What erectile dysfunction treatment is the best for me?

Doctors commonly prescribe medicines known as phosphodiesterase-5 inhibitors (PDE-5) as a first-line option to treat ED. These medicines are taken shortly before sex and work by increasing the blood flow to the penis, which causes an erection.

PDE-5 inhibitors include:

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Avanafil (Spedra)
• Vardenafil (Levitra)

See how the different ED pills compare in the table below:

*Some values may be dose-dependent

Like all medicines, ED drugs can cause side effects. Some common side effects include:

• Headache
• Nausea
• Hot flushes (a sudden feeling of heat in your upper body)
• Indigestion
• Blurred vision or visual disturbances
• Stuffy nose
• Dizziness

A vacuum pump or ‘penis pump’ is a device that creates a vacuum around the penis. It draws blood into the area, which causes an erection. Placing a band at the base of the penis maintains the erection. Vacuum pumps are made up of the following parts:

• A plastic tube that fits over the penis.
• A hand or battery-powered pump attached to the tube.
• A band that fits around the base of the penis once it is erect.

A penis pump might be a good choice if typical ED medicines don’t work or aren’t suitable for you or if you experience side effects with them.

Penis pumps can be a good ED treatment option because they:

• Are generally safe and effective if used correctly, but this takes practice
• Work well and can help most men get an erection firm enough for sex
• They are non-invasive and work outside the body
• They are affordable
• Can be used with other treatments and medicines

A study Trusted source PubMed Government Source Database of Biomedical Research Go to source showed that penis pumps had a patient-partner satisfaction rate of between 80% and 89%.

Just as there are side effects from ED medications, using a penis pump can also cause side effects and risks including pain, bruising, numbness or loss of sensation and more. It’s best to discuss this option with your doctor to see if a vacuum pump is right for you.

Medicines like Alprostadil can be injected into the penis or inserted as a suppository in the opening of the penis. Alprostadil is used before you plan to have sex.

It works by relaxing the smooth muscles and blood vessels in the penis. This allows more blood to flow into the area to produce an erection.

Some side effects may include dizziness, headache, skin reactions and more. This medicine may not be suitable for you if you use other ED treatments, take certain medicines or have some medical conditions.

When ED is caused by low levels of testosterone, treatment with testosterone may improve normal erections. It may also be beneficial when it’s used together with ED medications, such as PDE-5 inhibitors.

This treatment may not be suitable for everyone, so it’s best to check with your doctor to see if testosterone treatments will help you.

Erectile dysfunction surgery is usually a last-line treatment option when other treatments haven’t worked. The surgical treatment involves inserting an inflatable or malleable implant into the penis.

• Inflatable implants: This is a pump with two cylinders which are placed within the penis. When the pump is activated, fluid is sent from a reservoir into cylinders in your penis. This inflates it and causes an erection.
• Malleable implants: These are two semi-rigid rods inserted into the penis. These types of implants allow men to easily change the position of their penis from erect to non-erect.

Implants are usually reliable and effective and the procedure only takes 1 to 2 hours. One study Trusted source PubMed Government Source Database of Biomedical Research Go to source showed that the overall patient and partner satisfaction of inflatable implants was 85% and 76%, respectively.

However, as surgery is involved, there is a risk of infection or problems with the device. In terms of recovery, you may feel soreness, tenderness and discomfort for a few weeks after the procedure. Surgery may not be the best option for all men.

Sometimes, the best erectile dysfunction treatment may not be medication, but rather, lifestyle changes. Making sure you eat a balanced diet that supports heart health can have a positive effect on erectile function. Include lots of fruits, vegetables, whole grains, and lean proteins in your diet.

Physical activity and regular exercise improve blood flow through the body, including the penis. Aim for at least 150 minutes of moderate-intensity exercise per week.

Maintaining a healthy weight through healthy eating and physical activity can help delay or prevent conditions like diabetes and high blood pressure. These health problems are risk factors for ED. Studies show that men with obesity may be at a 30% to 90% Trusted source Nature Peer-reviewed Journals Multidisciplinary Research Go to source increased risk of ED.

Smoking is linked to blood vessel damage and heart disease, which can contribute to ED. If you smoke, quitting may improve ED.

Many products sold online claim to work as ‘herbal Viagra’. Ingredients found in these products include horny goat weed (epimedium), ginkgo, yohimbe, maca and more.

The herbal market is less regulated and safe. So, there is no guarantee of the quality and effectiveness of any herbal alternative. Some of these products contain unknown amounts of ingredients similar to those in prescription medications. These can cause dangerous side effects.

Another example of an unlicensed medicine for ED is Kamagra. Many men purchase it as they see it as a cheap alternative to licensed prescription medicines. Buying prescription medicine without a valid doctor's prescription is dangerous and should be avoided.

Sex therapy

This is a form of counselling that’s designed to help you treat sexual issues. Sessions might involve learning more about your sexual health, overcoming anxiety about sex, and other strategies to improve intimacy with your partner.

Shockwave therapy

Low-intensity shockwave therapy (LiSWT) is when a small wand-like device uses targeted sound waves to stimulate penile tissue and encourage blood flow. Research Trusted source National Center for Biotechnology Information (NCBI) Government Source Biomedical Research and Literature Go to source suggests that this therapy causes new blood vessels to grow in the penis. This means that the blood flow to the penis increases, which is essential for erections.

The first step to treating ED is to find and treat the underlying cause. If medical conditions such as diabetes or heart problems are the cause of your ED, treating these health conditions may improve it.

Emotional or relationship problems can also cause or worsen ED. If you think that this is the main cause, try options like open communication, cognitive behavioural therapy (CBT) and sex therapy. However, prescription ED pills may still help by giving you back your confidence.

If lifestyle changes haven’t improved your ED, your doctor may recommend ED pills, if they are suitable for you. If it's the first time you are trying ED pills, your doctor may start by prescribing Sildenafil (Viagra). If you have tried Sildenafil before but it hasn’t worked, talk to your doctor to figure out why. Here are some possible reasons:

It was taken incorrectly

Sildenafil (Viagra) should be taken 30-60 minutes before sexual activity, and it works best on an empty stomach. If you eat a high-fat meal before taking it, this can delay its effect.

Alcohol or drugs

Drinking too much alcohol or using drugs can interfere with how effective it is. These can also impact your sexual performance.

Wrong dose or wrong time

Some people may need a higher dosage to get an erection. If this medicine didn’t work as well as it should have, talk to your doctor about changing your dose. However, if it worked but you experienced side effects, your doctor can reduce your dose.

ED pills only work for a certain amount of time. If you have sex after the drug has worn off, it won’t work for you.

Medicine interactions

Some medicines can interact with ED pills and reduce their effectiveness. If you’ve started taking any new medicines, tell your doctor.

People's bodies can react differently to erectile dysfunction medications. What works for one person may not work as well for another. Your doctor can prescribe a different ED pill which may work well for you.

You can use our interactive tool at the top of this page to find the best treatment for erectile dysfunction for you.

After this, you will need to complete an online consultation where you have to fill out a quick medical questionnaire. This will be reviewed by one of our doctors and is completely confidential.

One of our registered doctors will review this and check to see if your chosen treatment is safe for you to take. If it isn’t the most suitable, our doctors can recommend a better alternative. Once approved, your ED drugs will be delivered to you in discreet packaging.

It’s important to speak to a healthcare professional to get a prescription for erectile dysfunction tablets as it ensures they're safe for you to take. Your doctor can also help to identify any underlying health issues causing ED, which can improve your overall health.