A healthier lifestyle can often be beneficial and can help prevent any further deterioration caused by underlying medical conditions. Stopping smoking for those that do is extremely important. A moderate amount of exercise and healthy diet may help. Alcohol intake should be moderated and stress should be identified and managed where possible.
In around 95% of cases, a suitable treatment can be found. The simplest treatments are talking therapies and tablets.
If the cause is mainly worry, other psychological problems or relationship difficulties – such as arguments and disagreements about sex – then talking to a counselor or psychosexual therapist will be most helpful. Therapy includes:
- Penile prosthesis : surgically placed semi-rigid or inflatable prosthesis within the penile body
- Penile vascular reconstruction : reserved for specific young patients who have suffered from pelvic trauma involving the penile vasculature
If hormone levels are found to be low, then replacement therapy with testosterone is often very useful.
In most other circumstances, a trial with a medicine that helps men obtain and keep an erection is the next step. There are now three different brands of tablets known as phosphodiesterase type -f (PDE5) inhibitors. The two newer drugs tadalfil (Cialis) and vardenafil (Levitra) work in a similar way to sildenafil (Viagra), the first drug of this type, but take effect more quickly. Men taking nitrate drugs (e.g., glyceryl trinitrate) for angina must not use PDE5 inhibitors at the same time as they can dangerously lower the blood pressure.
For all three medicines, sexual foreplay is needed to start the arousal process. The ability to have erections can last for several hours or with tadalafil for up to about 24 hours.
Side-effects with these treatments tend to be minor and may include headaches, nausea, indigestion and a stuffy nose. However, they are prescription only drugs and are not suitable for everyone. There have been rare but serious complications.
In more severe cases of ED, where patients do not respond to PDE5 inhibitors the need for second line agents should be assessed. These include the following:
- Intracavernosal injections : local injections of one or a combination of alprostadil, papaverine & phentolamine.
- Vacuum constriction devices : these are effective in most patients and do not require a prescription