Updated on November 3, 2022.
Erectile dysfunction (ED), the inability to get or keep an erection for sex, is a common ailment. About 30 million Americans have some degree of ED, according to the National Institute of Diabetes and Digestive and Kidney Diseases. It’s thought that it affects about 50 percent of men aged 40 and over at some point, and the rate increases with age.
The condition frequently has more than one cause. These include:
- Disorders that damage nerves and arteries, like high blood pressure, chronic kidney disease, clogged arteries, and uncontrolled diabetes
- Lifestyle choices such as smoking and consuming too much alcohol
- Insufficient physical activity
- Being overweight
- Treatments for prostate cancer
- Mental health concerns like depression, stress, and low self-esteem
- Certain medications
Making lifestyle changes like quitting smoking or limiting alcohol can improve ED for some people. Counseling for mental health concerns may help, as well. If you are experiencing ED and taking drugs for other medical conditions, you may want to speak with your healthcare provider (HCP) about switching prescriptions.
Taking oral medication prescribed specifically for you to address ED is often the most effective treatment. The majority of men who take these drugs show improvement.
How ED medication works
Oral medications for ED relax the smooth muscle cells around blood vessels, permitting greater blood flow to the penis. Viagra, the first drug to treat ED, came on the market in 1998. These days, multiple brand-name and generic ED medications are widely available.
If medication does not work at first, some adjustments to the regimen may be needed, says Nachum Katlowitz, MD, a urologist in Staten Island, New York. Your HCP may advise you to change the amount or timing of your dose, for example.
"It may be a matter of when the person takes it," Dr. Katlowitz explains. "The man may need to take it when getting into bed since it goes to work in 15 minutes. The average for Viagra to work is 30 minutes, although it could take an hour."
If you still don’t see an improvement in your ED, your HCP may try another medication. There are other medical treatments available, as well, such as injections and penile implants.
Speaking with your provider about ED medication
In years past, many people were embarrassed to talk openly about their ED. But that reluctance is less common today, says David Samadi, MD, a urologist in New York.
"There is not nearly the stigma there used to be," he explains. "Just 20 years ago, a man would deny having ED. It was a macho thing. Now there are commercials for treatments for ED airing during the Super Bowl. The idea is not that you are bad at sex, but just that you could be better."
So, can a person who has ED simply request a prescription from his physician?
"We believe that if a man has erectile dysfunction, it is important not to just throw a pill at it," says Cleveland urologist Daniel Shoskes, MD.
A complete evaluation is necessary before treatment can be decided upon. "The cause should be investigated. If the reason turns out to be low testosterone, there is a treatment for that. If the cause is heart disease, diabetes, or sleep apnea, treating these conditions is very important," Dr. Shoskes explains.
Dr. Samadi concurs, and says it’s crucial to see an internist or urologist before taking an oral medication like Viagra. "The penis is the window into the heart," he explains. "The blood vessels in the penis are very small but the vessels in the heart are larger and so take longer to become clogged. If a man is having trouble getting an erection, this can be a warning sign that within three to five years he will have trouble with his heart."
Ultimately, ED medication can benefit patients who want it, Samadi says. "These treatments have made it possible for men to be better able to enjoy sex at an older age," he explains. "And you are not just treating the man but treating a relationship and possibly saving the couple."
