These drugs have completely changed how erectile function is treated. They are usually effective (in approximately 70% of men) but cannot be taken by all men because of side effects, and because they can interfere with the effectiveness of other medications.

Men who take drugs called nitrates (such as nitroglycerin) for heart disease, angina, or high blood pressure; and men who use the recreational drug "poppers" (amyl nitrite, butyl nitrite, isobutyl nitrite) CANNOT take PDE-5 inhibitors. The combined drugs can cause blood pressure to drop which may lead to serious complications in men with heart disease.

Other side effects such as headache, stuffy nose, and flushing are not usually severe. Rarely, an erection can last for too long a time (more than 4 hours). Cialis is more likely to cause this problem since it can work for up to 36 hours. If a prolonged erection occurs, a physician should be consulted right away.

Viagra and Levitra should be taken one hour before intercourse is going to take place - these drugs work for about four hours.

Taking Viagra or Levitra with food can decrease the amount of the drug that gets into the blood stream. Cialis is not affected by eating.

The PDE-5 inhibitors can interfere with other drugs that are taken. All medications should be reviewed by the physician before a PDE-5 inhibitor is started.

This treatment causes no drug interactions or side effects. A specially-fitted vacuum pump is applied to the penis, drawing blood into it. Then a constrictive band, to keep the blood in, is placed on the base of the penis. The erection will usually last until the constrictive band is removed. It should not be left on for more than 30 minutes.

It does work, but men must be taught to use it. To get the most satisfaction from this treatment, both the patient and sexual partner must be motivated.

The medications that are being taken should be reviewed to see if something can be changed to help with erectile dysfunction. Most antidepressants, some blood pressure-lowering drugs, cholesterol-lowering drugs, anti-ulcer medicines as well as many other drugs can commonly cause erectile dysfunction. Alternative medications can sometimes be chosen to see if this improves erectile dysfunction.

Erectile dysfunction can occur in individuals with diabetes, certain kidney problems, some types of heart disease, cancer, epilepsy, stroke, and after surgery on the prostate or large intestine. Controlling blood sugar in people with diabetes can sometimes improve the erectile dysfunction, but usually only makes a modest difference.

This drug acts on the brain and works reasonably well. Side effects include nausea, headache, and dizziness. Some people access it by mail order; it cannot be prescribed in the USA. The company that manufactures it has no current plans to apply for American licensing.

Some men with ED are also depressed or have other psychological issues. These circumstances can often be improved with therapy. Counseling requires patients to make a commitment to the treatment and to be willing to talk about sexual difficulties. Counseling can be helpful alone, but works even better combination with other treatments.

About 50 percent of men have good results with this drug, which is given through injection directly into the penis. This compares to about 70 percent who have good results with a PDE-5 drug (such as Viagra).

The injections work better than the urethral suppositories, but many men cannot or will not be able to inject their own penis.

The main side effects are irritation at the injection site (if injected) and irritation at the tip of the penis (if given by suppository).

An implant is put into the penis by a surgeon to give an erection if simpler treatments have failed. Some types of implants (penile prosthesis) will maintain a permanent semi-erection, others have a pump. The implant can then be inflated when desired. The penis will not feel normal, but will be adequate for penetration.

Motivated men and their sexual partners report satisfaction with the results.

Possible complications of surgery include pain, long recovery time, infection, and failure of the implant to work properly. Repeat surgery may be required.

Hypogonadism (low testosterone) is a specific diagnosis. This condition is often suspected after men with erectile dysfunction have failed to improve with a PDE-5 type of drug (Viagra, etc). Testing for blood levels of this hormone should be done to determine if the levels are actually low. If so, testosterone can be given by injection every two weeks, or by a gel that is rubbed on daily. The pill form of testosterone is not effective.

When testosterone is replaced back to normal levels, erections and sex drive almost always improve. The main risk of using extra testosterone is prostate problems; so men who take testosterone should be followed carefully by their physician.

This type of surgery is only useful for younger men who have had some sort of trauma to the pelvis, such as a car accident, that has disrupted the normal flow of blood to the penis. Surgery can reroute arteries to improve the blood blow. Results are are only about 50% successful.