Comprehensive Guide to Erectile Dysfunction (ED) Treatments

What Is Erectile Dysfunction?

Erectile dysfunction is the inability to achieve or maintain an erection firm enough for sexual activity. It’s common, especially as men age. According to the Cleveland Clinic, approximately 40% of men are affected by age 40, and 70% by age 70.

While occasional issues are normal, ongoing ED could signal an underlying condition that requires medical attention.

ommon Causes of ED

ED can result from physical, psychological, or lifestyle-related factors, including:

• Cardiovascular disease or high blood pressure

• Diabetes and obesity

• Hormonal imbalances (low testosterone)

• Stress, anxiety, or depression

• Alcohol or tobacco use

• Certain medications (e.g., antidepressants, blood pressure meds)

• Nerve or spinal injuries

Understanding the root cause is key to choosing the right treatment.

1. Oral Medications (PDE5 Inhibitors)

These are the first-line treatment for most men with ED. They increase blood flow to the penis and are taken before sexual activity.

Top options in the U.S.:

• Sildenafil (Viagra)

• Tadalafil (Cialis)

• Vardenafil (Levitra, Staxyn)

• Avanafil (Stendra)

Pros: Easy to use, effective for most men
Cons: Can cause side effects like headaches, flushing, or nasal congestion
Note: Should not be taken with nitrates or certain heart medications

2. Hormone Therapy

If ED is caused by low testosterone (hypogonadism), testosterone replacement therapy (TRT) may help. Available as:

• Injections

• Gels or patches

• Pellets (implanted under the skin)

Important: Testosterone therapy is only effective if hormone deficiency is present—your doctor will test levels before prescribing.

3. Penile Injections or Urethral Suppositories

Medications like alprostadil can be injected directly into the penis or inserted as a tiny suppository. These cause an erection within minutes.

Pros: Fast and effective
Cons: Invasive and can cause discomfort or pain

4. Vacuum Erection Devices (VED)

These devices create a vacuum that draws blood into the penis. A ring is then placed at the base to maintain the erection.

Best for: Men who want a drug-free alternative or cannot tolerate medication
Covered by: Many insurance plans, including Medicare

5. Penile Implants (Surgical Option)

For men who don’t respond to other treatments, a surgically implanted penile prosthesis can be a permanent solution.

Types:

• Inflatable implants (most popular)

• Malleable (semi-rigid) implants

Success rate: Very high satisfaction—over 90% among patients and partners.

6. Psychological Counseling

If ED has psychological roots—such as anxiety, depression, or relationship issues—therapy can be effective, especially when combined with medical treatment.