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It might work longer if you have mild to moderate erectile dysfunction.

Self-care and prevention

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts. Worried about your inability to get or maintain an erection? Stop worrying and visit your doctor for an open and honest chat.

Medical treatments:

A urologist can help you find safe and effective treatment of erectile dysfunction that will enable you to approach any future dates with your partner with confidence. Urologists are experts in treating erectile dysfunction and other genitourinary issues, so do not be anxious about such a visit. In fact, you will be surprised to find that your doctor is probably seeing up to a half dozen men with ED every week. The first choice of treatment for ED is usually oral medications called phosphodiesterase inhibitors type 5 (PDEi-5). These drugs include the first-generation agents such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), together with second-generation agents like mirodenafil (Mvix), iodenafil (Helleva), udenafil (Zydena) and avanafil (Stendra). This medicine also works best when you take it an hour before sex on an empty stomach. As with sildenafil, a high-fat meal or alcohol keep the body from absorbing it as quickly.

Vardenafil usually works for 4 to 5 hours. Its effects might last longer if you have mild to moderate ED.

A newer form of the medicine that dissolves on the tongue might work faster than the pill that you swallow.

Here's how the different medications work.

With the drugs providing a normal, natural erection in 80-95 percent of men as long as there is sexual stimulation, they are the best option for many men with ED. They also deliver high efficacy rates and favorable safety levels. If you are unresponsive to oral drugs, your doctor will review your treatment and consider other options. The urologist may consider a transurethral injection with a drug called alprostadil. The doctor may go for this option if your penile nerves have been compromised and you need to bypass the neurological pathways responsible for an erection.

What you can do

Another option may be an intracavernous injection of papaverine, phentolamine, PGE1 or vasoactive intestinal peptide (VIP). The injections are a good treatment choice with 91-96 percent success rates and proven safety. These drugs may be combined for better efficacy. Vacuum erection devices also may be considered. But these are commonly offered to elderly patients who may only want occasional sexual intercourse. This medication is taken with or without food an hour before sex.

• Medications for managing anxiety and depression.
• Regular exercise to improve cardiovascular health.
• Quitting smoking to improve blood flow.
• Limiting alcohol for better erectile function.

It works for up to 36 hours. You can take it in a small dose daily or in a larger dose as needed. You can take this medicine with or without food 30 minutes before sex, depending on the dose. It lasts 4 to 5 hours, or longer if you have mild to moderate ED.

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Younger men do not like these devices because of the unnatural feeling of the erections and the mechanical procedure necessary to produce the erections. You should discuss this option with your doctor and find out if the devices are ideal for you. When medical therapies fail, your urologist may recommend surgery. Surgical procedures are often the last option because of the cost, non-reversibility and invasiveness involved. There are two kinds of surgery for men with ED: penile prosthesis and penile revascularization.

Lifestyle changes

In penile sex erection tablet prosthesis, the urologist inserts an inflatable or semi-rigid implant into the penis tissue. The success rate of penile prosthesis is 97 percent, but the implant must be replaced every 8-15 years. Penile revascularization is a surgical procedure to repair either venous ligation or arterial stenosis. Explore surgery with your doctor if the other options fail to work for you, but be sure to understand what is involved before you make a decision. Erectile dysfunction treatments may be accompanied by other interventions. These medicines all work well for ED.

Choosing your ED drug

For instance, psychotherapy is a noninvasive and highly effective intervention that is often combined with other therapies for a better success rate. Likewise, your urologist may recommend lifestyle modifications, such as increased physical activity, dietary changes, moderate alcohol consumption or a decision to stop smoking in order to improve your ED symptoms and minimize cardiovascular risk. If tests show that you have low testosterone, your doctor may recommend testosterone replacement therapy before you use ED-specific medications. If you are a younger, healthier man, testosterone therapy may just be what you need for enhanced sexual desire and harder erections. At Advanced Urology Institute, we have established a multidisciplinary, compassionate and patient-centered approach to the treatment of erectile dysfunction.

Hormone replacement therapy

We prioritize the needs and expectations of our patients during treatment, educating them and providing a supportive environment that ensures shared decision-making. We also conduct meticulous follow-ups to identify any changes in the relationships, health and emotional status of our patients to optimize the efficacy of our treatments. If you are experiencing bothersome and embarrassing ED, visit one of our urologists for help. Get more information on the treatment of erectile dysfunction at the “Advanced Urology Institute” site. Medicines that you take by mouth are called oral medicines. When choosing one, tell your doctor or other health care professional what your preferences are, such as cost, ease of use, how long the drug's effects last and side effects.

What Are the Most Common Side Effects?

Most people with ED do not need surgery. If you have tried all other options and your ED does not improve, you and your health care professional may consider surgery to implant a device—called a prosthesis—to make the penis erect, either using a pump in the scrotum or a rod that you can control on your own repair arteries to increase blood flow to the penis, a procedure that works best for younger men Your health care professional will describe the benefits and possible side effects of surgery. ED medicines that you take by mouth, through an injection, or as a suppository can have side effects, including erections that last longer than 4 hours, known as priapism vision or hearing loss after taking oral ED medicines Call your health care professional right away if you develop these problems. Lifestyle factors can often lead to ED or make its symptoms worse. Sometimes, changing a daily habit could help prevent or improve your ED.

Phosphodiesterase-5 inhibitors

If you smoke cigarettes, one of the best things you can do for your ED and your overall health is to quit smoking. Smoking cigarettes is linked to heart and blood vessel disease, which can lead to ED. Eating well helps to maintain erectile function. Consider working with a registered dietitian, if possible, to create an eating plan for your individual needs. You can find a registered dietitian online through the Academy of Nutrition and Dietetics or through your health care professional. Generic versions of sildenafil, vardenafil and tadalafil are available.

• Tadalafil ODT (orally disintegrating tablet) for easier administration.
• Penile skin necrosis prevention with proper injection technique.
• Social support and group therapy for men with ED.
• Resveratrol supplements for potential endothelial benefits.
• Platelet-rich plasma combined with shockwave therapy.
• Avoiding grapefruit with certain PDE5 inhibitors due to interactions.

Check with your health care team before you take any medicine for erectile dysfunction.

• Intralesional verapmil or collagenase for Peyronie's-related ED.
• Fish oil (omega-3) for anti-inflammatory effects and vascular health.
• Dynamic infusion cavernosometry to precisely diagnose venous leakage.
• Buspirone augmentation for SSRI-induced sexual dysfunction.
• The "Princeton III" protocol for penile rehabilitation after prostatectomy.
• Focus on soluble fiber intake to improve arterial health.

Oral ED medicines might not work or might be dangerous if you also take any of the following: Often, these are prescribed for chest pain called angina.

Erectile Dysfunction Treatments

A dietitian can create a custom meal plan for you. A healthy weight can improve testosterone levels and self-esteem, which may help prevent ED. Maintaining a healthy weight can also prevent diabetes and high blood pressure, which can cause ED. Physical activity increases blood flow through your body, including the penis, and can help keep you at a healthy weight. The Physical Activity Guidelines for Americans, 2nd edition, recommends at least 150 minutes, or 2 hours and 30 minutes, of moderate-intensity physical activity, such as brisk walking, each week.2 Taking care of your mental and emotional health can help prevent ED.

Vacuum devices

If you feel stressed, try relaxation techniques and other activities that might soothe you. A simple way to relax is deep breathing, which you can do anywhere. You can help prevent ED by avoiding recreational and illicit drugs and limiting how much alcohol you drink. Some drugs can prevent arousal or other sensations that are important for getting and keeping an erection. Sometimes, illicit drugs and too much alcohol may mask other mental health, emotional, or physical factors that cause ED. Some examples of nitrates are nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Bidil).

Erectile Dysfunction Medications

They're often the first line of treatment for trouble getting or keeping an erection, called erectile dysfunction (ED). Oral medicines for ED usually work well and cause few side effects. The four main medicines taken by mouth for erectile dysfunction are: They enhance the effects of a chemical the body makes that relaxes muscles in the penis, called nitric oxide. This boosts blood flow and helps you get an erection from sexual activity. Each oral medicine for ED has a slightly different chemical makeup.

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These small differences affect the way each medication works, such as how quickly it takes effect and wears off, and the possible side effects. Your doctor or other health care professional can recommend one for you based on these factors, other health conditions you have and any other medicines you take. This medicine works best when you take it on an empty stomach an hour before sex. The body takes longer to absorb it after a high-fat meal or alcohol. Its effects often last for 4 to 5 hours. These are commonly prescribed for an enlarged prostate or male pattern baldness. They include dutasteride (Avodart, Jalyn) and finasteride (Propecia, Proscar). Medicines that block an enzyme called CYP3A4.