There are a number of treatments available which work in different ways. Treatments include:
- vacuum pump
- pellets or cream
- testosterone therapy
A group of drugs called PDE5 inhibitors (phosphodiesterase type 5 inhibitors) could help you get an erection. These include:
- sildenafil (generic sildenafil or Viagra®)
- tadalafil (Cialis®)
- vardenafil (Levitra®)
- avanafil (Spedra®)
You need to be sexually aroused for the tablets to work. The tablets normally start to work about 30 minutes to an hour after taking them.
You can take sildenafil, avanafil and vardenafil when you need to. They will keep working for four to six hours or up to eight hours for vardenafil. So if they work you should be able to get an erection if you're sexually aroused during that time.
You can take tadalafil when you need to. It can work for up to 36 hours so it lets you be more spontaneous. Or your doctor may suggest you take a low-dose (5mg) tadalafil tablet 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 take nitrates ask your doctor or specialist about other ways to treat erection problems.
Erection problems can also be treated with drugs using an injection that you give yourself. These include:
- alprostadil (Caverject®, Caverject® Dual Chamber, Viridal Duo®)
- aviptadil with phentolamine mesilate (Invicorp®)
An injection may sound off-putting but many men find it isn’t that bad and doesn’t hurt. Your nurse or doctor will show you how to inject the side of your penis with a very thin needle.
The drug causes the penis to fill with blood and you’ll get an erection within 5 to 10 minutes. The erection will last for up to an hour.
Pellets or cream
The drug alprostadil is also available as a small pellet, called MUSE®, and as a cream called Vitaros®.
These don't tend to work as well as the injections, but they're a good alternative if you don’t like the idea of an injection.
You use an applicator to insert the pellet or cream into the opening or ‘eye’ of the penis. With the pellet, it helps if your urethra, which is the tube you urinate through, is already moist, so urinate first. With the cream, you or your partner can rub in any cream that's left on the tip and massage your penis to help it absorb the drug.
If the pellet works you should get an erection within 5-10 minutes which lasts for up to an hour. The cream may take a little longer to work.
You use a pump and a plastic cylinder to create a vacuum which makes the blood flow into your penis. This can give you an erection. After using the pump to get an erection, you slip a constriction ring from the end of the cylinder around the base of your penis. This stops most of the blood escaping when you remove the pump. You shouldn't wear the ring for longer than 30 minutes at a time.
The vacuum pump can be an effective way to get an erection hard enough for penetration. It may also help maintain the length and thickness of the penis if used regularly and soon after surgery.
This involves having an operation to put an implant inside your penis. Although it sounds quite off putting, it can be a good option 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 the penis and a pump in your scrotum (the skin around testicles). 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 and you can deflate it when you want to.
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.