Every ED Treatment Option, From Pills to Combinations

Erectile dysfunction is common, and it is treatable in several different ways. The American Urological Association's guideline recommends that men be informed of the full range of options, and that the choice reflect their health, preferences and goals.¹ Here is that range.

1. A medical evaluation

The first step is not a treatment. ED shares risk factors with heart disease, and in a large study of men 55 and older, ED was followed by a higher rate of later cardiovascular events.⁶ That is why a medical history and a look at blood pressure, diabetes and medications come before any prescription.¹

2. Lifestyle change

In a two-year randomized trial of obese men with ED, those who lost weight and exercised more improved their erectile function scores, while the control group did not.⁴ A meta-analysis of exercise trials found a similar benefit, especially for moderate-to-vigorous aerobic exercise.⁷ Lifestyle change rarely replaces other treatment, but it supports all of them.

3. PDE5 inhibitor tablets

Sildenafil, tadalafil and vardenafil are FDA-approved tablets that help blood vessels in the penis respond to sexual stimulation.^2,3,8 They differ mainly in timing: sildenafil is taken about an hour ahead,² while tadalafil's effect lasts up to 36 hours.³

4. Dissolving and combination doses

Telehealth companies also offer compounded products: chewables, sublingual doses and multi-drug combinations. These are prepared by a pharmacy for an individual patient and are not FDA-approved, and the sildenafil label notes that combining it with other ED treatments has not been studied,^9,2 so a clinician decides case by case whether one is appropriate.

5. Vacuum erection devices

A vacuum device draws blood into the penis, and a ring at the base holds it there. It involves no medication.^1,5

6. Injections and urethral medication

Alprostadil can be injected into the penis or placed in the urethra. These work without sexual stimulation and are usually prescribed when tablets are not suitable or not enough.^1,5

7. Penile implants

A surgically placed implant is a long-term option for men who do not respond to other treatments.^1,5

Choosing

There is no single best treatment. The right starting point depends on your health, your medications and what matters to you, which is exactly the conversation the guideline says should happen with a clinician.¹

Frequently asked questions

What is the first-line treatment for ED?

PDE5 inhibitor tablets such as sildenafil and tadalafil are the most widely used, but the American Urological Association recommends that men be told about all options.

Can lifestyle changes help ED?

In a randomized trial of obese men, weight loss and more exercise improved erectile function scores. A meta-analysis of exercise trials found a similar benefit.

Is ED linked to heart disease?

ED and heart disease share risk factors, and a large study found ED was followed by a higher rate of later cardiovascular events. That is why a medical evaluation matters.

More comparisons

• Compounded vs FDA-Approved ED Medications: What the Difference Means
• Sublingual vs Pill ED Treatments: What Actually Differs