Erectile dysfunction (ED) is the persistent difficulty in achieving or maintaining an erection during sexual activity. It can affect people of any age but becomes more common as you grow older. Studies estimate ED impacts nearly 9% of men in their early 40s and up to 56% of men over 65.

Although ED can be caused by medical, psychological, or lifestyle factors, the good news is that most cases are treatable with proper care. Treatment usually involves a mix of medications, lifestyle adjustments, counseling, or medical procedures.

Prescription Medications

The first line of treatment for ED often involves prescribed drugs designed to boost blood flow to the penis. These include:

• Viagra (sildenafil): The first FDA-approved pill for ED, typically effective within 30–60 minutes. Works best on an empty stomach. Side effects may include headache, flushing, dizziness, and indigestion.

• Cialis (tadalafil): Starts working within 15–45 minutes. Common side effects include indigestion, back or limb pain, and nasal congestion.

• Levitra (vardenafil): Usually effective in 15–30 minutes. Side effects can include flu-like symptoms, nausea, or sinus discomfort.

• Stendra (avanafil): Works within 30 minutes, with side effects similar to other PDE-5 inhibitors.

For those with low testosterone, hormone replacement therapy may also be recommended. However, this treatment carries risks like acne, mood changes, and potential links to certain cancers.

Other Medical Therapies

When oral medications are not effective, other targeted treatments may be used:

• Intraurethral therapy (MUSE): A tiny medicated pellet inserted into the urethra to improve blood flow. May cause mild burning or variable effectiveness.

• Intracavernosal injections: Medications like Caverject or Trimix are injected directly into the penis. Generally effective but may cause pain after injection.

Over-the-Counter (OTC) Options

While many supplements claim to improve ED, only a few are backed by evidence:

• Eroxon gel: An FDA-recommended topical treatment applied to the penis before sex. Works within 20 minutes for many users.

• L-arginine: An amino acid supplement that may improve circulation and support erectile function when taken regularly.

Surgical and Device-Based Treatments

For severe or treatment-resistant ED, surgical or procedural interventions may be considered:

• Vacuum erection devices: Pumps that draw blood into the penis, maintained with a constriction ring. Success rate 70–80%.

• Low-intensity shockwave therapy: Experimental therapy that promotes new blood vessel growth. Early results show promise.

• Penile prosthesis: Implants (either semi-rigid or inflatable) that allow manual control of erections. Risks include infection and device failure.

• Penile revascularization surgery: Rarely performed, usually for younger men with trauma-related ED.

Counseling and Therapy

Because ED can be both a cause and a result of psychological stress, counseling often plays an important role. Working with a therapist can address performance anxiety, depression, or relationship issues. Couples therapy may also help improve communication and intimacy.

Lifestyle Modifications

Adopting healthier habits can reduce ED risk and improve treatment outcomes:

• Quit smoking and reduce alcohol or drug use

• Manage weight with diet and exercise

• Control chronic illnesses such as diabetes or high blood pressure

• Engage in regular physical activity to improve circulation and heart health

Prognosis and Living With ED

ED itself is not life-threatening, but it can reduce quality of life and strain relationships. It may also serve as an early warning sign for heart disease. Encouragingly, with modern medications and therapies, success rates for managing ED are high.

Living with ED requires open communication with healthcare providers and, ideally, with partners. Many men find support through counseling or patient groups. With today’s treatment options, most people with ED can manage symptoms effectively and maintain a fulfilling sex life.