Most men with ED start with pills, such as Viagra™, Levitra™, Cialis™ and Stendra™. These may improve blood flow to the penis, and with sexual stimulation, can help you achieve an erection.17-19 40 If men don’t respond to oral medications, they may try other options.
PROS: Pills can help you achieve an erection quickly and may have an effect on sexual intimacy.
CONS: Some men cannot achieve a satisfactory erection with pills and other men will switch the type of pills to achieve a satisfactory outcome.17-19 27 40
PATIENT SATISFACTION AND OUTCOMES: Effective in ~70% of cases but less effective in patients with diabetes or damage to the nerves or endothelium.27 40 About 50% of men with ED stop oral medications due to side effects, cost and because the medications stop working.27
These medications (alprostadil, papaverine, etc.) may be combined and injected directly into the base or side of the penis. The recommended frequency of injection is no more than three times weekly, and should produce an erection in 5-20 minutes.22
PROS: An option for physical or psychological causes of erectile dysfunction using a fine gauge needle that may feel like pinprick.22
CONS: Beyond a possible fear of needles, men may experience pain, fibrosis, and risk of a persistent erection.22-23
PATIENT SATISFACTION AND OUTCOMES: Approximately 60% of patients were satisfied and continued use.68 Satisfaction for men and partners at 4 years was 91.4% and clinical studies report ~60-86% success rates.51 52
These medications (alprostadil, etc.) are inserted into the urethra at the end of the penis using an applicator (also called MUSE™). To relax the muscle, encourage blood flow, and cause an erection, apply medications that dissolve inside the penis 16 minutes before intimacy.24
PROS: For use multiple times a week, it may also be an option for physical or psychological causes of ED.
CONS: In addition to general discomfort, common side effects include penile pain and urethral pain or burning.23-24
PATIENT SATISFACTION AND OUTCOMES: Clinical study satisfaction rates are limited, but one study found 64 of 192 men (33%) were satisfied.69 In clinical literature, success rates are reported at 40-66%.49 50
Men with diabetes are more likely to move to advanced treatments than those without diabetes.9 A healthy lifestyle can help you control your diabetes and improve ED symptoms. Treatment options are available; however, men with diabetes are less responsive to oral ED medications.4
What’s good for the heart is good for your ED symptoms. If ED occurs, most treatment options are available. However, oral ED medication and heart medications don’t mix well and the medication in some injections should not be used if you have blood clotting problems.22
Understanding ED and heart disease
While ED may be a side effect of prostate cancer treatment, erectile function does not return in all cases. Penile rehabilitation and counseling may help both partners in recovery. Despite wide usage, 30-50% of patients who turn to sexual aids after surgery discontinue use within a year.27
Understanding prostate cancer and erectile dysfunction