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Erectile Dysfunction Pills — Which One Is Right for Me?


Erectile dysfunction (ED), difficulty achieving or maintaining an erection that is firm enough for sex, is the most common type of sexual problem that men experience. Approximately 1 in 10 men experience long-term problems with ED and one-third of adult men experience ED at some point in their lives. ED is more common in men as they age, with a significant increase in ED after age 50. Multiple ED treatment options are available, so how do you know which one is best for you? Depending on your health and your specific needs, the answer can vary. Here is what you need to know about medications for erectile dysfunction.

Erectile Dysfunction is Treatable

Erectile dysfunction is the most common sexual problem that men experience. ED can negatively impact more than just sexual function. ED can affect self-esteem, sexual confidence, and sexual satisfaction for both you and your partner. Fortunately, there are a variety of ED treatments available that are effective for many men. Oral medication is the most common treatment for ED, but other treatment options are available.

PDE5 Inhibitors

The primary medications used to treat ED fall into a class of drugs called phosphodiesterase 5 (PDE5) inhibitors. PDE5 inhibitors cause vasodilation, relaxing smooth muscle cells in blood vessels throughout the body to increase blood flow. In addition to ED, they are used to treat pulmonary hypertension, a type of high blood pressure that affects the lungs. In the penis, these drugs allow the corpus cavernosum to fill with blood more easily. ED medications do not cause erections, they allow you to achieve an erection more easily. You still need to be sexually aroused, both physically and mentally, to have an erection. This means that you must have proper blood flow and nerve function for the drugs to work effectively.

Drugs for ED

Four PDE5 inhibitors are approved to treat mild to moderate ED. Typically, these medications are taken as needed at least 30 minutes to an hour before having sex and they last for different lengths of time. They are all similar, but each has its distinct advantages and disadvantages. For instance, sildenafil, tadalafil, and vardenafil are available as generic medications, making them much less expensive.

Sildenafil (Viagra) is effective for 4-5 hours but must be taken 1 to 2 hours before sex on an empty stomach. It is very effective, but requires some amount of planning, making spontaneous sex more difficult.

Tadalafil (Cialis) is effective for as long as 36 hours, making it the longest-lasting ED medication. It is taken at least 1 to 2 hours before sex, either with or without food, but can also be prescribed daily. Its long-lasting effect allows for more flexibility in timing than other ED pills.

Vardenafil (Levitra, Staxyn) lasts for 4-6 hours and is taken 1 hour before sex either with or without food. Staxyn comes as a tablet that dissolves on the tongue; it may work more quickly than Levitra.

Avanafil (Stendra) lasts for up to 6 hours and is taken 30 minutes before sex with or without food. Higher doses can be effective in as little as 15 minutes, making it useful for spontaneous sex.

Warnings about ED Drugs

First of all, you should never begin taking any prescription medication without discussing it with your healthcare provider. If you use an online pharmacy or subscription service to fill your ED prescription, be sure that it is a legitimate pharmacy; there are many dangerous counterfeit ED pills out there.

People with heart disease, heart failure, low blood pressure, liver disease, or are on dialysis should not take any PDE5 inhibitors without being evaluated by a doctor. You should never take any PDE5 inhibitor if you are taking nitrates, medications commonly prescribed for heart-related chest pain (angina). This can cause a sudden and massive drop in blood pressure that can be life-threatening, especially for people with serious heart problems. Common nitrate medications include nitroglycerin (Nitrostat, Nitrotab, and others), isosorbide mononitrate (Imdur, Ismo, Monoket), and isosorbide dinitrate (Dilatrate-SR, Isochron, IsoDitrate, Isordil Titradose). Dangerously low blood pressure can also occur when using PDE5 inhibitors with amyl nitrate and amyl nitrite, commonly called “poppers”, a type of recreational drug.

Side Effects of ED Pills

Common side effects of ED pills include headache, flushing (redness in the face), nasal congestion or runny nose, vision changes (blurred vision, light sensitivity), upset stomach, and back pain. These effects are temporary, but, if they are severe, you should stop taking the medication for ED (do not stop if you are taking it for other medical reasons). In rare cases, PDE5 inhibitors can also cause sudden loss of hearing or vision.

Serious, potentially life-threatening side effects can occur with PDE5 inhibitors, including dangerously low blood pressure when taken with nitrates and priapism. Priapism is having an erection that lasts more than 4 hours. While it may sound like too much of a good thing, priapism can be a serious medical emergency. In addition to being painful, if normal blood flow does not return to the penis it can lead to permanent injury, including erectile dysfunction or gangrene, in extreme cases. If you experience priapism, seek medical help immediately.

Testosterone and ED Medication

Testosterone is the primary male sex hormone. Testosterone levels tend to decrease with age, but if they are too low they can cause ED, fatigue, loss of sex drive, and other symptoms. In men with low testosterone levels (male hypogonadism), research shows that testosterone replacement therapy may help ED drugs work better. When discussing ED with your healthcare provider, be sure to talk about any other symptoms you are having — they may be related to your ED.

Other ED Treatments

PDE5 inhibitors are not always successful and some men cannot take them due to medical conditions. Another drug used to treat ED is alprostadil, which works similarly to oral ED drugs. Rather than a pill, alprostadil is injected into the penis (Caverject) or inserted into the urethra (Muse). Other ED treatments available include vacuum-assisted erection devices (penis pumps), penile implants, or surgery to correct specific problems with the penis.

ED Is a Medical Problem That Should Be Treated

If you have erectile dysfunction you should seek medical treatment; ED can be the first sign of an underlying medical condition. Tell your doctor about any symptoms you are having (not just ED) and discuss treatment options. A simple pill may be all you need to get your sex life back on track.

Key takeaways

Mild to moderate ED is common and can often be effectively treated with medication.

There are 4 types of ED pills available. Talk to your doctor about which one is best for you.

Do not take ED medications without seeing a healthcare provider. Underlying medical conditions can lead to dangerous, even life-threatening, side effects.

References

Urology Care Foundation. What is Erectile Dysfunction?

Cleveland Clinic. Erectile Dysfunction.

Sexual Medicine. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies.

Frontiers in Pharmacology. The Effect of Phosphodiesterase-type 5 Inhibitors on Erectile Function: An Overview of Systematic Reviews.

National Library of Medicine. PDE5 Inhibitors.

Mayo Clinic. Erectile Dysfunction: Viagra and Other Oral Medications.

International Journal of Clinical Practice. Counterfeit Phosphodiesterase Type 5 Inhibitors Pose Significant Safety Risks.

Circulation. Drug Interactions With Phosphodiesterase-5 Inhibitors Used for the Treatment of Erectile Dysfunction or Pulmonary Hypertension.

Mayo Clinic. Priapism.

Journal of Surgical Technique and Case Report. Penile Gangrene: An Unusual Complication of Priapism in a Patient with Bladder Carcinoma.

Mayo Clinic. Male Hypogonadism.

Translational Andrology and Urology. Do Testosterone Supplements Enhance Response to Phosphodiesterase 5 Inhibitors in Men with Erectile Dysfunction and Hypogonadism: A Systematic Review and Meta-Analysis.

National Library of Medicine. Alprostadil.

Mayo Clinic. Penis Pump.

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