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If you think you have ED, a good first step is to talk with your doctor. The treatment you need will depend on what’s causing it.

You may find that simple lifestyle changes will help, like losing weight, drinking less alcohol, or quitting smoking.

If a medication is causing your ED, your doctor may lower your dose or try a different drug altogether.

There are also other treatments. They include:

• Counseling
• Medications
• Pumps
• Surgery

Counseling

If anxiety or stress is causing your ED, it may help to talk to a professional therapist.

Life-changing problems or even everyday stress can trigger erectile dysfunction. Talking about these things with a licensed therapist can ease sexual anxiety and help you feel more confident in your relationship.

Usually you’ll only need a handful of sessions. You may want to include your partner, as well.

Medications

ED medicines can be pills, drugs inserted into the tip of the penis, or injections into the penis.

The first things doctors usually prescribe to men with erectile dysfunction are pills like:

• Avanafil (Stendra)
• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra, Staxyn)

They are taken anywhere from 15 minutes to 36 hours before having sex, depending on the drug. You shouldn’t use these more than once a day.

Staxyn dissolves in the mouth. The other medications are swallowed.

These pills work for about 80% of men who take them. But if your erection lasts more than 4 hours, seek emergency medical help. Side effects include:

• Headache
• Stuffy nose
• Muscle ache

In rare cases, a temporary blue-green shading of your vision.

You shouldn’t take these pills if you take nitrate drugs for heart disease. Doing so can cause a dangerous drop in blood pressure.

Also use caution if you’re taking alpha-blockers for prostate problems or blood pressure.

Tell your doctor about all medications you’re taking, including over-the-counter drugs, herbs, and supplements

Injections and Suppositories

If the pills don’t work or aren’t safe for you to take, your doctor may prescribe a drug called alprostadil. It helps boost blood flow to the penis, triggering an erection within minutes.

It can be given in two ways:

Injection: The medication is put into the side of the penis by a needle. This raises your risk for dangerously prolonged erections and scarring.

Suppositories . Pellets are placed inside the penis. You may hear this procedure called MUSE (medicated urethral system for erections). This may be less successful than injections

Not Recommended for ED

Testosterone. It’s a male hormone. If you have a normal testosterone level, you don’t need more.

Trazodone. This is an antidepressant. It’s still uncertain whether it works for ED. It’s not recommended.

A lot of over-the-counter products have been hailed as all-natural ways treat ED. But it’s not sure if they’re effective or if they’re safe.

The FDA warns that some products may contain harmful substances or the active ingredient in some prescription medications.

Some of these products have been found to contain sildenafil (the active ingredient in Viagra) or a substance similar to vardenafil (the active ingredient in Levitra and Staxyn). These products can be dangerous for people who take nitrates to treat chest pain or heart disease.

In recent years, the FDA has seized many over-the-counter products for male sex problems because they contained dangerous or undeclared ingredients. Lab tests have discovered these risky ingredients in nearly 300 products.

The FDA’s web site states that you should beware of products that:

• Promise quick results (within 30 to 40 minutes)
• Are advertised as alternatives to FDA-approved prescription drugs
• Are sold in single servings
• Advertise via spam or unsolicited emails
• Have labels written primarily in a foreign language
• Have directions and warnings that mimic FDA-approved products

Vacuum Devices

A vacuum device improves firmness by boosting blood flow to the penis. About 80% of men who use the device correctly get an erection hard enough for sex.

They’re often used for penis rehabilitation, usually after prostate surgery. Your doctor will put you on a regimen designed to restore normal blood flow to the penis. This will allow you to get a spontaneous erection.

It may take several months to see results.

Vacuum erection device, also called vacuum constriction devices, are made of three parts:

• A clear, plastic tube that slides over the penis
• A manual or battery-operated pump that sucks air out of the cylinder, sending more blood to the penis
• An elastic ring that is placed around the base of the penis after an erection is obtained. It’s like a rubber band. It helps maintain firmness by preventing blood from draining out of the penis. If you have venous leak syndrome, this may help you.
• A vacuum device can be cumbersome. It also will hinder spontaneity. The elastic ring may lead to skin irritation, bruising, loss of feeling or sensitivity, or pain.
• Vacuum devices are available with or without a prescription. Talk to your doctor before getting one.

Surgery

If all other ED treatments have failed, your doctor may recommend surger.

The operations are:

• Placement of an implant (prosthesis) in the penis
• Vascular reconstruction surgery to improve blood flow to or reduce blood leakage from the penis and surrounding structures. This procedure works in very few cases.
• Implants, or prostheses, help restore firmness for many men with ED. There are two types:

Malleable implants are a pair of bendable rods placed inside the penis. You manually move your penis, and therefore rods, into a position suitable for sex. Such implants do not affect penis size.

Inflatable implants are a pair of tubes placed in the penis and connected to a squeezable pump inside the scrotum. You squeeze the pump to get an erection. Inflatable implants can also help slightly increase length and width.

Once you have a penile implant, you must always use it to get an erection.

Implants may cause infection. If you have a urinary tract infection, skin infection, or systemic (body-wide) infection, you shouldn’t get one.