Erectile Dysfunction (ED) Treatments - Tablets, Creams and Sprays

Erectile dysfunction affects most men at some point in their lives. Recent data has shown that more than half of all British men between 40 and 70 have some degree of ED. It may only happen once, or it may be a regular issue. It can be a part of ageing, though it can happen at any age. While ED can be embarrassing, it's common and treatable.

“ED is very common. By 2025, the condition is expected to affect approximately 322 million men worldwide – a figure that has more than doubled since 1995.” – Dr Neel Patel

ED can have physical, lifestyle, medicinal and psychological causes. Most often, it is due to a reduced blood flow to the penis. We’ve compiled the most common below:

Physical causes

• Narrowing blood vessels due to high blood pressure
• Atherosclerosis
• Hormonal imbalance
• COVID-19
• Nerve problems
• Changes in penis structure

Medicinal causes
Medicine for:

• Depression
• Psychotic illness
• heart conditions
• Blood pressure
• Prostate conditions

Psychological causes

• Stress
• Trauma
• Depression
• Relationship troubles
• Performance anxiety

Lifestyle causes

• High cholesterol
• Smoking
• Alcohol
• Recreational drug use
• Sedentary lifestyle
• Being overweight

Additionally, find out if screen time is damaging your sex life in our survey report.

“ED can have both physical and psychological causes. In most cases it is due to a reduced blood flow to the penis. However external factors, including some lifestyle choices, can also cause erectile problems.” - Dr Neel Patel

Losing or failing to maintain an erection can be a one-off event. However, if you have had multiple erection problems it is best practice to see your GP or visit a sexual health clinic.

At your appointment, you may:

• Be asked about your medical history, sexual history and mental health factors
• Take basic health / cardiovascular checks, i.e. measuring blood pressure and heart rate
• Undergo a physical examination of your penis, or a digital rectal examination if you show signs of an enlarged prostate

ED can often be a symptom of a health condition affecting your blood vessels and heart. These can include high blood pressure, diabetes or high cholesterol. If left untreated these could lead to serious health problems such as heart or kidney disease. We advise you to have a health check to check there is no underlying condition causing your ED.

“As erectile dysfunction has many possible underlying causes, there are multiple different ways to treat it. It’s important to establish what is causing the issue with your doctor so the correct course of treatment can be advised.” - Dr Neel Patel

8 out of 10 men will have a good chance of ED medication working. It increases blood flow to the penis, enabling an erection when aroused.  

Having erectile dysfunction or impotence does not directly affect fertility. However, it can understandably make conceiving difficult.

Does erectile dysfunction treatment affect fertility?
There is currently no evidence to suggest that ED treatments like Viagra and Cialis affect fertility according to the NHS. If you’re concerned about the side effect of your ED treatment, talk to your GP.

What can affect my fertility?
The following can impact male fertility:

• STIs
• Hormone imbalances
• Illness and disease
• Some medicines and treatments - please speak to your GP if you're trying to conceive before you start any treatment
• Exposure to radiation or certain chemicals
• Injuries to the testicles
• Recreational drugs and alcohol consumption

When should I take a fertility test?
If it’s been over a year of trying to conceive, you should talk to your GP. They can investigate and suggest a relevant fertility test, if needed.

Side effects vary per treatment, but ED pill side effects commonly include:

• Headaches
• Facial flushing
• Indigestion
• Nausea
• Nasal congestion
• Back / muscle ache

Uncommon side effects (can affect up to 1 in 100 people) can include:

• Vomiting
• Chest pain
• Allergic reaction
• Eye irritation
• Heart palpitations

Rare side effects (can affect up to 1 in 1000 people) can include:

• Painful erections
• Decrease / loss of vision
• Skin reactions
• Irregular heartbeat
• Fainting

For ED creams common side effects include itches, inflammation and rashes. Uncommon side effects include light-headedness, prolonged change to sensation, and potential for UTI.

Most common side effects are mild. If you are suffering from any side effects, please talk to your GP.

There are several ED treatments available in both pill and cream forms. If you’re wondering which erectile dysfunction treatment is best for you, take a look at this comparison table.

Viagra / Viagra Connect

• Active ingredient: Sildenafil

• How long to take effect: 30–60 minutes

• How long does it last: Up to 5 hours

• Effectiveness: Works for up to 82% of men

Cialis

• Active ingredient: Tadalafil

• How long to take effect: 30–60 minutes

• How long does it last: Up to 36 hours

• Effectiveness: Works for up to 80% of men

Levitra

• Active ingredient: Vardenafil

• How long to take effect: Within an hour

• How long does it last: Up to 5 hours

• Effectiveness: Works for up to 87% of men

Spedra

• Active ingredient: Avanafil

• How long to take effect: 60 minutes

• How long does it last: Up to 4 hours

• Effectiveness: Works for up to 58% of men

Vitaros

• Active ingredient: Alprostadil

• How long to take effect: 5–30 minutes

• How long does it last: Up to 2 hours

• Effectiveness: Works for up to 52% of men

Several of these treatments are available in their generic forms (Sildenafil, Tadalafil, etc.). Take an online consultation to determine which treatment is right for you.

Previous studies have shown that long-term use of tadalafil (the active ingredient in Cialis) and alprosdatil (the active ingredient in Vitaros cream) is safe. The NHS has also stated that sildenafil (the active ingredient in Viagra) is safe for long-term use.

If your erectile dysfunction persists after treatment talk to your GP.

If you don’t feel that medical treatment for erectile dysfunction or impotence is right for you, there are several alternative treatments available:

• Counselling can help if stress or anxiety are causing your ED.
• Lifestyle changes like a healthier diet or cutting back on alcohol or drug use can have a positive effect on blood flow.
• Devices like vacuum pumps or constriction rings can also be effective.
• Penile prosthesis surgery can be performed. However, this is a last resort option to patients that have failed to respond to any medical, mechanical or psychological treatment.
• Non-prescription remedies and pills for sale online are often not regulated. For your safety, we advise you to avoid these.

• https://www.nhs.uk/medicines/tadalafil/pregnancy-breastfeeding-and-fertility-while-taking-tadalafil/
• https://www.nhs.uk/medicines/sildenafil-viagra/common-questions-about-sildenafil/
• https://pubmed.ncbi.nlm.nih.gov/15036680/
• https://pubmed.ncbi.nlm.nih.gov/9806184/
• https://patient.info/mens-health/erectile-dysfunction-impotence
• https://www.baus.org.uk/patients/conditions/3/erectile_dysfunction_impotence/
• https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/

Images for illustrative purposes only. Posed by models.

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