Treatment for erectile dysfunction has come a long way in the past few decades, with most men finding some relief from the condition through the use of medication. Research into new treatments also continues, with various breakthroughs promised in the near future.

There are several different treatments for erectile dysfunction. They come in various forms, and work in slightly different ways, but all with the aim of helping men get and keep an erection firm enough for sex.

For men who are new to treatment, there can be quite a lot to take in and learn about erectile dysfunction. On this page, we'll take a look at the types of treatment in a little more detail, and focus on how each works in the body.

How each product works

First developed as a treatment for high blood pressure, Viagra soon became known as the “little blue pill” and was advertised as a breakthrough for the condition. Today, Viagra is synonymous with erectile dysfunction treatment. Such was its success that research for alternative medications began, with a wide range of products manufactured as a result, providing a variety of choice for those with the condition.

Sildenafil (Viagra), vardenafil (Levitra), avanafil (Stendra) and tadalafil (Cialis)

These medications are known as PDE5 inhibitors. After sildenafil’s introduction to the market in 1998, drug companies worked hard to bring out their own version, with tadalafil (Cialis) and vardenafil (Levitra) the next successful products to be released in 2003. These remain popular to this day. Avanafil is a later addition to the list, first approved in 2013 for the European market. All these drugs are oral tablets.

PDE5 inhibitors work by increasing the flow of blood to the penis, which allows it to get and stay erect. This is usually achieved by sexual stimulation, which leads to the release of a substance called nitrous oxide in the penis, which itself produces another substance called cGMP, the primary trigger for the increase of blood flow to the penis. This chain reaction can easily become hindered by a variety of psychological or physical circumstances. PDE5 inhibitors prevent the release of another enzyme called phosphodiesterase from being produced. This enzyme destroys cGMP, and makes erections more difficult. So by blocking this enzyme, PDE5 inhibitors help the user to achieve and maintain an erection.  

Aviptadil and Phentolamine (Invicorp)

Invicorp contains two active ingredients, and is administered in a different way than the PDE5 inhibitors described above as it is injected into the penis (transurethral injection). It is generally prescribed when other treatments have failed, with some studies showing it to be more than 80% effective at treating cases where other medications have failed.

Aviptadil is known as a VIP medication, which stands for vasoactive intestinal polypeptide/phentolamine. The substance aviptadil works by stopping blood from leaving the penis, which allows a maintaining of the erection. Phentolamine widens the blood vessels allowing blood to flow efficiently to the penis. 

Alprostadil (Caverject, Vitaros and Muse)

Another injection administered medication is alprostadil, the active ingredient in Caverject. Like Invicorp, it is injected directly into the penis. It is also available as a urethral suppository called MUSE, which is a very small pellet that is placed into the urethra (hole at the tip of the penis). Alprostadil is also the active ingredient in Vitaros, which is a cream applied to the end of the urethra.

Alprostadil belongs to a group of medications known as prostaglandins. These medications work by mimicking the naturally occurring substance prostaglandin E1, which allows blood flow to the penis to increase. It does this by relaxing the muscles widening the arteries that carry blood to the penis. 

Contraindications

For the most part, these medications are well tolerated, although there may be reasons why the individual treatments will be unsuitable for some. Each of these medications have advantages and disadvantages, such as interactions with other treatments and risk of side effects. This means the treatment will relate to the needs and restrictions of the person taking it.

While contraindications for Viagra, for example, do exist, they are relatively rare and mild. Your prescribing clinician will be able to inform you of the risk of negative interactions with any medication you are taking and, if appropriate, find a more suitable treatment.

Page last reviewed:  24/07/2020