Understanding Erectile Dysfunction

What are the Treatments for ED?

Treatment options will vary depending on the cause…

Therapy based treatments include counselling, cognitive behavioural therapy and psychotherapy such as focused sex group therapy, which are usually effective for anxiety related or relationship issues.

For psychological problems though, often a short course of tablets to help with erections may help to build confidence. But they may not be the best way to manage psychological causes of erectile dysfunction in the long term.

Tablet options for ED

Viagra, Sildenafil & others – Phosphodiesterase-5 inhibitors (PDE-5)

There are various treatments that have been shown to work for the majority of men, and PDE-5 inhibitors such as Viagra are the most commonly used. These have revolutionised the management of ED, with their demonstrated effectiveness, ease of use, good tolerability and excellent safety record.

How does Viagra work?

Viagra, one of the PDE-5 treatments, help with muscle relaxation of the arteries to the penis, resulting in increased blood flow to the penis and therefore a penile erection.

What are the alternatives to Viagra?

Different medicines can be tried, such as Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil) or Spedra/ Stendra (avanafil). These all usually have a brand name, which are made by pharmaceutical company who first developed the medicine, and then non-branded names, also known as generics, which we’ve added as the names in brackets.

Viagra is the most popular drug. Like the others, it works by widening the blood vessels once a man is already aroused to help get and maintain an erection. This increases blood flow into the penis. It works within 30-60 minutes and can help one initiate or maintain an erection usually between 4-6 hours after taking it.

A common misconception is that using the drug will cause a constant erection. In fact, you must be sexually stimulated for the drug to work and in most men the erection will go away after climax is reached.

Side-effects can sometimes occur, most of which are mild. The more common effects can include headaches, visual disturbances and dizziness. The other medications work in a similar way, but Cialis can work for much longer – up to 72 hours, and Avanafil has been shown to work faster – within 15 minutes.

What are the best alternatives to Viagra?

Sildenafil is the same as Viagra. It’s much cheaper too. Tadalafil is one of the other most commonly prescribed tablets. The main difference is that it stays in the body for up to 36 hours. This means that you only need to take one tablet, and you will usually be able to have an erection when sexually stimulated for the next 36 hours.

What about other options apart from tablets?

If these treatments aren’t working, there are other options. These include injections, creams, vacuum pumps, rings, external splints, vibrators

Nutrition may have a big role to play in managing and prevention of ED, with many studies showing ED is affected by what we eat. There is a lot of research going on, with still emerging evidence.

ED is a topic often not discussed. However, it is a common condition that can seriously affect a man’s confidence, and sex relationships. There are many different treatments that have been shown to work; however, it is important to consider the causes of why you have ED too.

If you would like further information and treatment, please visit The Doctor Service Erectile Dysfunction page for further information.

Edited by Dr Kiran Sodha & The Doctor Service


  1. Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation; European Association of Urology (2015)
  2. Melnik T, Soares BG, Nasello AG; The effectiveness of psychological interventions for the treatment of erectile dysfunction: systematic review and meta-analysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. J Sex Med. 2008 Nov 5(11):2562-74. doi: 10.1111/j.1743-6109.2008.00872.x. Epub 2008 Jun 17.
  3. Nehra A, Jackson G, Miner M, et al; Diagnosis and Treatment of Erectile Dysfunction for Reduction of Cardiovascular Risk. J Urol. 2013 Jan 9. pii: S0022-5347(13)00009-8. doi: 10.1016/j.j
  4. nice.org.uk. (2017). Erectile dysfunction – NICE CKS. [online] Available at: https://cks.nice.org.uk/erectile-dysfunction
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