Erectile dysfunction (ED)

Erection problems are common and most men have trouble getting and keeping an erection every now and then. But, if the problems won’t go away, you might be having ED.

ED treatments can work in different ways, but the two main routes they take are:

• Making getting erections easier by improving blood flow to the penis

• Improving the underlying causes of your ED

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What erectile dysfunction treatment options are there?

There are 7 main categories of erectile dysfunction treatment that are proven to work are:

• Erectile dysfunction tablets

• Topical erectile dysfunction treatments (that you apply directly to the penis)

• Counselling

• Lifestyle changes

• Penis pumps

• Penile implants

• Erectile dysfunction exercises

The first-choice treatment option for a lot of people is erectile dysfunction pills like Viagra. These treatments are usually effective (roughly 75% of men find they work for them) and they’re very safe.

You should also think about checking your blood pressure, taking a diabetes test, or having your medications checked. If your erectile dysfunction is being caused by an underlying health problems, or it’s a side effects of your medications, then you could improve it by addressing these problems directly.

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What are the different erectile dysfunction tablets?

There’s 4 main active ingredients used in erectile dysfunction tablets:

• Sildenafil (used in Viagra, Viagra Connect, and generic Sildenafil) – these are the NHS’s first choice and they’re the most popular. They start working about 30 mins after you take them and last for 4-6 hours.

• Tadalafil (used in Cialis, Cialis Daily, and generic Tadalafil) – often known as the ‘weekend pill’, tadalafil medications get to work in about 30 mins and can last for up to 36 hours.

• Vardenafil (used in Levitra and generic Vardenafil) – similar to Viagra, vardenafil medications start after about 30 mins and last 4-6 hours, but they can be slightly better to take for men with eye problems.

• Avanafil (used in Spedra) – this medication is the fastest-acting one, getting to work in as little as 15 mins.

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Can you get treatment on the NHS?

When you go to the NHS about your erectile dysfunction (ED), a doctor or nurse will start by asking you about your lifestyle, relationships, and any specific problems you’re having. Then they’ll carry out some basic health checks, which include taking your blood pressure and doing a physical exam. Depending on your symptoms, you might need some extra tests too.

Once your doctor has checked you out, they’ll go through some NHS recommendations for treatment, including:

• Lifestyle changes – a doctor will give advice on lifestyle changes you can make and the extra support they can give you for these.

• Medical treatments – the NHS does recommend pills like Viagra for treating ED. They can only give NHS prescriptions for ED medications to certain people, and most people will only be given a private prescription which means they still pay full price for the treatments.

• Counselling – you can be put in touch with either NHS or private counselling services to help you with erectile dysfunction.

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About erectile dysfunction creams

Alprostadil is the only topical treatment for erectile dysfunction. This means it’s the only medication that you apply directly to the penis. Alprostadil comes in 3 different forms:

• A cream you rub into the penis

• An injection you use on the base of the penis

• A pellet that you put down the urethra (hole you pee from)

Alprostadil is normally only used if you can’t use erectile dysfunction tablets, or they aren’t safe for you. This is because Alprostadil can be trickier to use, and it’s more likely to cause penis pain as a side effect. Still, Alprostadil gets to work in 5-15 mins and works for up to 75% of men who try it.

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Can you get erectile dysfunction treatment over the counter?

Yes, you can now order Viagra Connect from a pharmacy, without seeing a doctor first. But, if you buy Viagra over the counter in person, you’ll still need to go through an assessment with a pharmacist to check that it’s safe for you.

There aren’t any other over the counter alternatives to Viagra you can get from a pharmacy without going through the assessment. But, if you don’t want to do the assessment face-to-face, you can order Viagra online instead.

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Are there any natural remedies for erectile dysfunction?

While medical treatments are usually the best options, it’s understandable if you want to try a more natural approach first. There are ED treatments that don’t involve medication, but the ones that actually work aren’t in pill form:

• Erectile dysfunction exercises – there are exercises you can do to make the muscles around your penis stronger, which can improve blood flow and erections.

• Lifestyle changes – by making some changes to the way you live your life, you could naturally improve your erections, for example:

  • Quitting smoking

  • Cutting down on alcohol

  • Eating a balanced diet

  • Exercising regularly

  • Losing weight if you’re overweight

  • Reducing your stress levels

Why we don’t suggest herbal products – you might be hoping for there are herbal products like Viagra that can do the same thing, without you needing to get assessed first. Unfortunately, there aren’t any that are proven to work. There are supplements or herbal mixtures that are sold or used by some people to treat erectile dysfunction, but studies show they aren’t effective in the same way as real medications are.

If you want to try out supplements to improve your erections – we recommend you go for ones that are properly checked for safety. A lot of herbal products out there aren’t guaranteed to contain what they say they do in the amounts listed on the packaging. They can also be sold in combinations that haven’t been proven to be safe either.

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Can erectile dysfunction exercises help?

The symptoms of erectile dysfunction are characterized by regularly not being able to get or keep a firm enough erection to have sex. Failing to get an erection occasionally (for example, as a result of drinking too much alcohol), or less than once every five times, is generally not considered to be erectile dysfunction. Erectile dysfunction, sometimes called ED or impotence, is very common.

Just under seventy percent of men aged over 70, and thirty to fifty percent of men aged between 40 and 70, will experience it at least once in their life. Sadly, it is estimated that only a quarter of all men experiencing erectile dysfunction seek treatment. 

Often, erectile dysfunction is a symptom of more serious health issues, so your doctor might want to do further tests to find the cause of your ED.

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Can erectile dysfunction exercises help?

Erectile dysfunction (ED) exercises are exercises you can do to help make the muscles around your penis stronger. The main types of exercises that can improve your erections are pelvic floor exercises, including kegel exercises for men. These exercises can help 40%-50% of men get better erections.

Pelvic floor exercises has been studied properly, but you might have heard about other exercises or techniques for helping ED. These can include the use of penis weights, or massages like jelqing. These options aren’t proven to work, but you could still try them. Just be aware there are some risks involved if you don’t use them safely.

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What you can do

Moore, R. A., Derry, S. and McQuay, H. J. (2005). Indirect comparison of interventions using published randomised trials: systematic review of PDE-5 inhibitors for erectile dysfunction. BMC Urology, Dec; 5(18): 1-16.

NHS (2017). Erectile dysfunction (impotence). [online] Available at: https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 29th May 2019].

Roessler, G. et al (2019). Ocular side effects of Levitra® (vardenafil) – results of a double-blind crossover study in healthy male subjects. Drug Des Devel Ther., Dec; 13: 37-43.

Rosenbaum, T. Y. (2007). Reviews: pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review. The Journal of Sexual Medicine, Jan; 4(1): 4-13.

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