Treatments and drugs - erectile dysfunction

A variety of options exist for treating erectile dysfunction. They range from medications and simple mechanical devices to surgery and psychological counseling. The cause and severity of your condition are important factors in determining the best treatment or combination of treatments for you.
Cost You and your partner may want to talk with your doctor about how much money you're willing to spend and your preferences. Treatment for erectile dysfunction can be costly and insurance coverage varies. Because erectile dysfunction can by a sign of a number of underlying health conditions, initial evaluation of the problem is covered by most insurance policies. Medications or other treatments for erectile dysfunction may or may not be covered by your policy — check with your insurance provider to find out. Many policies have a limit on how many pills or injections are covered per month. Standard Medicare prescription drug coverage doesn't cover medications for erectile dysfunction.
Oral medications Oral medications available to treat ED include:
Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)
All three medications work in much the same way. Chemically known as phosphodiesterase inhibitors, these drugs enhance the effects of nitric oxide, a chemical that relaxes muscles in the penis. This increases the amount of blood flow and allows a natural sequence to occur — an erection in response to sexual stimulation.
These medications don't automatically produce an erection. Instead they allow an erection to occur after physical and psychological stimulation. Many men experience improvement in erectile function after taking these medications regardless of the cause of their impotence.
These medications share many similarities, but they have differences as well. They vary in dosage, duration of effectiveness and possible side effects. Other distinctions — for example, which drug is best for certain types of men — aren't yet known. No study has directly compared these three medications.
Not all men benefit Although these medications can help many people, not all men can or should take them to treat erectile dysfunction. You should not take these medications if:
You take nitrate drugs for angina, such as nitroglycerin (Nitro-Bid, others), isosorbide mononitrate (Imdur) and isosorbide dinitrate (Isordil)
You take a blood-thinning (anticoagulant) medication
You take certain types of alpha blockers for enlarged prostate (benign prostatic hyperplasia) or high blood pressure
Viagra, Levitra or Cialis may not be a good choice for you if:
You have severe heart disease or heart failure
You've had a stroke
You have very low blood pressure (hypotension)
You have uncontrolled high blood pressure (hypertension)
You have uncontrolled diabetes
Don't expect these medications to fix your erectile dysfunction immediately.
Work with your doctor to find the right treatment and dose for you. Dosages may need adjusting. Or you may need to alter when you take the medication.
Before taking any medication — including Viagra, Levitra or Cialis — make sure to discuss with your doctor:
Potential benefits and side effects of the medication you are considering
Any illnesses or serious health problems you have now or have had in the past
Any prescription or over-the-counter medications you take (including herbal remedies)
Prostaglandin E (alprostadil) Two treatments involve using a drug called alprostadil. Alprostadil is a synthetic version of the hormone prostaglandin E. The hormone helps relax muscle tissue in the penis, which enhances the blood flow needed for an erection. There are two ways to use alprostadil:
Needle-injection therapy. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. This generally produces an erection in five to 20 minutes that lasts about an hour. Because the injection goes directly into the spongy cylinders that fill with blood, alprostadil is an effective treatment for many men. And because the needle used is so fine, pain from the injection site is usually minor. Other side effects may include bleeding from the injection, prolonged erection and formation of fibrous tissue at the injection site. The cost per injection can be expensive. Injecting a mixture of alprostadil and other prescribed drugs may be a less expensive and more effective option. These other drugs may include papaverine and phentolamine.
Self-administered intraurethral therapy (Muse). This treatment involves using a disposable applicator to insert a tiny alprostadil suppository, about half the size of a grain of rice, into the tip of your penis. The suppository, placed about two inches into your urethra, is absorbed by erectile tissue in your penis, increasing the blood flow that causes an erection. Although needles aren't involved, you may still find this method painful or uncomfortable. Side effects may include pain, minor bleeding in the urethra, dizziness and formation of fibrous tissue.
Hormone replacement therapy For the small number of men who have testosterone deficiency, testosterone replacement therapy may be an option.
Penis pumps This treatment involves the use of a hollow tube with a hand-powered or battery-powered pump. The tube is placed over the penis, and then the pump is used to suck out the air. This creates a vacuum that pulls blood into the penis. Once you achieve an adequate erection, you slip a tension ring around the base of your penis to maintain the erection. You then remove the vacuum device. The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse.
Vascular surgery This treatment is usually reserved for men whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery may also be used to correct erectile dysfunction caused by vascular blockages. The goal of this treatment is to correct a blockage of blood flow to the penis so that erections can occur naturally. But the long-term success of this surgery is unclear.
Penile implants This treatment involves surgically placing a device into the two sides of the penis, allowing erection to occur as often and for as long as desired. The inflatable device allows you to control when and how long you have an erection, the semirigid rods keep the penis in a rigid state all the time. These implants consist of either an inflatable device or semirigid rods made from silicone or polyurethane. This treatment is often expensive and is usually not recommended until other methods have been considered or tried first. As with any surgery, there is a small risk of complications such as infection.
Psychological counseling and sex therapy If stress, anxiety or depression is the cause of your erectile dysfunction, your doctor may suggest that you, or you and your partner, visit a psychologist or counselor with experience in treating sexual problems (sex therapist). Even if it is caused by something physical, erectile dysfunction can create stress and relationship tension. Counseling can help, especially when your partner participates.