Treatment for men unable to have an erection took a great leap forward
when the first oral erectile dysfunction (ED) medication, Viagra
(sildenafil), was introduced in 1998. But there have been strides
recently in a range of other ED treatments too.
1. Pills Viagra,
Cialis (tadalafil), and Levitra (vardenafil) fight erectile dysfunction
by relaxing smooth muscle in the penis, a process that increases blood
flow and enables an erection.
The effectiveness of these
phosphodiesterase type 5 inhibitors is well documented. "ED drugs are
70% effective in allowing the penis to achieve hardness for sexual
activity," says Irwin Goldstein, MD, director of San Diego Sexual
Medicine and the editor in chief of The Journal of Sexual Medicine.
the pills are generally considered safe. Side effects can include
headaches, sinus congestion, indigestion, and blue vision, but all are
usually mild. "It's one of the safer drugs on the planet," says Dr.
If you're on ED drugs, don't take nitrates—such as nitroglycerine pills
for chest pain or the recreational drugs known as "poppers." The
combination can lower blood pressure to dangerous levels and can even
cause a heart attack.
2. Injections If oral
medications don't work, a doctor might recommend injecting medication
directly into the base or the side of the penis with a tiny needle or
inserting a suppository into the urethra.
The injectable drug
alprostadil is a synthetic version of prostaglandin E1, a hormone-like
substance that functions similarly to ED pills. Some injections mix
alprostadil with other medications—such as the vasodilator papaverine
and the alpha-blocker phentolamine—to increase its effectiveness.
Your doctor can teach you to perform the injections yourself at home.
3. Suppositories For
guys who prefer not to inject themselves or have a fear of needles, a
suppository called MUSE—containing the drug alprostadil—is also
available but it is not considered as effective as the shots. "The
injection is a direct delivery of medication to the penis, while the
suppository is inserted into the urethra and when it is absorbed, it
loses some of its strength," says Ridwan Shabsigh, MD, director of the
division of urology at Maimonides Medical Center and professor of
clinical urology at Columbia University in New York City.
men who use injections or MUSE complain that they take away from the
spontaneity of sex because it takes time to prepare and administer the
4. Pumps Penis vacuum pumps get a good laugh in the Austin Powers films, but they happen to be quite effective at increasing blood flow to the penis.
5. Constriction rings "Cock
rings" worn around the base of the penis can slow down the speed at
which blood leaves the penis. While constriction rings won't increase
blood flow into the penis, they can prolong an erection once one is
achieved (using a vacuum pump, for instance). Rings should not be used
for more than 30 minutes and should be removed immediately if you
experience cold, numbness, or pain in the genital area.
6. Implants The
technology of penile implants is improving all the time. "They rival
implants in other parts of the body, like the pacemaker," says Dr.
There are two types of implants:
implants are cylinders that are implanted in the erection chambers of
the penis and inflated by a hydraulic pump implanted in the scrotum.
implants are semi-rigid, bendable rods that are implanted into the
penis and allow it to be manipulated into an erect or flaccid position.
7. Surgery Vascular surgery is rarely performed but
may be a last resort for some men. "There are some patients that can
benefit from vascular surgery, but the number is less than 1% of men
who have ED," says Dr. Shabsigh. "It's the equivalent to a coronary
artery bypass and there are only a handful of surgeons in the country
who do it."
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