Lloydspharmacy.com Health - ED treatments summary

Written by Helen Marshall, pharmacist

A variety of effective treatment options are now available for men with erectile dysfunction (ED). This means the sooner you make an appointment to see your GP, the sooner your sex life can return to normal.

To start with, you can try the basic lifestyle modifications suggested. Your GP may then prescribe further treatment.

Lifestyle modification

Sexual function is influenced by your overall wellbeing.

ED may be a sign that you are not giving enough attention to a healthy lifestyle. It can also be the first symptom of more serious conditions such as diabetes, heart disease and prostate cancer.

For this reason, it's important you discuss your concerns with a GP who will give you a check up to rule out these problems.

Below are some things you could do that can improve your ability to get and sustain an erection, and at the same time lower your risk of many other serious conditions.

Action	Reasons	Tips
Stop smoking	Smoking hardens the arteries, including those that supply blood to the penis. This can limit the flow of blood and cause ED.	Quitting is difficult, but it is easier with support. Ask your pharmacist or GP about their smoking cessation services. You could also try an online programme.
Increase the amount you exercise	Exercise improves blood circulation, builds strength and stamina, lifts mood and relieves stress. This will benefit your sex life, as well as your overall health and wellbeing.	Walking more is the simplest way of increasing fitness. Start with short 15 minute walks and aim for five days a week. Exercise with your partner or a friend to spur your motivation.
Improve your diet	Food is your body's fuel. You can't expect your body to function properly if you don't supply it with the foods it needs.	Follow the basics of healthy eating: five fruit and veg portions a day, more fibre, more water, less salt, sugar, saturated fat and caffeine.
Moderate alcohol consumption	Alcohol can cause and worsen ED.	Try to stick to the safe limit of no more than three units of alcohol per day for men. Don't drink every day, and don't get drunk before sex.
Manage stress	Stress and overwork are culprits of many problems. ED treatments can't do much if you are constantly exhausted, don't get enough sleep etc - especially if these issues cause tension in your relationship.	Write down what causes your stress and think about ways you can tackle them. Good communication with your partner and taking time out to relax will also help. For starters, pick one thing you enjoy and make an effort to do it once a week.

Psychological treatments for erection problems

Psychological problems need to be addressed if they are the predominant cause of ED. If not, drugs are unlikely to restore enjoyable and satisfying sexual intimacy to your relationship.

Problem	Treatment
Psychological conditions such as depression, anxiety	Your GP can prescribe counselling and medicines.
Relationship difficulties	You need to be able to talk to your partner about your sexual problems. Ask your GP about sex or relationship counselling. If matters are bad, it is worth talking to Relate.

Physical treatments

There is a good chance of finding a treatment that works and allows you to enjoy a fulfilling sex life for years to come.

The treatments depend on your medical history, and he will also take into account your personal preferences and your preferences as a couple.

Medicines taken by mouth

In the UK, current tablet treatments are a type of medicine called PDE-5 inhibitors. They work by stopping the breakdown of a chemical that relaxes the erectile tissue within the penis. This allows the penis to fill with blood and become erect.

Because the chemical they act on is only produced when you are aroused, the tablets below only give an erection in response to sexual stimulation.

Clinical trials have found varying success rates of between 57 and 80 per cent with these medicines.

Name	Dose	When to take	How soon it works	How long it works	How often to use
Cialis	10mg or 20mg tablets	At least 30 minutes before sex.	Can be as early as 16 minutes after taking the tablet, but only if sexually stimulated.	Up to 36 hours after the dose.	No more than once a day and preferably not every day.
Cialis	2.5mg or 5mg tablets	Once a day at the same time each day	Can be as early as 16 minutes after taking the tablet, but only if sexually stimulated.	Allows erections to be produced at any point during the 24 hours of the day	Every day, but no more than once a day
Levitra	5mg, 10mg or 20mg tablets	25 minutes to 1 hour before sex.	15 minutes to 2 hours after taking the dose, providing there is sexual stimulation.	For 4 to 5 hours after taking a dose.	No more than once a day.
Viagra	25mg, 50mg or 100mg tablets	1 hour before sex.	25 minutes to one hour in response to sexual stimulation.	For 3 to 4 hours after the dose. Some men find their erections are still improved the next day.	No more than once a day.

Medicines administered directly into the penis

Alprostadil is the same as a naturally occurring hormone called prostaglandin E1, which causes blood vessels in the penis to expand.

Alprostadil medicines increase blood flow into the penis to cause an erection.

The injections have been widely used by men since the 1980s and produce erections firm enough for sex in 80 to 90 per cent of men.

MUSE is slightly less effective, producing an erection suitable for intercourse in around 65 per cent of men. More recent studies have reported lower response rates.

Name	Dose	When to use	How soon it works	How long it works	How often to use
mcg = micrograms
Caverject	5 mcg, 10 mcg, 20 mcg or 40 mcg injection into the penis shaft.	10 minutes before sex.	Under 10 minutes.	Dose usually adjusted to give an erection that lasts 1 hour.	No more than three times per week.
MUSE	125 mcg, 250 mcg, 500 mcg or 1000 mcg pellet inserted into the tip of the penis.	10 minutes before sex.	5 to 10 minutes.	30 minutes to 1 hour.	No more than twice in any 24-hour period, and no more than seven times in any seven day period.
Viridal Duo	10 mcg, 20 mcg or 40 mcg injection into the penis shaft.	10 minutes before sex.	Under 10 minutes.	Dose usually adjusted to give an erection that lasts 1 hour.	No more than three times per week.

Mechanical aids

Type	Description
Constriction ring	Latex rubber or silicone ring that is fitted around the base of the erect or semi-erect penis. It causes blood to build up in the penis and maintains the erection until the ring is removed.
Vacuum pump	Plastic chamber that is placed over the penis. Air is extracted using a pump, which allows blood to be drawn more effectively into the penis. After the pump is removed for sex, the erection can be maintained with a constriction ring. Erections should not be maintained for more than 30 minutes.
Semi-rigid penile prosthesis	Surgery to insert flexible rods into the shaft of the penis. The rods are firm enough to allow intercourse. The penis can be bent up for penetration and bent down at other times.
Inflatable penile prosthesis	Surgery to place two cylinders inside the penis, with a pump and fluid reservoir in the scrotum. During intercourse, the pump is activated by squeezing a device in the scrotum. This draws fluid from the reservoir into the cylinders, making the penis hard. After sex a valve is pressed to allow the fluid to drain back into the reservoir.
Arterial surgery	Performed only rarely to repair an injury or blockage to the arteries going to the penis, if this has been the cause of ED.

Are these treatments suitable for everyone with ED?

No, and the main factor affecting your choice of treatment will be what other conditions co-exist with your ED. For example, the tablets must not be taken by men taking nitrate drugs for angina, and if you have severe heart disease it may not be safe for you to have sex.

What are the side effects of these treatments?

All medicines have side effects associated with their use, and listed below are the most common. People respond differently to medicines - the fact that a side effect is listed here, doesn't mean you will experience it. For more details, refer to the information leaflet in the pack.

Treatment	Side-effects
Cialis	Headache and indigestion. Other common effects include muscle or back pain, nasal congestion, flushing and dizziness.
Levitra	Headache and flushing, indigestion, nausea, dizziness and a runny or blocked nose. Less common problems include changes in blood pressure, abnormal skin reactions to sunlight, eg a rash, and abnormal vision such as a blue/green tinge to vision.
Viagra	Headache, flushing and indigestion. Some men may experience nasal congestion, dizziness and mild visual disturbances, such as an odd blue tint to the vision and increased perception of light.
Caverject and Viridal Duo	Penis pain affects around 20 per cent of users and is caused either by the injection or a reaction to the drug. The pain is usually mild and short-lived. Priapism - a prolonged erection lasting for more than four hours - affects about 1 in 250 men. Other effects include tissue hardening within the penis (fibrosis).
MUSE	Mostly due to the insertion of the drug and applicator into the tip of the penis. This can cause penis pain, a burning sensation and minor bleeding. Other side-effects include pain in the testicles, headache, dizziness and engorgement of varicose veins in the legs.
Vacuum pumps and constriction rings	Blue-looking, uncomfortable erections. The ring can impair or prevent ejaculation. Your partner may complain that your penis feels cold. Your penis may pivot at the base so it's difficult to achieve intercourse.
Penile protheses	As with any operation on the genitals, there is a risk of infection, bruising and bleeding. In both types of prostheses, sensation may be reduced and ejaculation may be absent.

Last updated 27.02.2009