Medicines for erectile dysfunction fall into different categories depending on how they work.
Phosphodiesterase type 5 Inhibitors
Phosphodiesterase type 5 inhibitors (PDE5Is) are the most common treatment for erectile dysfunction. They are a group of medicines that work by relaxing the smooth muscle in the vessels of the penis to increase blood flow. Taking a PDE5I on its own is not enough to cause an erection and you need to be sexually aroused for these drugs to work.
Due to the success of PDE5Is in treating erectile dysfunction, there are many counterfeit pills appearing in society. These unlicenced drugs are not approved for sale and will not have been clinically tested. They may damage your health or could even be poisonous. Always talk to your doctor or healthcare provider before buying or using medication for erectile dysfunction.
All types of PDE5Is can be very effective. The one that works best for you will depend on your personal circumstances. They are all available as tablets and in a range of doses, so the strength can be adjusted according to your needs and expectations.
If you are taking a PDE5I, it is important during any medical consultations to tell the healthcare professional you are taking it. If you need emergency medical care for a heart problem, the doctors will need to know when you took your last PDE5I tablet.
The 4 approved types of PDE5Is are:
Sildenafil (the most famous brand name is Viagra®)
This is the oldest available PDE5I. Sildenafil works by improving blood flow to the penis. You can feel the effects of the drug 30-60 minutes after taking it, and the effects can last for up to 12 hours. If you eat a fatty meal just before taking sildenafil, the drug does not work as well.
Due to changes in regulations, you do not need a prescription from your doctor to buy sildenafil over-the-counter at a pharmacy, but you will need to have a consultation with the pharmacist to make sure it’s safe for you to take.
Vardenafil (the most famous brand name is Levitra®)
This is available as a pill, or as a dissolvable tablet. You will start to feel the effects of the drug roughly 30 minutes after taking it. Like sildenafil, eating a fatty meal just before taking vardenafil will affect how well the drug works.
Avanafil (the most famous brand name is Spedra®)
The effects of avanafil can happen as quickly as 15-30 minutes after taking it. Taking the pill with any food can delay its effects.
Tadalafil (the most famous brand name is Cialis®)
Unlike some other PDE5Is, food has no effect on how well tadalafil works. You will start to feel the effects of the drug roughly 30 minutes after taking it. It is most effective after 2 hours and the effects may last for up to 36 hours.
Alprostadil
Alprostadil comes in two forms:
- A pellet, known as MUSE (Medicated Urethral Suppository for Erection), which is inserted into the tip of the penis using a plastic applicator.
- A cream, known as VITAROS, applied to the opening of the urethra at the tip of the penis.
You will be advised to use a condom to prevent transfer of this medicine to your sexual partner.
Both methods work by widening the blood vessels in the penis, helping to increase blood flow which is necessary for getting an erection.
MUSE takes around 5-10 minutes to produce an erection that will last around 30 minutes to 1 hour. VITAROS cream takes anywhere between 5 and 30 minutes to produce an erection but it will typically last between 1 to 2 hours.
The major advantage of alprostadil cream is that side-effects are very rare and there are no interactions with other drugs, such as blood pressure medications, or blood thinners like heparin or warfarin.
Frequently asked question about medications for erectile dysfunction
Will my partner know I’m taking medication for erectile dysfunction?
You may feel embarrassed or concerned about telling a new or existing partner that you have erection problems. While medications allow you to “hide” your problem to some degree, the length of time it can take to achieve an erection means it is difficult to have spontaneous sex. So, if your partner is aroused and begins to initiate foreplay with you, you would need to stop any interaction to use your medication.
This might be okay the first couple of times but being honest with your partner is likely to cause you less anxiety during sex and allow you to enjoy the experience more.
Self-injecting medicines
Although the thought of putting a needle into your penis may make you wince, the needle is very small, and many men choose injection therapy on the basis that the benefits outweigh the discomfort of the injection.
Success rates with these injections are very high and 85% of men achieve and maintain erections 10-15 minutes after injection, even without sexual stimulation.
If you are offered this type of treatment, you will receive full training on how to correctly inject the base of your penis, as well as ways to avoid bruising and minimise side effects.
If you are needle-phobic, or have difficulty with the dexterity of your hands, talk to your doctor about the possibility of being prescribed an automatic pen device. In some cases, your partner can receive training on how to inject your penis for you.
Frequently asked question about selfinjecting medicines for erectile dysfunction
Does it hurt?
The biggest obstacle to self-injecting treatments for erectile dysfunction is the thought of sticking a needle into your penis. But once you get over the psychology of what you’re about to do, the reality isn’t half as bad. In fact, a study from 2009 looked at the severity
of pain associated with injections for erectile dysfunction.
The results showed that out of 65 men, the majority experienced little or no pain from inserting the needle, or from the effects of the medication. Even for men who experienced pain, the severity was relatively low.
Will sex feel different for me or my partner?
Typically, no. Most men and their partners won’t notice anything substantially different. However, some people report that injections affect the sensation in their penis and their ability to ejaculate.
