Erectile dysfunction (ED)

Erectile problems are common with many men having trouble getting and keeping an erection every now and then. But, if the problem won’t go away it’s important to see your doctor to ensure there is no serious underlying cause.

If all the investigations are ok then ED treatments such as Viagra can help.ED treatments can work in different ways, but the two main routes they take are:

• improving blood flow to the penis
• overcoming any performance anxiety you may have 

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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:

• Erectile dysfunction tablets

• Topical 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 are tablets such as Viagra. These treatments are usually very safe and effective with roughly 75% of men finding they work well. 

Before taking tablets, and especially if the problem is a new one, you should check your blood pressure, take a diabetes test, and  having your medications checked, to ensure this is not the cause of your ED. If your erectile dysfunction is caused by an underlying health problem, or a side effects of your medications, then discussing your options with your doctor may help.

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What are the different erectile dysfunction tablets?

There’s are 4 main types of 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. They will carry out some basic health checks, which include taking your blood pressure and doing a physical exam. Depending on your symptoms, you might need to do some extra tests too.

Once your doctor has examined you and carried out some investigations, 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

Vitaros (Alprostadil) cream is the only topical treatment for erectile dysfunction. This means it’s the only medication that you apply directly to the penis. Vitaros (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 (the hole at the tip of the penis)

Vitaros (Alprostadil) is normally only used if you can’t use erectile dysfunction tablets, or they aren’t safe for you. This is because Vitaros (Alprostadil) can be trickier to use, and it’s more likely to cause penis pain as a side effect. The benefit is that Vitaros (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 alternatives to Viagra you can get over the counter 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 a few ED treatments that don’t involve medication:

• 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 a herbal alternative to Viagra that can do the same thing, without you needing to get an examination. 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 medications such as Viagra are.

If you want to try out over the counter supplements to improve your erections – we recommend you opt for ones that are properly checked for safety. A lot of herbal products out don't necessarily contain what they claim to on the packaging. They can also be sold in combinations that may be unsafe.

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What are the symptoms of erectile dysfunction?

The symptoms of erectile dysfunction are defined as regularly not achieving or keeping a firm enough erection to have sex. Failing to get an erection occasionally (less than once every five times for example), or as a result of drinking too much alcohol or due to stress, 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 can 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 have bene well researched, 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

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Sources

Erectile dysfunction (impotence) (2017) NHS [accessed 23 June 2020]

Indirect comparison of interventions using published randomised trials: systematic review of PDE-5 inhibitors for erectile dysfunction (2005) BMC Urology [accessed 23 June 2020]

Ocular side effects of Levitra® (vardenafil) – results of a double-blind crossover study in healthy male subjects (2019) Drug Des Devel Ther [accessed 23 June 2020]

Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review (2007) The Journal of Sexual Medicine [accessed 23 June 2020]

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