Erectile dysfunction has more treatment options today than at any point in history. While many men default to the first oral medication they hear about, there are multiple effective approaches — and the right one depends on your specific cause, health history, preferences, and how previous treatments have performed.
Oral Medications (PDE5 Inhibitors)
Oral medications are the most widely used first-line treatment for ED. They work by inhibiting phosphodiesterase type 5, increasing blood flow to erectile tissue in response to sexual stimulation.
- Sildenafil (Viagra): Taken 30–60 minutes before activity. Effective for 4–6 hours. Generic available at low cost.
- Tadalafil (Cialis): Daily low-dose or as-needed. As-needed version lasts 24–36 hours — the "weekend pill." Preferred for spontaneity.
- Vardenafil (Levitra): Similar to sildenafil with slightly different tolerability profile.
- Avanafil (Stendra): Fastest onset (15 minutes); favorable side effect profile; higher cost.
Success rate: 60–80% in men without significant vascular disease. Lower in men with diabetes, post-prostatectomy nerve damage, or severe vascular disease.
Cannot be used with: Nitrate medications (used for chest pain) due to dangerous blood pressure interaction.
Penile Injections
Intracavernosal injections deliver vasodilating medication directly into erectile tissue, producing erections independent of sexual stimulation and nerve function.
- Alprostadil (Caverject, Edex): FDA-approved single-agent injection
- Trimix: Compounded combination of papaverine, phentolamine, and alprostadil — often more effective than single agents with lower doses
- Bimix: Two-agent combination for men who cannot tolerate alprostadil alone
Success rate: 70–90%, including in men for whom oral medications have failed. Requires comfort with self-injection.
Vacuum Erection Devices (VED)
Non-pharmacological option using negative pressure to draw blood into the penis. A constriction ring maintains the erection. No medication, no systemic effects. Particularly useful for men who cannot use medications due to cardiac contraindications.
Success rate: Approximately 90% mechanical efficacy, though patient satisfaction is lower than injection therapy.
Shockwave Therapy (Low-Intensity)
Low-intensity extracorporeal shockwave therapy (Li-ESWT) applies acoustic waves to erectile tissue to stimulate blood vessel growth and nerve regeneration. A series of 6–12 sessions. Evidence is emerging and promising for vasculogenic ED; it is not FDA-cleared for ED but is offered widely off-label.
Testosterone Replacement
When ED is accompanied by documented low testosterone, TRT can restore erections — sometimes without requiring additional ED medication. For men with borderline or normal testosterone, TRT adds little benefit for ED specifically.
Penile Implants
Surgical prosthetics are the most permanent option, reserved for men with severe vasculogenic ED who have failed all other treatments. Satisfaction rates are very high (90%+) but the procedure is irreversible.
ED Treatment Comparison
| Treatment | Invasiveness | Success Rate | Best For |
|---|---|---|---|
| Oral PDE5 inhibitors | None | 60–80% | First-line, mild-moderate ED |
| Penile injections | Minimal | 70–90% | Oral medication failures |
| Vacuum erection device | None | ~90% (mechanical) | Cardiac contraindications |
| Shockwave therapy | Minimal | Emerging evidence | Vasculogenic ED |
| Penile implant | Surgical | 90%+ | Severe, refractory ED |
Frequently Asked Questions
Should I try oral medications before anything else?
For most men without contraindications, yes — oral PDE5 inhibitors are safe, effective, and the least invasive option. They are the appropriate starting point unless there is a specific contraindication or a clear diagnosis pointing toward a different cause.
What if oral medications do not work for me?
Failure of one oral medication does not mean all will fail. Trying a different molecule (tadalafil vs. sildenafil) or optimizing dosing is worthwhile first. If oral PDE5 inhibitors genuinely fail, injections and shockwave therapy are effective next steps with excellent evidence bases.
Find an ED Provider Matched to Your Needs
Our comparison covers ED care platforms offering oral prescriptions, injection therapy options, and clinician-supervised programs — so you can find care appropriate for your specific situation.
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