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Erectile Dysfunction Treatments

Erectile Dysfunction Treatments

There are now a number of treatments for erectile dysfunction. The most popular are the oral medications which all fall into the category of PDE-5 inhibitors. These medications inhibit the production of the enzyme PDE-5 which attacks the chemical signal that causes the arteries in the penis to expand. This process allows more blood to flow into the penis than would otherwise be the case, thereby improving the quality of the erection and its sustainability.

You can buy Viagra, Cialis, Levitra and MUSE from The Online Clinic after an online consultation. You do NOT require an existing prescription. Simply click on the free consultation button below to get started.

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Viagra was the first oral medication for the treatment of erectile dysfunction to be developed and brought to market. Viagra was developed by Pfizer and was originally designed as a treatment for angina. Its effectiveness as an angina treatment was not overly impressive but one notable side effect was detected which gave hope that Viagra could be the first oral treatment for erectile dysfunction.

Viagra is not appropriate for everyone so it can only be prescribed by a doctor. Viagra works best if it is taken on an empty stomach and fatty foods should definitely be avoided as this will inhibit the absorption of the medication. Viagra normally gets working in around 30 minutes and lasts for up to 4 hours. This does not mean that you will have an erection for 4 hours – such a situation could be dangerous and may require medical attention. The 4 hour effectiveness merely provides a window in which an erection can be achieved.

Viagra does have some potential side effects but most are very mild in nature and it is unusual for these to cause such a degree of discomfort that the treatment is not attempted again. The most common side effects are headaches, facial flushing, dizziness, vision disorders and indigestion.

Viagra comes in 25 mg, 50 mg and 100 mg. Your doctor will advise which dose is most suitable for you but 50 mg is the normal starting dose.


Cialis works in a very similar way to Viagra and it comes from the same family of medications but it has a longer duration of effectiveness and its absorption is not inhibited by fats. Cialis was developed by Lily ICOS and it has become very popular with younger men who might have a number of sexual encounters within the window of opportunity which has been demonstrated to be as long as 36 hours. Cialis also appears to be effective more rapidly than Viagra, with an erection being achieved within 15 minutes of administration in some patients.

Again, Cialis is not appropriate for everyone so it is important that you make a full disclosure to the doctor about your medical history and any medications that you are taking. Specifically, Cialis is not appropriate for someone being treated with most alpha blockers or nitrates. There are a number of underlying conditions which would render Cialis an inappropriate treatment and only a doctor can advise you on these matters.

Cialis has the same side effects as Viagra but around 6% of people have also complained of back pain. What you have to remember about Cialis is that, as it has a longer duration of effectiveness, if you are unfortunate enough to get side effects, then the side effects are likely to last for the period of effectiveness.

Cialis comes in 10 mg and 20 mg doses with 10 mg being the usual starting dose. It is not recommended that patients take the 20 mg without first trying the 10 mg dose because of the possibility of side effects which may endure for up to 36 hours or more.


Levitra is significantly less well known than either Viagra or Cialis but it is equally effective. All of these medications have rates of effectiveness of around 75%. The PDE5 inhibitors do not work uniformly so if one does not work for you, it is usually advisable to take another treatment to see if this makes any difference but you should not take another treatment immediately after failing to achieve an erection as this could lead to a dangerous side effect. It is advisable to wait 24 hours until trying another treatment but please ask your doctor for specific advice on this matter as it may be possible to try another treatment within this timeframe depending on which medication you tried first. There is some anecdotal evidence that Levitra is particularly effective in hard to treat cases where Viagra has not had any impact. We have not found any scientific data to confirm this but we have made the observation in our own clinic from patient feedback.

Levitra has similar side effects to Viagra and Cialis. Levitra comes in 5 mg, 10 mg and 20 mg. The normal starting dose is 10 mg but elderly men should start on 5 mg as vardenafil (the active ingredient in Levitra) clearance is lower in elderly men. They can be moved up to 10 mg or 20 mg if this is warranted and decided to be safe.


As well as these oral medications, there is another pharmaceutical treatment call Alprostadil but this needs to be injected into the penis or inserted as a suppository into the urethra. Clearly this type of treatment is not as popular as Viagra, Cialis and Levitra as it is more difficult and uncomfortable to administer. When Alprostadil is introduced into the penis it causes blood vessels to expand and an erection can form. Alprostadil is normally only prescribed to men for whom the oral PDE5 inhibitors have not worked.


Caverject is the injection form of Alprostadil and it works for around 80% of men who have erectile dysfunction.

MUSE (Medicated Urethral System for Erection)

MUSE is the suppository form of Alprostadil and it is inserted directly into the urethra. The success rate is not as high as with Caverject as only 30% - 40% suffering from erectile dysfunction will achieve an erection using this method.

Alprostadil should not be used by men who are not suffering from erectile dysfunction as it could lead to priapism which is a serious condition where a man has a prolonged erection for 4 hours or more which could lead to permanent damage to the penis which could render it incapable of achieving an erection ever again. Anyone suffering from priapism should seek medical attention immediately.

Vacuum Constriction Device

Before we had medications to help solve erectile dysfunction, the most common method of overcoming the problem was the use of a vacuum constriction device or a vacuum pump as it is better known. Essentially the device consists of an acrylic tube into which the penis is inserted along with a rubber band at one end and a pump at the other. After the penis is inserted into the cylinder the air is pumped out to create a vacuum. The vacuum draws blood into the penis and an erection should form if sexual stimulation is present. The rubber band is then attached to the end of the penis nearest to the body to prevent the blood flowing back out and the erection being lost. It is safe to leave the band on for around 30 minutes, which should be sufficient time for sexual intercourse.

Studies have suggested that a vacuum constriction device has a success rate of between 50% and 80% but this is clearly not a popular method of solving the problem of erectile dysfunction as it requires quite a bit of preparation and it is a bit of a passion killer!

Certain men should not use this sort of device. Those with a congenital bleeding disorder or other abnormality such as sickle cell anaemia, which may increase the risk of priapism, should not use a vacuum constriction device.

There are relatively few side effects of using this form of solution. Some men experience bruising to the shaft of the penis but this is generally painless and disappears after a few days. The rubber band will restrict the ejaculate so this is not as powerful as the patient previously enjoyed prior to his erectile dysfunction. The semen might dribble out after the band has been removed.

Penile Implant

Where there is no chance of a man ever achieving a “natural” erection through the use of medications, it is possible to implant a penile prosthesis, which consists of two inflatable cylindrical tubes which are inserted into the corpus cavernosa along with a pump containing fluid which is located in the groin area. When a man is sexually aroused, he simply needs to press the pump to inflate the tubes leading to an erection. The erection should last around 20- 30 minutes. This procedure has a success rate of around 90% and it has a similarly high satisfaction rate. If the tubes are removed, it is highly unlikely that the patient will ever have an erection again.

Vascular Reconstructive Surgery

Very few men would be eligible candidates for this sort of surgery where a blocked artery is bypassed by linking the arteries in the penis to an artery in the abdomen. The procedure is expensive and has very low success rates of about 5%. This is sometimes used in young men who have suffered some damage to a particular artery as a result of injury. In this younger group of men, the success rate is significantly higher.

Testosterone Replacement Therapy

A lack of testosterone is a very rare cause of erectile dysfunction but where this has been identified as the cause, it is possible to have testosterone replacement therapy. Testosterone deficiency can only be identified through a blood test. Doctors will normally check testosterone levels first thing in the morning as this is when levels are at their highest. Testosterone replacement therapy is not appropriate for everyone who has a testosterone deficiency and we would always recommend trying the PDE5 inhibitors first.

Sex Therapy

Where it is believed that the underlying cause of the erectile dysfunction or impotence is psychological rather than physical then a course of sex therapy may be recommended. It is sometimes very difficult to make a diagnosis as to the underlying cause but a conversation with your doctor may help to reveal the underlying cause. Sex therapy tends to be more successful where the partner is also engaged in the therapy session.

Lifestyle Changes

Sometimes erectile function is affected by things that we do in our life so an adjustment in certain areas can sometimes yields results. Giving up smoking is an obvious one: atherosclerosis is a side effect of smoking, and as we have mentioned on our erectile dysfunction page, this is a common cause of erectile dysfunction. Stopping smoking will not lead to an immediate improvement in erectile function, but it will help over time.

Stress is a major factor in erectile dysfunction so some form of stress management may pay dividends. Of course, this is easier said than done. Nobody wants to have stress in their lives but it is sometimes unavoidable because of work pressures and other factors external to our relationship with our sexual partners, which can often be managed.

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Reviewed by: Dr Joyce Braaksma
GMC registration number: 4621289
Date: 10 March 2022
Next review: 11 March 2024
All UK registered doctors can have their registration checked on
The Medical Register at the GMC website.

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