 minutes before sexual activity. Only 1 tablet should be taken per day. It should be taken on an empty stomach. Increasing the dosage of Viagra beyond the recommended amounts will not improve the response and will only result in greater side effects.
Several drugs very similar to Viagra have recently been approved by the FDA. These drugs, called vardenafil (Levitra), Stendra (avanafil) and tadalafil (Cialis), have essentially the same activity and general precautions as Viagra. Levitra may be taken with food where Viagra needs to be taken on an empty stomach. Cialis has a much longer duration of improved erection function (up to 24-36 hours) compared with Viagra and Levitra (up to 4 to 6 hours). Cialis in daily dosage now has FDA approval for treatment of patients with benign prostatic hyperplasia and erectile dysfunction for clinical situations where treatment of both conditions has been shown to be of medical necessity. Stendra is effective when taken with or without food, and it works within 15 minures. Moderate consumption of alcoholic beverages is possible with Stendra.
Last Reviewed 11/21/2017
Stephen W Leslie, MD, FACS
Bradley Fields Schwartz, DO, FACS
Francisco Talavera, PharmD, PhD
Martin I Resnick, MD
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The eMedicineHealth doctors ask about Erectile Dysfunction FAQs:
Erectile Dysfunction - Treatment
What kind of treatment are you getting for erectile dysfunction?
Erectile Dysfunction - Medications
What medications have you tried for erectile dysfunction?
Erectile Dysfunction - Causes
What were your underlying medical conditions that caused your erectile dysfunction?