There are many different factors, both physical and psychological, that can cause erectile dysfunction, and some are signs of serious medical conditions. That’s why it’s important to consult a doctor if you are experiencing ED.
Once you’ve consulted a doctor, they will recommend treatments that will be effective for your specific condition.
Primary and Recommended Treatments
Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) inhibit an enzyme calledPDE5. This helps trap blood in the penis, resulting in firmer erections.
Oral medications are usually the first treatment prescribed by doctors. They most effective for mild to moderate cases of ED. Some men dislike the lack of spontaneity when using oral medications; about 30% of ED patients don’t respond to these drugs.
For more information, see “Oral Medications for ED.”
Changing Prescription Medications
Certain medications may cause or contribute to ED (see our article, “Causes of Erectile Dysfunction“). Your doctor may be able to prescribe alternate medications that alleviate the effect.
Coaching or therapy may overcome psychological causes of erectile dysfunction. It can also be helpful to deal with issues of self-esteem or relationship problems resulting from ED. See our article, “Counseling for Erectile Dysfunction.”
Circulatory problems are a very common cause of erectile dysfunction, especially in older men. Lifestyle changes can improve circulation, though making these changes requires a major commitment. Lifestyle changes may increase the effectiveness of other treatments, and have the added benefit of improving your overall health.
A study published in 2014 found that lifestyle changes reduced the incidence of ED1.
Changes to consider include:
- Eating a “heart-healthy” Mediterranean diet.
- Eating foods that are rich in nitrates, to increase nitric oxide (NO) levels. Examples include leafy green vegetables, beets, celery, citrus fruits, blueberries, pomegranates, and raw dark chocolate. You should limit meat, and follow a heart healthy or Mediterranean diet.
- Exercising, particularly cardiovascular exercise
- Limiting alcohol consumption
- Losing weight
- Stopping smoking
Some patients find that changes to their lifestyle do not give the degree of improvement they expect. Also, many men have difficulty sticking with the changes.
See our article “Can Diet and Exercise Cure Erectile Dysfunction?“
Also called intracavernosal injection (ICI) therapy. Injections of drugs (typically called Bimix, Trimix, or Papaverine) directly into the penis can trigger the chemical signals that inflate the corpora cavernosa, and trap the blood in the penis. Trimix contains a drug called alprostadil, which needs to be refrigerated.
The drug mix is prescribed by a urologist, who shows the patient how to perform the injection, using a very fine needle. The first injection is done in the doctor’s office, using a very low dose. The patient then gradually increases the dose, at home until he is able to achieve a satisfactory erection.
Note that injecting too much can cause priapism, a condition where blood does not drain from the penis. This can cause permanent damage to the erectile tissues. If the erection persists more than a few hours, the patient should see a doctor immediately; it may require blood to be drawn from the penis.
This is not a good treatment option for men who have difficulty controlling their hands due to neural issues or arthritis. Injections should not be combined with oral medications.
For more information, see “Intracavernous Penile Injections for Erectile Dysfunction.”
Shockwave therapy is quickly becoming a mainstream treatment option, given a large number of clinical trials showing its effectiveness.
For more information, see “Shockwave Therapy for Erectile Dysfunction.”
Suppositories use the same active chemicals as Penile Injections. However, rather than being injected, a small suppository is inserted into the urethra.
A penis pump is a plastic tube that fits over the penis. A pump draws the air out of the sleeve, causing the penis to inflate with blood. A constriction band is then used to trap the blood in the penis.
Penis pumps can be effective if you have circulatory problems or nerve damage, but may not produce a sufficiently firm erection. Also, many men find pumps uncomfortable or painful.
For more information, see “Vacuum Erection Devices.”
A penile implant consists of inflatable chambers inserted in the penis, replacing the corpora cavernosa. A small pump in the scrotum inflates the chamber, producing an erection. They may be the only viable treatment for men with server ED. See our article, “Penile Implants.”
For more information, see “Penile Implants for Erectile Dysfunction.”
Drugs to increase testosterone may be used if the patient has a Testosterone deficiency.
Testosterone increases libido (sexual desire), and also plays an important role in the erection process.
For more information, see “Does Low Testosterone Cause Erectile Dysfunction?“
Specific vitamins may be administered if the patient has a vitamin deficiency that is causing or contributing to erectile dysfunction. However, if you don’t have a vitamin deficiency, taking vitamins will not help.
Surgery may be used to clear blocked arteries in the penis, or to repair a venous leak. Surgery can be a very good option for some men, but it is only useful for very specific conditions.
The following treatments are not generally recognized as being effective, but may sometimes be recommended:
If you’d like to try Kegel Exercises, get started by reading our article “Kegel Exercises for Men.”
Clinical studies have shown that herbal supplements have little if any benefit. More importantly, there are a number of serious risk factors associated with their use.
See our article, “What You Should Know About Natural Herbal Remedies for Erectile Dysfunction.”
There is some evidence that Functional Electrical Stimulation (FES) may be effective in treating ED8. FES is the use of electrical stimulation to produce contractions in weak or paralyzed muscles. This contraction is combined with a functional activity where the targeted muscle is typically activated.
This treatment should not be confused with Transcutaneous Electrical Nerve Stimulation (TENS). TENS devices are intended for temporary pain relief in sore and aching muscles or for symptomatic relief of chronic pain. There is no clinical evidence that supports TENS as an effective treatment for erectile dysfunction.
For more information, see our article, “New and Experimental Treatments for Erectile Dysfunction.”
Platelet-Rich Plasma (PRP) Injection Therapy*
A one-time PRP injection may stimulate nerve regeneration. There are very few studies of PRP injections as a treatment for ED. In one preliminary study, PRP injections have improved erectile function when used in conjunction with vacuum pumps and oral medications9.
Because this treatment uses the patient’s own blood, it does not require FDA approval, and therefore has been subject to less scrutiny that drug therapies. PRP injection treatments are marketed under several proprietary brand names, including Priapus Shot®, P-Shot® and the NuMale® Eros Procedure.
Stem Cell Therapy*
Stem cells are harvested from the fatty tissue in the patient’s body, and injected into the penis. The therapy increases the production of nitric oxide (NO)10. Early studies have shown that many patients regain normal, spontaneous erectile function, and that the improvements are still present a year after the procedure.
* New or experimental therapies. This means that:
- The treatment has not yet been proven to be effective in a large-scale clinical trial.
- The treatment may have unknown side-effects or risks.
- The treatment may not be covered by insurance.
New treatments may be a good option, but you should discuss potential drawbacks carefully with your doctor. (See our article on “New and Experimental Treatments for Erectile Dysfunction.“)
- Martin, Sean A; Atlantis, Evan; Lange, Kylie; Taylor, Anne W; O’Loughlin, Peter; Wittert, Gary A. “Predictors of Sexual Dysfunction Incidence and Remission in Men.” The Journal of Sexual Medicine. Feb 2014.
- Richter, S; Vardi, Y; Ringel, A; Shalev, M; Nissenkorn, I. “Intracavernous injections: still the gold standard for treatment of erectile dysfunction in elderly men.” International Journal of Impotence Research. Jun 2001; 13(3):172-5.
- Gruenwald, Ilan; Appel, Boaz; Kitrey, Noam D.; Vardi, Yoram. “Shockwave Treatment of Erectile Dysfunction.” Therapeutic Advances in Urology. Apr 2013 5(2): 95–99.
- Levine, Laurence A; Estrada, Carlos R; Morgentaler, Abraham. “Mechanical Reliability and Safety of, and Patient Satisfaction with the Ambicor Inflatable Penile Prosthesis: Results of a 2 Center Study.” The Journal of Urology, Sep 2001, Volume 166, Issue 3, pp 932–937.
- Ji, Yoon Seob; Ko,Young Hwii; Song, Phil Hyun; Moon, Ki Hak. “Long-Term Survival and Patient Satisfaction with Inflatable Penile Prosthesis for the Treatment of Erectile Dysfunction.” Korean Journal of Urology. Jun 2015; 56(6):461-465.
- Dorey, G.; Speakman, M.J.; Feneley, R. C.; Swinkels, A., Dunn, C. D. “Pelvic Floor Exercises for Erectile Dysfunction.” BJU International. Sep 2005; 96(4):595-7.
- Dorey, G; Siegel, A; Nelson, P. “The Effect of a Pelvic Floor Muscle Training Program Using Active and Resisted Exercises on Male Sexual Function: A Randomised Controlled Trial.” 2015.
- Averbeck, M A; Bragante, K; Carboni, C; Fornari, A. “An initial study on the effect of functional electrical stimulation in erectile dysfunction: a randomized controlled trial.” International Journal of Impotence Research . May 2018; 30(1 Pt 2). <https://www.researchgate.net/publication/325298985…>
- Banno, Joseph J.; Kinnick, Tyson; Roy, Lisbeth; Perito, Paul P.; Antonini, Gabriele; Banno, Daniella. “The Efficacy of Platelet-Rich Plasma (PRP) as a Supplemental Therapy for the Treatment of Erectile Dysfunction (ED): Initial Outcomes.” Sexual Medicine Society of North America Fall Meeting. 3 Nov 2016.
- Reed-Maldonado, Amanda B.; Lue, Tom F. “The Current Status of Stem-Cell Therapy in Erectile Dysfunction: A Review.” The World Journal of Men’s Health. Dec 2016: 34(3): 155–164.