Impotence, referred to more commonly now as erectile dysfunction, is a common condition that affects as many as one in five men in the UK. It is a global issue, with 322m predicted to suffer from it by 2025 according to a review in the BJU Internal Journal of Urology. Thankfully, there are many treatments that can help with erectile dysfunction.

When is treatment for ED recommended?

Erectile dysfunction, sometimes referred to as ED, can have many causes, with no two people exactly the same. Most men will at some point in their lives fail to get an erection at an inopportune time, with some the most common causes being physical (having an underlying condition), psychological (such as stress or anxiety) and lifestyle (smoking and alcohol consumption). It is only when it occurs regularly that it is defined as ED. 

If you experience erectile dysfunction it is important to seek help as it may be a sign of an underlying condition that will require treatment, including high blood pressure, high cholesterol and diabetes. Lifestyle factors, such as a lack of exercise, smoking and poor diet, may also play a role. Another common cause is emotional distress, as this International Medical Journal study from 2012 shows. Talking therapies have been proven to be highly effective for many who have an emotional cause at the root of their erectile dysfunction.

Emergence of PDE5i treatments for erectile dysfunction

In recent decades, medicinal treatments for erectile dysfunction have come a long way. Since the release of sildenafil on to the market in 1998 (the active ingredient in Viagra), the condition has become much more easily managed. Originally manufactured to treat hypertension and angina, the history of Viagra tells us that the drug has become a success at least partly by accident; it has revolutionised the way we see the condition, with various other medication produced as a result. 

Each of these medications have their own advantages and disadvantages. Cialis can be taken as needed and works quickly in the system, around 30-60 minutes, as is the case for Levitra, which was introduced in 2003. 

A more recent addition to oral erectile dysfunction medications (2014) is Spedra, which can take effect within 15-30 minutes, depending on the dosage. MUSE is taken as a urethral suppository, where the medication is taken through the urethral tube of the penis. Caverject, on the other hand, is an injection, which can be administered as needed and its effects are felt after around five to 20 minutes and lasts up to an hour. Another injection is Invicorp, which can work even more quickly, between five and ten minutes, its effects lasting up to four hours. 

Differences between PDE5i treatments for ED

Most erectile dysfunction medications work in the same way, but there are slight differences in how they affect the body and how they should be taken. For example, The best way to take Viagra is to avoid a large meal and to swallow with water an hour before sex. It is usually effective for around four to five hours. Avoiding a large meal before sexual activity is also the best way to take Cialis as it can slow down its effects. It should be noted that everyone is affected in unique ways, so there are no guarantees as to the effectiveness or longevity of any treatment.

Spedra (avanafil) and Levitra (vardenafil) aren’t quite as well known as Viagra and Cialis, but a number of men do find them advantageous. Levitra is available in low doses so can be better for men with pre-existing conditions. When you read the section in the leaflet on how to take Levitra you’ll notice that it recommends taking it 25-60 minutes before sex, and that the drug lasts for up to five hours.

The main characteristic that sets Spedra apart is its speed. The instructions on how to take Spedra explain that it can be taken 15-30 minutes before sex.

Because they come in various different forms, including as an injection, a urethral suppository or as a cream, how to take alprostadil products can differ depending on the type you’re using.

Some men may have to try more than one treatment before settling on the one that is the most effective for them. Talking through the different options with a prescriber can help to answer any questions about ED treatment you have, and they should be able to recommend a suitable option for you to start with (or help you switch to something more suitable if you’re already taking medication). 

Dealing with ED long term

ED, while not necessarily a sign of a deeper physical health condition, has a major effect on those that suffer from it. For most, the psychological issues that cause the problems become self-perpetuating, resulting in further anxieties and the worsening of the condition. Talking therapies are very effective at breaking this cycle, particularly CBT (cognitive behavioural therapy), where, with practice, you can recognise how negative thoughts build on other negative thoughts and avoid this from escalating. Physical causes can often be treated with medications or surgery. For example, high blood pressure is effectively lowered with statins. In the meantime, ED treatments, such as Viagra and Cialis, manage erectile dysfunction symptoms, but it also is important to understand that there are many options available to manage it and its underlying causes.

Page last reviewed:  28/07/2020