Depending on the cause and severity of your ED and any underlying health conditions, you might have various treatment options.
For many people, a physical exam and answering questions (medical history) are all that is needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or a doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.
Tests for underlying conditions of ED might include:
- Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
- Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels, and other health conditions.
- Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
- Ultrasound. This test is usually performed by a specialist in an office. It involves using a wand-like device (transducer) held over the blood vessels that supply the penis. It creates a video image to let a doctor see if you have blood flow problems. This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.
- Psychological exam. A doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.
The first thing a doctor will do is to make sure you’re getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.
Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. A doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner’s preferences also might play a role in your treatment choices.
Oral medications are a successful erectile dysfunction treatment for many men. They include:
- Sildenafil (Viagra)
- Tadalafil (Adcirca, Cialis)
- Vardenafil (Levitra, Staxyn)
- Avanafil (Stendra)
All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.
Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing normal penile function in some people. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement, and are not needed in people who get normal erections.
The medications vary in dosage, how long they work, and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache, and stomach upset.
A doctor will consider your particular situation to determine which medication might work best. These medications might not treat your erectile dysfunction immediately. You might need to work with a doctor to find the right medication and dosage for you.
Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get a doctor’s OK. Medications for erectile dysfunction do not work for everyone and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:
- Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket), and isosorbide dinitrate (Isordil, Bidil)
- Have heart disease or heart failure
- Have very low blood pressure (hypotension)
Other medications for erectile dysfunction include:
Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include alprostadil and phentolamine. Often these combination medications are known as Bimix (if two medications are included) or Trimix (if three are included).
Each injection is dosed to create an erection lasting no longer than an hour. Because the needle used is very fine, pain from the injection site is usually minor.
Side effects can include mild bleeding from the injection, prolonged erection (priapism), and, rarely, the formation of fibrous tissue at the injection site.
Alprostadil urethral suppository. Alprostadil (Muse) intraurethral therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.
The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include a burning feeling in the penis, minor bleeding in the urethra, and the formation of fibrous tissue inside your penis.
Testosterone replacement. Some people have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies.
Lifestyle and home remedies
For many people, erectile dysfunction is caused or worsened by lifestyle choices. Here are some steps that might help:
If you smoke, quit. If you have trouble quitting, get help. Try nicotine replacement, such as over-the-counter gum or lozenges, or ask a doctor about a prescription medication that can help you quit.
Lose excess pounds. Being overweight can cause — or worsen — erectile dysfunction.
Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight, and increasing blood flow.
Get treatment for alcohol or drug problems. Drinking too much or taking certain illegal drugs can worsen erectile dysfunction directly or by causing long-term health problems.
Work through relationship issues. Consider couples counseling if you’re having trouble improving communication with your partner or working through problems on your own.
What you can do
Take these steps to prepare for your appointment:
- Ask what you need to do ahead of time. When you make the appointment, be sure to ask if there’s anything you need to do in advance. For example, a doctor might ask you not to eat before having a blood test.
- Write down any symptoms you’ve had, including any that might seem unrelated to erectile dysfunction.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins, herbal remedies, and supplements you take.
- Take your partner along, if possible. Your partner can help you remember something that you missed or forgot during the appointment.
- Write down questions to ask a doctor.
For erectile dysfunction, some basic questions to ask a doctor include:
- What’s the most likely cause of my erection problems?
- What are other possible causes?
- What kinds of tests do I need?
- Is my erectile dysfunction most likely temporary or chronic?
- What’s the best treatment?
- What are the alternatives to the primary approach that you’re suggesting?
- How can I best manage other health conditions with my erectile dysfunction?
- Are there any restrictions that I need to follow?
- Should I see a specialist? What will that cost, and will the visit be covered by my insurance?
- If medication is prescribed, is there a generic alternative?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend?
In addition to your prepared questions, don’t hesitate to ask additional questions during your appointment.
What to expect from a doctor
A doctor is likely to ask you a number of questions. Be prepared for questions such as these:
- What other health concerns or chronic conditions do you have?
- Have you had any other sexual problems?
- Have you had any changes in sexual desire?
- Do you get erections during masturbation, with a partner, or while you sleep?
- Are there any problems in your relationship with your sexual partner?
- Does your partner have any sexual problems?
- Are you anxious, depressed, or under stress?
- Have you ever been diagnosed with a mental health condition? If so, do you currently take any medications or get psychological counseling (psychotherapy) for it?
- When did you first begin noticing sexual problems?
- Do your erectile problems occur only sometimes, often, or all of the time?
- What medications do you take, including any herbal remedies or supplements?
- Do you drink alcohol? If so, how much?
- Do you use any illegal drugs?
- What, if anything, seems to improve your symptoms?
- What, if anything, seems to worsen your symptoms?
If you’ve got any additional concerns, feel free to contact our team of qualified experts and ask for help.