Many of the treatments for erection problems work by improving the flow of blood to the penis. There are a number of treatments available.
A group of drugs called phosphodiesterase type 5 (PDE5) inhibitors can help men get erections. These include:
- sildenafil (generic sildenafil or Viagra®)
- tadalafil (Cialis®)
- vardenafil (Levitra®)
- avanafil (Spedra®)
PDE5 tablets don’t cause spontaneous erections - they only work if you are sexually aroused. They normally take 30 minutes to an hour before they start to work.
Sildenafil, vardenafil and avanafil are taken when needed and will work for four to six hours. This means you’ll be able to get an erection if you’re sexually aroused in that time.
Tadalafil can work for up to 36 hours, so it allows you to have more spontaneous sexual activity. Your doctor may suggest you take a low-dose tablet (5mg) every day.
Don’t take PDE5 tablets with nitrates: Nitrates are usually used to treat heart problems and are used in some recreational drugs (called poppers). If you have a heart problem or you’re taking nitrates discuss other ways to treat your erection problems with your doctor or specialist.
Erection problems can also be treated with a drug called alprostadil (Caverject® or Viridal Duo®) injected into the side of your penis.
An injection may sound alarming but many men find it isn’t that bad and doesn’t hurt. The first time you use the drug a nurse or doctor in the clinic will show you how to inject into your penis with a very fine needle.
The drug causes the penis to fill with blood and you’ll get an erection within 5 to 10 minutes. The erection will normally last for 30 to 40 minutes.
Pellets or cream
The drug alprostadil is also available as a small pellet, called MUSE®, and as a cream called Vitaros®.
These may not work as well as the injections but are a good alternative if you don’t like the idea of an injection.
You use an applicator to insert the pellet into the opening or ‘eye’ of the penis. You or your partner can then massage your penis to help absorb the drug. You’ll get an erection within 5 to 10 minutes, which will last between 30 and 60 minutes.
The cream may take a little longer to work. The cream is put onto the tip and ‘eye’ of the penis and gently rubbed in.
You use a pump and a plastic cylinder to create a vacuum, which makes blood flow into your penis to make it hard. You then slip a constriction ring from the end of the cylinder onto the base of your penis. This stops most of the blood escaping when you remove the vacuum pump. You shouldn't wear the ring for longer than 30 minutes at a time.
The vacuum pump may help men get an erection hard enough for penetration. It may also help maintain the length and thickness of the penis if used daily within four to eight weeks after surgery.
You have an operation to put an implant inside your penis. Implants are usually only recommended if other treatments haven’t worked. There are two main types:
- Semi-rigid rods that keep your penis fairly firm all the time but allow it to be bent down when you don’t want an erection.
- An inflatable implant in your penis and a pump in your scrotum. When you squeeze the pump the implant fills with fluid (saline) to make the penis hard. Your erection will last for as long as the implant is inflated.
Testosterone replacement therapy
If you’ve had treatment for prostate cancer that was contained inside the prostate and have erection problems caused by low testosterone levels, then you may be able to have testosterone replacement therapy.
Because getting an erection also relies on your thoughts and feelings, tackling any worries or relationship issues as well as having medical treatment for erection problems, often works well.
Keeping a healthy weight, stopping smoking and doing pelvic floor exercises may help improve your erections.