Erectile dysfunction (ED) is trouble getting or keeping an erection firm enough for sex. An occasional episode is common and usually nothing to worry about, often caused by stress, tiredness, or alcohol, and it tends to pass on its own. But ED that keeps happening is not a normal part of aging and can be an early warning sign of an underlying problem such as clogged blood vessels, diabetes, high blood pressure, low testosterone, or depression, so it is worth seeing a doctor. There is no genuine over-the-counter drug for ED in the US: the proven medicines are prescription-only PDE-5 inhibitors, and the "natural" or "male enhancement" supplements sold online and in stores are not safe substitutes. Treatment usually starts with lifestyle changes and treating any underlying cause, then a doctor-prescribed pill, with devices, injections, or surgery as further options.
A doctor may prescribe these — not for self-treatment.
Sildenafil Viagra PDE-5 inhibitor (oral) | Clinician-prescribed first-line pill. Per MedlinePlus, oral PDE-5 inhibitors usually start working in 15 to 45 minutes and only work when you are sexually aroused. Prescription-only in the US and not for everyone: a doctor must check it is safe, especially because combining it with nitrate heart medicines (e.g. nitroglycerin) can cause a dangerous drop in blood pressure. Never self-start or buy without a prescription. |
Cialis PDE-5 inhibitor (oral) | Clinician-prescribed alternative with a longer duration of action than sildenafil, which some doctors choose for less rigid timing around sex. Same prescription-only status and the same serious nitrate interaction; a doctor decides if and which PDE-5 inhibitor fits your health history. |
Vardenafil Levitra / Staxyn PDE-5 inhibitor (oral) | Another doctor-prescribed PDE-5 inhibitor option named by MedlinePlus and NHS. Choice among the four PDE-5 inhibitors is individualized by a clinician based on other medicines, heart health, and side effects, not chosen by the patient alone. |
Stendra (Spedra in the UK) PDE-5 inhibitor (oral) | A faster-onset prescription PDE-5 inhibitor a doctor may try if other pills are unsuitable or poorly tolerated. Prescription-only; requires the same medical review for nitrate and other drug interactions. |
Start with what you can control. Both NHS and MedlinePlus say lifestyle change can help and is the safe first step: lose excess weight, stop smoking, eat a healthy diet, exercise regularly, sleep well, manage stress, keep alcohol under about 14 units a week, and avoid more than about 3 hours of cycling per week. Because persistent ED can be an early sign of heart or blood-vessel disease, diabetes, or low testosterone, the most important "treatment" is often having a doctor find and treat the underlying cause, including reviewing any medicines that may be contributing. If a pill is appropriate, a clinician will choose among the prescription PDE-5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) based on your health and other medications; they differ mainly in how fast and how long they work. When pills do not suit you, a doctor may offer a vacuum pump, urethral or injected alprostadil, or, less commonly, surgical penile implants. If stress, anxiety, depression, or relationship issues are driving the problem, counselling can be part or all of the treatment. Be honest about the limits of "natural" options: the FDA warns that over-the-counter "all natural" sexual-enhancement and ED supplements sold online and in stores frequently contain hidden, undeclared prescription drugs like sildenafil and tadalafil, may carry dangerous or excessive doses, and can interact with nitrate heart medicines to drop blood pressure to life-threatening levels. They are not a safe shortcut around seeing a doctor.
Seek emergency care immediately (go to the ER) if you take an ED medicine and get an erection that lasts more than 4 hours, or if you have chest pain, fainting, or severe dizziness after taking an ED drug, especially alongside any nitrate medication. Make a routine GP/doctor appointment if erection problems keep happening (more than about a quarter of the time), come on suddenly, or appear with other symptoms such as reduced sex drive, trouble urinating, or signs of depression, because ED can be an early warning of heart disease, diabetes, high blood pressure, hormone problems, or mental-health conditions that need treatment. Do not buy ED pills or "enhancement" supplements online to avoid a doctor's visit: only a clinician can confirm a PDE-5 inhibitor is safe with your other medicines and heart health.
General reference, not medical advice, and not a substitute for your doctor or pharmacist. The right choice depends on your symptoms, health conditions, age, and other medicines — always read each label and confirm before taking anything.
Caverject / Edex / MUSE Prostaglandin (penile injection or urethral suppository) |
| For men in whom pills do not work or are unsuitable. Per MedlinePlus, this is medicine inserted into the urethra or injected into the penis to improve blood flow, using very small needles. Started and dose-titrated under medical supervision, never self-initiated. |
Testosterone replacement AndroGel / Testim / Natesto (gels, patches, injections) Hormone (androgen) replacement | Only appropriate when blood tests confirm low testosterone, per MedlinePlus and NHS. Requires diagnosis and monitoring by a clinician (often an endocrinologist); it is not a general ED remedy and should never be taken without confirmed low levels and a prescription. |