Erectile dysfunction: causes and treatments that work
Erectile dysfunction (ED) is common and treatable. It is also a health signal. The arteries of the penis are small, so ED often appears years before heart disease. A good urologist checks blood pressure, sugar, cholesterol and hormones, and reviews your medications, not just your prescription.
Treatment options
PDE5 inhibitors (sildenafil, tadalafil) work for most men. They need sexual stimulation, and they must never be combined with nitrate heart medications.
Penile injections (such as Trimix) work even when pills don't. The first dose should be given in the office, to set a safe starting dose and teach the technique. An erection lasting more than four hours is an emergency that needs same-day treatment. Never stack injections with pills.
Vacuum erection devices are drug-free and inexpensive, though some men find them awkward.
Low-intensity shockwave therapy is widely marketed. It is not FDA-cleared for ED, and the American Urological Association considers it investigational. Ask what evidence a clinic is relying on before paying out of pocket.
Penile implants are the most reliable long-term solution when other treatments fail. They have very high satisfaction rates in experienced hands. How many implants the surgeon does each year matters.
A word on testosterone
Low testosterone can lower desire, but it is rarely the main cause of ED. Testosterone therapy also shuts down sperm production. Men who may want children should discuss alternatives first. See our low testosterone guide.
Questions to ask
- What do you think is causing my ED, and do I need any heart or hormone testing?
- If pills don't work, do you offer injections, and is the first dose given in your office?
- How many penile implants do you perform a year?