Treatment is based on the underlying medical issue causing the problem.

Oral Medications

All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow to the penis and helps the penis to become erect.

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

Sexual stimulation or physical stimulation of the penis will cause the release of nitric oxide from your penile nerves. These medications amplify the amount of nitric oxide, the penis to become erect normally. These medications do not enhance libido

The side effects include:

  • Flushing
  • Nasal congestion
  • Headache
  • Muscle aches
  • Visual changes
  • Backache
  • Stomach upset

Your doctor will help you find the right medication and proper dosage.

DO NOT these medications if you:

  • Take nitrate drugs — usually given for chest pain — like Minitran, Nitro-Dur, Nitrostat, isosorbide mononitrate, and isosorbide dinitrate
  • Have heart disease or heart failure
  • Have very low blood pressure (hypotension)

Other Medications

Alprostadil self-injection. With this method, you use a fine needle to inject medication into the base or side of your penis. Some examples of the different medications that can be injected include papaverine, alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).

  • Side effects of the injection can include mild bleeding from the injection site, prolonged erection called priapism which is an emergency and scar tissue at the injection site.

Alprostadil urethral suppository. Alprostadil intraurethral therapy called MUSE involves placing a tiny suppository inside your the opening of the penis called the urethra.  

  • The erection usually starts within 10 minutes. Side effects can include urethral or penile pain, rarely bleeding at urethra and formation of scar tissue inside your penis.

Testosterone replacement. Some men have erectile dysfunction because of low testosterone. Testosterone replacement therapy or other treatments to raise testosterone levels may be given by injection, patch or gel applied to the skin.

Doctor collaborating

Penis Pumps and Implants

Penis pumps or vacuum erection device is a hollow tube with a hand-powered or battery-powered pump to pull blood into the penis. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This vacuum creates a force to pull blood into the penis.

  • Once you get an erection, a ring is placed around the base of your penis to hold in the blood and keep it erect. The pump is removed.
  • You remove the ring at the base of the penis after intercourse. side effects include bruising of the penis and decreased ejaculation.

Penile implants. A device is placed surgically inside the penis to make it erect. These implants consist of either inflatable or bendable rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.

  • Penile implants are a surgery, there’s a risk of complications, such as infection or mechanical failure of the device. Usually we like to try all other options before proceeding to the device.

New Treatments Being Studied at JWCI

  • Penile stem cell injection
  • Shockwave therapy

Follow Up

The doctor will follow patients through treatment options to make sure the erectile dysfunction is resolving and penis is able to become erect enough to sexual intercourse.