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Erectile dysfunction becomes more common with testosterone decline as men age. It may also occur due to treatments or surgery related to the prostate gland or conditions affecting the nervous system. In addition, the same process of artery clogging that can lead to heart problems can also affect arteries supplying the penis with blood, causing or contributing to erectile dysfunction.
Oral drugs are typically the first choice doctors use to treat erectile dysfunction. Called phosphodiesterase type 5 (PDE5) inhibitors, these include sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis) and avanafil (Stendra). Most men have good results with PDE5 inhibitors, although it can take a few tries to find which one works best for you. When PDE5 inhibitors aren’t effective or aren’t an option, your doctor may suggest:
- Sexual health counseling — Addressing the emotional and psychological aspects of erectile functioning such as performance anxiety or concern about partner’s pain can be an important aspect of treatment. If an erection is simply not possible due to medical factors, that doesn’t have to mean the end of intimacy. Counseling can help you accept and adapt to redefine your sexual relationship with activities that don’t require an erection.
- Self-injections — A fine needle is used to inject a drug such as alprostadil (Caverject, Edex) into the penis. This quickly triggers an erection that often lasts 20 to 40 minutes.
- Urethral suppositories — With these, you use a special applicator to place a tiny suppository of the drug alprostadil (Muse) inside your penis. An erection will begin within about 10 minutes and last 30 to 60 minutes.
- A vacuum erection device (VED) — This is a tube with a hand- or battery-operated pump. The tube is placed over the penis, and the pump is used to create a vacuum that pulls blood into the penis to simulate an erection. An elastic ring is placed at the base of the penis for up to 30 minutes to trap blood and keep the penis erect. It may feel different from a natural erection, but can still be a great option for some couples.
- Penile implants — This involves surgically placing a device in the penis to assist with obtaining a firm erection. There are several types of implants, including inflatable cylinders that are controlled by a pump that is placed near the testicles. Another type is a semirigid device that is firm but bendable. Implant devices are associated with a very high level of satisfaction from both partners and can be an excellent option for men unsatisfied with other treatment options.
It's not an easy topic to talk about, but there's a conversation about ED going on in the Men's Health group.
Men's health and much more, can be found in the Mayo Clinic Health Letter.
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Brand name meds like Viagra and Cialis are still extremely expensive and generally not covered by insurance.
There is a free phone app called GoodRx which can save you hundreds of dollars. A nurse told us about it when balking at an expensive prescription. She looked it up on her phone and immediately found several local pharmacies including Walmart, Target, Walgreens etc. The price was actually cheaper than going through insurance. Have your DR write the prescription for generic Viagra (sildenafil), Cialis (tadalafil), etc. Show the GoodRx screen to the cashier.
no questions asked. They are used to seeing it a lot.
Here is an example. My doctor wrote a prescription for 5mg daily tadalafil (Cialis) with 11 refills. I filled it twice 30 tab $10. I asked if I could fill more than one month at time (yes). I ordered 300 5mg tadalafil. The price was 9 cents per tab. We check GoodRx all the time. It doesn't cost anything to try it.
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1 Reaction90 tablets of 20 mg sildenafil (the generic) are about $24.00. I only need 2 and use GoodRX. That is not too expensive.
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1 ReactionI have tried pills for ED assistance without much help. I'm looking a the the pump approach and would like to hear any experiences you may have had using these devices. Pros and cons and brand experience. Thanks.
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1 ReactionHi Perry, you will find members like @jimhd @jakedduck1 @glenner075 and others talking about pump approaches and other treatments for erectile dysfunction in the Men's Health group (https://connect.mayoclinic.org/group/mens-health-1/) in this discussion:
- ED treatments https://connect.mayoclinic.org/discussion/ed-treatments/
I suggest you hop over there, join the discussion and ask your questions.
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1 Reaction@a2perry
I have no experience with pumps or implants.
Neuropathy was the primary cause of my ED. I tried pills too that didn't help.
I tried pills including Cialis and was expecting some help for a drug I paid over $60 for.
Someone told me about penis injections and immediately I said “NO WAY!” but I checked into it and now use it (Trimix) very successfully. Don't be concerned about the injections being painful, it's not. The needles are very small. At worst it's like a pinprick but usually I never feel it at all.
It isn't cheap though. I last paid $37.50 for prefilled syringes but it's available in vials that are a little cheaper. I imagine the price varies by strength & dose. This medication has to be filled at a Sterile Compounding Pharmacy. I live in California, not sure if it's more expensive here or not. I believe another member, @jimhd had a penile implant awhile back. Hopefully he will join in.
Best of luck you,
Jake
@a2perry I've tried everything except for the needles, which I can't afford, and nothing did the job. I made the arrangements with a urologist in January of last year - pre-covid - for a penile implant, just when the hospital stopped all elective surgeries. I told the urologist that if my arm suddenly stopped working, it would be essential surgery, so why not a penis? And now, with the implant planned for mid September, it's pretty likely going to be put on hold again because of the Delta variant.
The implant I'm getting eventually is the Titan. From what I've seen, it's the most natural one, and it's dependable. Viagra helped at first, but then it didn't. I take quite a few meds and that could well be the cause of my ED. Antidepressants, anti anxiety, morphine for neuropathy pain in my feet and legs. I have two types of neuropathy. Peripheral neuropathy affects the extremities, numbness, pins and needles, and burning pain. Autonomic neuropathy is another whole subject. It hits in all kinds of places. For me, double vision, OAB, RLS, balance,reduction in smell and taste, and ED is likely related to it, along with the medication side effects.
Sorry if I'm not saying anything relevant to your situation. Just letting you know what's worked and what hasn't for me.
Jim
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2 ReactionsJim, Thanks for your response. You have given me some food for thougut. Good luck with your quest.
Thanks Jim. I am not at that point yet but if the pump doesn't work your info will be helpful SA shots would probably be the next option.
Thanks I will.