Erectile Dysfunction (ED) Treatments: The Complete Guide

Written by
The Manual Team
Medically approved by
Dr Earim Chaudry
Last updated
4th May 2021

In 30 seconds

These days, there are so many treatments for erectile dysfunction (ED) available. From prescription medications, to surgery, to simple changes in your lifestyle – you have a lot of options. But crucially, whichever you choose, know that you do not need to accept ED as a necessary part of your future.

We recommend the ED drugs known as PDE5 – such as Sildenafil and Tadalafil. These are affordable, safe, and have been shown to be effective for the vast majority of men. Put simply, they work by encouraging blood flow in the area where you need it, which increases the chances of achieving and sustaining an erection.

However, different men have different preferences. You might rather want something more permanent, like a penile implant or serious changes to your lifestyle. Or else, some more experimental options are available.

Finding the Right ED Treatment for You

Every man is different. And, for those of us struggling with erectile dysfunction (ED), there are now treatment options available that suit every single one of us.

ED is more common than you think. A 2018 study found that as many as 43% of men have experienced the symptoms – with as many as 50% of men in the thirties struggling with the condition. Yet, the study showed up something else that was alarming. A third of men have never told anyone else about their problem – and only 28% have sought medical help.

This is such a shame. ED can be embarrassing, and it can impact on our mental health. But with such a range of treatments around, it’s really something that you can manage. You are not doomed to struggle with the problem forever – nor should you face it alone.

Here, we want to give you the full list of options for the treatment of erectile function. You’ll see for yourself that there are really many that work. So, no one needs to know – but one of these ED treatments could change your sex life, and your mental health, for the better.

The PDE5 Inhibitors: Sildenafil, Tadalafil, and Others

The most famous treatments for erectile dysfunctions are those known as PDE5 inhibitors. These are medicines that have been approved to be safe and effective for ED treatment – and besides being famous, they are the easiest to source and one of the most reliable in their effect too.

PDE5 inhibitors tackle one of the leading physical causes of erectile dysfunction. That’s the problem with reduced blood flow to your penis. By inhibiting the enzyme, known as phosphodiesterase-5 (PDE5), that is responsible for smooth muscle contraction in the blood vessels in your penis, these drugs increase blood flow to where you need it. And, as a result, they increase your chances of achieving and sustaining an erection.

While each of the individual drugs have slightly different effects – and work slightly differently from person to person – they all function on this same mechanism. And while they do not solve the physical cause of poor blood flow in the first place, they are a reliable treatment the vast majority of the time.

Sildenafil (The generic unbranded form of Viagra)

The first of the PDE5 inhibitors is one that you should really know already. That’s Viagra. Either ‘Vitamin V’ or the ‘little blue pill’ – call it what you will. The active ingredient in Viagra is called Sildenafil. Viagra is the original treatment for erectile dysfunction, but the same benefits are now available without having to pay for the familiar brand name.

Take it 30 minutes to an hour before you want it, and you can expect it to stay in your system for 4 hours. This should give you and your partner plenty of time to do everything you want to do. However, remember the important part of all PDE5 drugs: you need to be aroused for it to take effect. “On-demand” erections are not something you can ever expect.

Side effects are possible for all medicines – and this is true for Sildenafil, too. Headaches, flushing, indigestion, and back ache are all possible, as are those associated with changes in blood pressure. Vision changes are possible too, although they are very rare.

Tadalafil (Cialis)

Like Sildenafil as the ingredient in Viagra, Tadalafil is more commonly known due to the branded ED treatment, Cialis. However, whether it’s the branded version you buy, or the less-costly generic version, the results will be the same. Tadalafil is often chosen as an alternative to Sildenafil by those who experience side effects with the other medicine, or by those who want to give sexual activity a bit more spontaneity.

While working in the same way as Sildenafil, Tadalafil has a longer half-life. This means that it stays in your system for longer. You’ll need to take it at least half an hour before you need it, but then you have 36 hours to enjoy its effects. This means that you don’t need to put things on pause to wait for it to kick in.

Side effects are possible here too. Clinical trials have suggested that muscle pain and back pain may be more common, and flushing less common, than with Sildenafil.

Other PDE5 Inhibitors: Vardenafil (Levitra), Avanafil (Stendra), and Udenafil (Zydena)

Other PDE5 inhibitors exist – and are often recommended to those men who do not tolerate either Tadalafil or Sildenafil, or for whom these drugs haven’t been effective. These include:

  • Vardenafil, which goes under the brand names of Levitra and Staxyn,
  • Avanafil, or Stendra or Spedra, and
  • Udenafil, or Zydena

The onset times and half-lives of these individual drugs differ. Vardenafil, for example, lasts 5-7 hours on average, while Avanafil commonly reaches 10 hours of effectiveness. Avanafil has been marketed as the fastest-acting ED drug, yet you should still wait for 30 minutes for reliable effectiveness.

Udenafil is an alternative PDE5 inhibitor which is licenced only in South Korea, Russia, and the Philippines. However, with a 24-hour effectiveness, it may be around in the UK and US markets soon.


There’s another medication that is thought to be effective in treating ED. That’s Alprostadil, and it’s available as a cream and as an injection.

Alprostadil is a vasodilator which, when applied to the penis, enables the relaxation of your blood vessels a bit like PDE5 inhibitors – promoting blood flow to the area. While it is a possible alternative to PDE5 inhibitors, success rates are low – while the chance of side effects is high.

Erection Devices: Vacuum Pumps and Penis Rings

Besides pharmaceutical interventions, there are plenty of other options for the treatment of erectile dysfunction. Here, we’ll start with what are known as vacuum devices: penis pumps and penis rings.

These are a type of mechanical device which consist of a tube that is placed over the penis, a seal, and a battery powered vacuum. Air is sucked out of the vacuum and, as a result, blood is drawn into the penis. Once you’re hard enough for sex, you can slip a penis ring over the base of the penis to keep blood in.

While the use of these has been eclipsed by erectile dysfunction medication, they have consistently been shown to be safe and effective in clinical trials – although they may seem a little nerve-wracking.

Surgery: Penile Implants

A more radical, and less common, solution to ED is the penile implant. These require surgery, in which an inflatable device is implanted into the areas in the penis, the corpora cavernosa, which fill with blood when you have an erection.

As blood enters your penis, it enters the implant too, which helps to sustain your erection. 90% of men are satisfied with the procedure and its effectiveness – even though it might seem like a radical step.

Lifestyle Changes

It is said that ED is an early warning sign of heart disease. This is because it is a condition that is commonly seen among those with other cardiovascular health conditions – including high blood pressure and high cholesterol.

As a result, while ED medications can be hugely helpful in mitigating the symptoms of the problem, lifestyle changes might be the real way to address the underlying causes relating to your health. And it’s not just your heart. Stress, anxiety, and poor sleep can all contribute to problems with erectile function.

However, you do have options – and they don’t require any medical interventions whatsoever.

Quitting Alcohol and Cigarettes

Drinking alcohol and smoking tobacco are big risk factors for cardiovascular disease – and for ED, too. Those who smoke over 20 a day have a 40% risk of ED. Meanwhile, 70% of heavy drinkers experience some sort of sexual dysfunction.

Simply enough, quitting smoking improves your erections – while those who drink in moderation may have better erections than those who don’t drink at all.


Exercise is good for your heart. We all know this by now. Less of us probably know that it’s good for our erections too.

Nonetheless, one study showed that walking for 30 minutes every day can reduce the chance of ED by 41%. That wasn’t a one off. Other studies have confirmed the benefit too. It’s much easier than a penile implant – that’s for sure.

Healthy Diet

Along with reducing alcohol and dialling up the exercise, the next best way to help your erections is by watching your diet. Fatty foods and those high in sugar are bad for the system that powers your blood flow – as they leave fatty deposits in your arteries.

Replace the processed foods with a balanced diet of fruits and veg, pulses, and whole grain. You are what you eat, and all that.


This one might be a surprise, but sleep is pretty crucial for your sexual health. It affects your desire for sex and your physical ability to get it up too.

7 to 9 hours a night is what medical professionals recommend. If you struggle with this, try and put in some steps to make sleep easier – including reducing stress (see below), or removing phones and electronic devices from the bedroom. Other solutions you know already: cut booze, exercise more, and eat better. Everything here is related, and they’ll all help you get a better night’s sleep.

Stress Management

Stress is really not something that’s good for you. Alongside making you potentially distracted and irritable, it affects your bowels, heart, and quality of sleep. It also releases certain hormones, including adrenaline and cortisol, which diminish your interest in sex.  

Stress can cause ejaculation problems and erectile dysfunction too. So, finding a way to manage it – whether that is exercise or meditation, or a more radical lifestyle change – will help.

The ‘Natural’ Remedies

You may have seen many products online which claim to be a ‘natural’ remedy for ED – or even a ‘herbal Viagra’. However, these need to be treated with extreme caution. In fact, we are only including them here to make sure you know what is really to be expected of them.

While anecdotal evidence to support them might seem convincing, the science is much less convinced.

Panax Ginseng

Panax ginseng has been a traditional medicine in parts of China and Korea for potentially thousands of years – and it has been recently marketed to help lung function, cognitive function, premature ejaculation, and ED, among other things. It would be really remarkable if it were to do everything it promised.

A number of trials have found it moderately effective for ED treatment. However, it is nowhere near as effective as licenced medicines, and it also may not be safe for prolonged use.


Yohimbine used to be prescribed for the treatment of ED. However, along came the PDE5 inhibitors, and this African tree bark soon fell out of use.

Scientists these days are convinced by its powers in treating ED. And if you don’t know for sure whether it is going to work – and if it is not approved as safe – it is probably not worth trying.


Maca is another purported ‘natural’ treatment for ED – but, this time, it’s from the root of a Peruvian tree. Where the belief in its efficacy in treating sexual dysfunction arrived from is unclear, however. The one study that investigated a link between sexual performance and ED was conducted in rats. It worked – yet, this should not be enough for you to rely on, particularly when better options are available.

Into the Future: Experimental ED Treatments

Research into possible ED treatments is ongoing – and there have been promising results in fields that you may not have expected. Here are two possible therapies that may well be common reasonably soon. 

For now, however, they remain experimental – and the chances of your ED being treated effectively in this way are currently slim. But keep an eye out for these…

Shock Wave Therapy

Shock wave therapy sounds pretty sci-fi. And, in a way, it is. It involves the administration of shock waves – usually low-intensity acoustic waves – to break up plaque in your blood vessels. As a result, blood flow should improve.

However, right now, you can expect 1,500 shocks twice a week for 3-6 weeks, according to studies. So, in its current form, it won’t be the easiest solution around. Yet, this technique has been used for a while to help clear kidney stones, so it should be safe and effective.

Stem Cell Therapy

Most common ED treatments tackle the symptoms of the problem – rather than addressing the underlying causes of ED. That’s what stem cell therapy hopes to change.

Stem cells are cells in the body which are capable of renewing and repairing tissue thanks to their unique capacity for division and differentiation. The idea is that these cells could supply the material that can help to solve the root cause of ED. Clinical trials have been promising – but you can add it to the list of treatments more easily available to future generations.

Key Takeaways: Erectile Dysfunction Treatments

The medical landscape is these days awash with possibilities for ED treatment. From surgical interventions to vacuum devices, your options are many – and it’s up to you to find the one that suits you best. We recommend the PDE5 inhibitors such as Sildenafil and Tadalafil, alongside lifestyle changes to improve your health. These medicines are safe, effective, and reliable – and are easy to get hold of. 


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  3. Reuters -FDA approves Vivus’s fast-acting Viagra rival:

  4. Science Direct –Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia and Erectile Dysfunction:

  5. The National Institute for Health and Care Excellence (NICE) -Erectile dysfunction: Alprostadil cream:

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While we've ensured that everything you read on the Health Centre is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.

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