If you think you have erectile dysfunction, or ED, a good first step is to talk with your doctor. The treatment you need will depend on what's causing it. And to find the cause, your doctor may ask you to take some tests. Or they may refer you to a doctor called a urologist, who can diagnose and treat conditions such as ED that affect the reproductive organs.
What Tests Will a Urologist Do if I Have ED?
Medical and sexual history
This one's not actually a test, but your doctor will likely ask you questions about your medical and sexual history. The reason is simple: They want to better understand how ED affects you and see whether there might be a clear cause for it.
When you talk about past surgeries, the medicines you take, injuries, and lifestyle choices, your doctor can learn about diseases or other issues you might have that could lead to ED.
By asking about your sexual history — your relationships, sex drive, if you ever get erections — they can begin to figure out whether the issue is more likely to be physical or mental. Be honest with your doctor. They can't help you if you withhold information.
Physical exam
Your doctor will check your penis and testicles to make sure they seem normal and their nerves work as expected. They may also look for hair loss and larger-than-normal breasts. Both of these can be signs that you have a hormone problem.
They may also:
- Check your pulse at your wrists and ankles to see whether your blood flow is normal
- Listen to your heartbeat
- Check your blood pressure
Blood and urine tests
Based on your physical exam as well as your medical and sexual history, your doctor may want to order certain blood or urine tests. They'll use these to check for problems that can lead to ED, such as:
- Diabetes
- Heart disease
- Kidney disease
- Hormonal problems such as low testosterone
Thyroid health is also checked with a type of blood test. Your thyroid helps with the flow of sex hormones. This test can check whether it's working right.
Overnight erection test
Usually, men have three to five erections during the night as they sleep. Your doctor may use an overnight erection test to see whether you're able to get an erection.
For this test, you will place a device around your penis before you go to sleep. It measures how many erections you have and how strong they are. A simpler version of this test uses a special plastic ring around your penis. If you get an erection, the ring breaks.
If the test shows that you can get erections, it's more likely that your ED is caused by something mental or emotional.
Injection test
An injection test is also called an intracavernosal test. Your doctor injects a medicine into the base of your penis, which should give you an erection. If you don't get one, you may have a problem with blood flow to your penis.
Ultrasound
Sometimes called Doppler ultrasound, this is another way to check blood flow to the penis. It may be used along with the injection test.
Your doctor takes a device that looks like a wand and holds it over your penis. It uses sound waves to create a video of your blood vessels so your doctor can look at blood flow.
Mental health exam
If it looks more likely that a mental or emotional issue is the source of the problem, your doctor will ask you standard questions about your mental well-being. These questions help them check for depression, anxiety, and other common causes of erectile dysfunction.
If you have a regular sexual partner, your doctor may ask to talk to the two of you together.
What Lifestyle Changes Can Help With Erectile Dysfunction?
Your doctor may tell you to make some day-to-day adjustments. Expect to hear things such as:
- Stop any tobacco or illegal drug use.
- Cut back on alcohol.
- Lower stress.
- Eat a healthy diet.
- Exercise regularly.
- Lose weight if you are overweight or have obesity.
- Lower your cholesterol and blood pressure levels.
If a medication is causing your ED, your doctor may lower your dose or try a different drug.
Other treatments include:
- Counseling
- Medications
- Pumps
- Surgery
Counseling for Erectile Dysfunction
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.
You may want to include your partner in these sessions as well.
What Are the Best Medications for Erectile Dysfunction?
ED medicines can be pills, drugs inserted into the tip of the penis, or shots into the penis.
The first things doctors usually prescribe to people with erectile dysfunction are pills such as:
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 those who take them. But if your erection lasts more than four 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 any over-the-counter drugs, herbs, and supplements.
What Injections and Suppositories Treat Erectile Dysfunction?
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 urethra. You may hear this procedure called MUSE (medicated urethral system for erections). This may be less successful than shots.
Can Vacuum Devices Help With Erectile Dysfunction?
A vacuum device improves firmness by boosting blood flow to the penis. About 80% of people 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 program designed to restore normal blood flow to the penis. This will allow you to get a spontaneous erection.
It may take many months to see results.
Vacuum erection devices, 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 will also make sex less spontaneous. 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.
Should I Get Surgery for Erectile Dysfunction?
If all other ED treatments have failed, your doctor may recommend surgery.
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 and is currently not recommended.
Implants, or prostheses, help restore firmness for many people 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 the 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 body-wide infection, you shouldn't get one.
The following may also happen:
- It may inflate on its own.
- The device may break down.
- The pump may shift.
Implants also make it harder to do surgery for an enlarged prostate, bladder cancer, or other urological conditions.
Vascular reconstruction surgery can:
- Repair blocked blood vessels to improve blood flow to the penis
- Block veins to prevent blood from leaking out of the penis
Blood vessel repair is best for younger people with a small blockage. It usually doesn't work well for those who have more widespread blockages.
What Are Alternative Treatments for Erectile Dysfunction?
Maybe you've thought about trying alternative medicine therapies rather than traditional erectile dysfunction treatments. These could include options such as:
Acupuncture. This traditional Chinese practice involves placing very fine needles at certain spots on your body. It's thought to boost your body's ability to heal itself. Acupuncture may help some men with ED, but most studies offer no conclusive evidence about its effectiveness. Anyway, acupuncture is safe, and if you want to give it a try, you should.
Aromatherapy. Some scents, such as that of lemon, may improve your mood. And that may put you in the mood.
Talk therapy. If your ED is caused by psychological or emotional issues, consider seeing a counselor or therapist. They can teach you ways to reduce the anxiety related to sex. You can even invite your partner to talk about new ways to explore intimacy and different techniques to treat the physical causes of your ED.
Can Supplements Help Erectile Dysfunction?
A few supplements have shown promise against erectile dysfunction. But in general, use of supplements or herbal remedies for ED comes with serious safety concerns.
Many of these supplements haven't been studied as closely as other medications for effectiveness. They can also have side effects based on their ingredients. What's more, many supplements promoted for ED and sexual enhancement have been found to be tainted with drug ingredients or related substances. Some products include combinations of multiple ingredients or excessively high doses, both of which can be dangerous.
You can't tell whether a product contains these ingredients because they're not listed on the product label. Also, drug ingredients in some ED supplements may affect prescription drugs or certain health conditions in harmful ways.
Check with your doctor before you try any supplement for your ED, including these:
Taking high doses of L-arginine helps against erectile dysfunction by boosting blood flow, some studies show. But it may cause side effects such as stomach pain, bloating, headache, insomnia, and diarrhea. Don't take L-arginine with the ED medication sildenafil.
Also, one study found that when L-arginine and a supplement called pycnogenol were used together, men who had mild ED had a significant improvement in sexual function without any side effects.
Ginseng
Panax ginseng may boost the ability to get an erection with ED. A cream version is used for premature ejaculation. Panax ginseng seems to be safe when you use it for up to six months. It can cause side effects such as insomnia, headaches, and vertigo.
Propionyl-L-carnitine
Research suggests taking this supplement with sildenafil as a combination may be more effective against erectile dysfunction than sildenafil alone. It's likely safe to take propionyl-L-carnitine for up to six months.
The hormone dehydroepiandrosterone (DHEA) may improve erectile dysfunction that is tied to high blood pressure or has an unknown cause, early research shows. But use of DHEA may be linked with some cancers when it's taken heavily or over the long term. Using low doses of DHEA for up to six months can bring on side effects such as insomnia, headache, mood changes, upset stomach, and acne.
Flavonoids
According to a 10-year study of more than 25,000 men, those who ate a diet high in flavonoid-rich foods were less likely to have ED. Whether that means flavonoid supplements can help with ED still needs to be studied.
Zinc
There seems to be a link between severe zinc deficiency and men who have low testosterone. Researchers know that a zinc supplement increases testosterone serum levels in men, so it could also help with ED.
Vitamin D
There may also be a link between ED and vitamin D deficiency. A study determined that a lot of men with ED have low levels of vitamin D, especially when their ED is caused by injury.
How to Identify Safe Supplements
Keep in mind that most nutritional supplements aren't regulated by the FDA as drugs or foods. Instead they're regulated as dietary supplements.
That means they have to meet certain quality standards, but it doesn't guarantee that they're safe for everyone. That's why you should always talk with your doctor before taking any supplements. And stay safe by following these tips:
- Avoid supplements from outside the U.S.
- Check with the FDA for supplements under review.
- Don't take more than the recommended dosage.
- Take only one supplement at a time.
The FDA says you should be careful of products that:
- Promise quick results (in 30-40 minutes)
- Are advertised as alternatives to FDA-approved prescription drugs
- Are sold in single servings
- Are advertised via spam or unsolicited emails
- Have labels written mostly in a foreign language
- Have directions and warnings that mimic FDA-approved products
What Treatments Might Not Work for Erectile Dysfunction?
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 helps with ED. It's not recommended.
Supplements. A lot of over-the-counter products have been hailed as all-natural ways to treat ED. But it's not clear if they're effective or safe.
The FDA warns that some products may contain harmful substances or the active ingredients found 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. 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 issues because they contain dangerous or undeclared ingredients. Lab tests have discovered these risky ingredients in nearly 300 products.
Cell therapy. Doctors transfer cells from a pig's gonads into humans. More research is needed to prove if this therapy works, and it's very costly.
Magnetic field therapy. Early small studies hint that there could be some benefit to this treatment, but more research is needed.
Low-intensity extracorporeal shock wave therapy. This treatment is considered investigational. The benefits do not outweigh the risks. There is only a small amount of evidence that it works in the short term and little evidence that normal erectile function returns after treatment.
Stem cell intracavernosal therapy and platelet-rich plasma (PRP) therapy. Both of these supposed therapies are considered investigational.
Can I Use Insurance?
Some insurance policies cover ED treatment if it's medically necessary. Check with your insurance provider.
Takeaways
The right treatment for your erectile dysfunction depends on what's causing it. Talk with your doctor to find out. Your treatment options may include medications, shots, suppositories, medical devices, or surgery. You can also think about trying alternative therapies such as acupuncture and talk therapy. Talk with your doctor before you try any supplement that claims to help with ED.
Erectile Dysfunction Treatment FAQs
Can you use baking soda for erectile dysfunction treatment?
Although baking soda is useful in the kitchen, there's no clear proof that it can help in the bedroom against ED. Talk with your doctor about proven treatments for ED.
Does hair loss treatment cause erectile dysfunction?
Erectile dysfunction can be a side effect of the hair loss treatment with finasteride (Propecia, Proscar), a pill you take by mouth. A compounded version of finasteride that goes on skin and is not FDA-approved has also been linked with ED.
Can you permanently get rid of ED?
It depends on the cause of your ED. Various things can contribute to ED — including lifestyle habits, stress, health conditions, and certain medications and surgeries. Some causes of ED are within your ability to change or get treated, which might in turn get rid of your ED. Other causes of ED can't be cured. Even so, various treatments might help you get and keep an erection that's firm enough for sex.
