Most experts will tell you that every man will deal with some level of erectile dysfunction (ED) at some point in his life. Many men, especially as they get older, will have it seriously enough that they'll consider seeking some help. The upside is that the vast majority of ED cases can be treated with great effectiveness. For many, it's a simple as taking a pill. Here's what you need to know before you do.
1. How to Talk to Your Doctor
Given that ED is such a common problem, don't be too daunted about talking to your doctor about it. However, don't expect them to throw you a bunch of free samples right away. First, they are going to want to make sure your erectile issues require medication. They will likely ask about your diet, weight, stress-levels, and sleep. "Making sure the dysfunction is from a medical problem and not necessarily related to anxiety or a psychogenic cause is also important to tease out before to running to give them medicine," says Dr. Benjamin Breyer, Chief of Urology at San Francisco General Hospital.
Medical history can also be an important factor, especially for men who have had surgery or radiation that could affect functioning. Age and baseline erectile functioning are also important determinants of how various ED treatments will work.
2. How the Pills Work
You probably already know the names of the most popular pills — Viagra, Levitra, Cialis — but how do they work? First of all, all increase the effects of nitrous oxide in the body, which relaxes muscles around your penis and allows for increased blood flow. Although they are referred to interchangeably in the common lexicon, there are some differences between these pills. The biggest is how long they last. Cialis is the standout here, as a man can take it well before he thinks he will need it and, if he takes it daily, there is no time delay in terms of when it will work. Viagra and Levitra, on the other hand, have to be taken at least 30 to 60 minutes prior to sex and can last four to five hours. A new pill, Avanafil (Stendra), has cut this time down to 15 to 30 minutes and lasts six to 12 hours. Cialis is also the only ED pill that is also FDA-approved to treat benign prostatic hyperplasia (BPH), an enlarged prostate condition which can affect urination. So, some men may take Cialis for this reason as well.
Overall, these pills are quite safe for most men. Common side effects that exist are pretty mild and Breyer says they often improve over time. "By and large, they are safe. There are common side effects, like headaches, dizziness, flushing, back pain, some guys get runny noses, feeling congested," says Breyer. This is particularly good to know, considering men using these treatments will likely use them for the rest of their lives. Erectile dysfunction medications may be ineffective or dangerous for men who take nitrates or blood thinners, and those who have had heart problems, stroke, or issues with their blood pressure.
3. Non-Oral Medications
Oral medications work for most men with ED but some may require more potent options. The first of these is a suppository pellet, Alprostadil (Muse), which is inserted directly into the urethra (the tube that carries urine and semen out of the penis). In order to use this, a man urinates to lubricate the urethra and then inserts the pellet. This a strong medication and the delivery is much more direct than in oral pills. It is still fairly safe. "Guys tend to tolerate it well, but some men will complain of penile pain or burning afterwards when they urinate," says Breyer.
The other non-pill medication treatment for ED is direct injection. This entails using a needle to deliver medication — usually a mix of two to three meds — into the penis prior to sex. This mix is usually created in special pharmacies and is the strongest ED medication available. Due to its potency, doctors will put their patients on the lowest possible doses and increase the dose only if necessary.
4. Over-the-Counter Supplements
Different experts have different opinions on the effectiveness of supplements. Most agree, however, that using them is a gamble. Supplements, unlike medications, are not regulated by the U.S. Food and Drug Administration (FDA) and this can be problematic. "Because of how it's regulated or the lack of regulation, really you don't know what you're getting," says Breyer. This lack of certainty means supplements could be potentially dangerous. More often, it seems that they simply don't work.
5. Recreational Use and Sketchy Retailers
It's no secret that many men use ED drugs without getting the go-ahead from their doctor. "We know that people use it recreationally and I wouldn't advise them to do it medically," says Breyer. "If they're going to do it, they should obviously be careful." This warning is even more important for people trying to use the injectable medications without medical guidance. Because these are so strong, there is an increase chance that they will cause priapism — that erection lasting longer than four hours that you've heard so much about. This condition is a medical emergency, which, if not addressed immediately, could result in very severe ED that cannot be treated with medications.
Recreational users tend to get these medications from nonconventional places, like the Internet or foreign pharmacies, without talking with their doctor. Some of the people buying ED drugs from these places truly have erectile problems but cannot afford to purchase the proper medications from their pharmacy. These medications are prohibitively expensive for many people and there are innumerable unapproved retailers offering what they say are the same drugs at a much lower price. It's an understandable risk for men to take but a risk all the same. "The truth is, it's really hard to tell whether it's reliable or not, whether it's counterfeit or not when you're not obtaining it through a well-established, known source," says Breyer. Often, the problem with these drugs is that they are diluted and, therefore, less effective.
6. The Big Picture
Erectile dysfunction may be challenging, frustrating, and embarrassing but it is impressively treatable. The pills that are available do wonders for many men and there are enough other options out there that almost all cases of ED can be successfully addressed. While, there are many avenues that men use to try and fix ED themselves but the best way is through consulting with a medical professional.