But the main challenge to finding the best ED drug for you may turn out to be health insurance rules—not biochemistry. It's a common practice among insurers to limit the number of pills you can obtain per month. After you hit your limit, the out-of-pocket cost for a single pill can be as high as $20. "The main obstacle in my practice is the cost," Dr. Liou says. You'll need to work with your doctor to get the pill you need at a price you can afford.
• Blood Vessels: Diabetes damages blood vessels, especially the smallest blood vessels such as those in the penis. Diabetes can also cause heart disease and other circulatory problems. Proper blood flow is absolutely crucial to achieving erection. “Erection is a hydraulic phenomenon that occurs involuntarily,” says Arturo Rolla, MD, of Harvard University School of Medicine. “Nobody can will an erection!” Anything that limits or impairs blood flow can interfere with the ability to achieve an erection, no matter how strong one’s sexual desire.
Metabolic syndrome, comprising central obesity, hypertension, increased fasting blood glucose levels and dyslipidaemia, has been linked with erectile dysfunction.15 While the worldwide prevalence of metabolic syndrome is increasing, erectile dysfunction has been reported in up to 80–95% of patients with metabolic syndrome.15 There are several pathways in which metabolic syndrome may impair erectile function, including hormonal changes, inflammation, endothelial dysfunction and atherosclerosis. Patients with metabolic syndrome may benefit from lifestyle modifications, pharmacological interventions or surgery. Treatment of metabolic syndrome may result in improvement in erectile function.
None of the ED drugs is safe to take with cardiac drugs called nitrates because it could cause a dangerous drop in blood pressure. Drugs that many men take for urinary symptoms, called alpha blockers, can also lower blood pressure, so take them at least four hours apart from ED drugs. Your doctor may start you on a smaller dose of the ED drug if you already take an alpha blocker, or may recommend the alpha blocker tamsulosin (Flomax), which affects blood pressure less.

Inflatable prostheses are complex mechanical devices that imitate the natural process of erection. Parts are inserted surgically into the penis and scrotum, and activated by squeezing. When erection is no longer desired, a valve on the pump is pressed, and the penis becomes flaccid. Self-contained single-unit prostheses are similar to the inflatable types, but more compact. The entire device is implanted into the penis. When erection is desired, the unit is activated by either squeezing or bending, depending on which of the two types of self-contained prostheses is used.
We use cookies and similar technologies to improve your browsing experience, personalize content and offers, show targeted ads, analyze traffic, and better understand you. We may share your information with third-party partners for marketing purposes. To learn more and make choices about data use, visit our Advertising Policy and Privacy Policy. By clicking “Accept and Continue” below, (1) you consent to these activities unless and until you withdraw your consent using our rights request form, and (2) you consent to allow your data to be transferred, processed, and stored in the United States.
Evidence of possible causative factors (e.g. diabetes, pituitary disease, lipid disorders, vascular or neuropathic disease, androgen deficiency) should be sought systematically. Gonadal status (secondary sexual characteristics, testis size) and visual field defects suggesting pituitary tumour should be assessed. Altered peripheral pulses and neurological reflexes in the legs can be evidence of vascular or neurological disorders.
Even in cases where the correct active ingredient is contained in the correct quantity, people have limited opportunities to receive information about contraindications when they buy medicine from illegal online sources. Some sites provide prescriptions from cyberdoctors, but it is often unclear whether these ‘doctors’ are computer programs or real people and if they have any medical credentials. Men who should not use PDE-5 inhibitors have been ‘prescribed’ these medications during online consultations.
Most patients will not need specialised investigations. For patients in whom the aetiology is unclear, or first-line or second-line treatments have not worked, ultrasonography should be considered.21 A penile duplex Doppler ultrasound, using an intracavernosal vasoactive agent, can help to classify the aetiology of erectile dysfunction and may help direct if further subspecialised tests are needed. It can also predict which treatments may be beneficial. If arteriogenic erectile dysfunction is diagnosed, consideration of referral to a cardiologist for assessment of occult ischaemic heart disease is warranted.
Erectile problems can happen to men of any age.  There are many factors that contribute to ED including poor health, untreated medical problems, medications and pornography use.  Many men struggle with understanding when they are experiencing situational sexual dysfunction verses when is your erectile issue an ongoing problem that requires medical help.
But the main challenge to finding the best ED drug for you may turn out to be health insurance rules—not biochemistry. It's a common practice among insurers to limit the number of pills you can obtain per month. After you hit your limit, the out-of-pocket cost for a single pill can be as high as $20. "The main obstacle in my practice is the cost," Dr. Liou says. You'll need to work with your doctor to get the pill you need at a price you can afford.
Some men say certain alternative medicines taken by mouth can help them get and maintain an erection. However, not all “natural” medicines or supplements are safe. Combinations of certain prescribed and alternative medicines could cause major health problems. To help ensure coordinated and safe care, discuss your use of alternative medicines, including use of vitamin and mineral supplements, with a health care professional. Also, never order a medicine online without talking with your doctor.
Following a detailed discussion about the history of erectile dysfunction and its risk factors, your doctor will examine the testicles and penis to help determine the cause of erectile dysfunction. Your doctor will check reflexes and pulses in the area to see if problems with blood vessels or nerves are contributing to the erectile dysfunction. If necessary, your doctor will order tests to help diagnose erectile dysfunction.

Patients taking PDE5 inhibitors should avoid consuming large amounts of alcohol, which may cause a sudden decrease in blood pressure when getting up from a standing or reclining position. Although effects can be variable, symptoms may include a fast heart rate, dizziness, headache and fainting. Studies with some PDE5 inhibitors have shown a decrease in blood pressure and symptomatic effects when combined with alcohol.
The success of most commonly-used therapies will depend on co-operation of the partner. It is important to determine the partner's attitudes to the problem and involve them in discussions of treatment options. Men who do not have a regular or supportive partner rarely do well with therapies which necessitate treatment at the time of intended intercourse.
Dr Kenny du Toit is a urologist practicing in Rondebosch, Cape Town. He is also consultant at Tygerberg hospital, where he is a senior lecturer at Stellenbosch University. He is a member of the South African Urological Association, Colleges of Medicine South Africa and Société Internationale d’Urologie. Board registered with both the HPCSA (Health professions council of South Africa) and GMC (General medical council UK). He has a keen interest in oncology, kidney stones and erectile dysfunction.http://www.dutoiturology.co.za
injections – some medication can increase blood flow when it is injected into the penis. A penile injection can create an erection within five to 10 minutes and last for up to one hour. Men must be shown how to use the penile injections properly and should have several supervised injections in a doctor’s surgery. One possible side effect is a painful erection lasting for hours, known as priapism. This occurs if the medication dose is too high. If an erection lasts for four hours or longer, the penis may be permanently damaged. In this situation, you should seek immediate medical attention
Yohimbine: The main component of an African tree bark, yohimbine is probably one of the most problematic of all natural remedies for ED. Some research suggests that yohimbine can improve a type of sexual dysfunction that is linked with a drug used to treat depression. However, studies have linked yohimbine to a number of side effects, which can include anxiety, increased blood pressure, and a fast, irregular heartbeat. Like all natural remedies, yohimbine should only be used after advice and under supervision from a doctor.
Counselling or sex therapy (58% of people find this works for them) –mind-related causes of erectile dysfunction can affect anyone. They are more likely if you experience erectile dysfunction at a younger age. Talking to a counsellor or therapist can help some people overcome erectile dysfunction related to these problems, possibly for good. They can also help you if your erectile dysfunction is causing you stress, as this can make matters worse.
Doses of the active ingredient contained in counterfeits vary, from not containing any active ingredient, to containing up to twice the dose of the medicine they are supposed to mimic. Only 10% of counterfeit ED drugs tested in the European Union contained an amount of active ingredient that was within 10% of the quantity contained in the original product. However, containing the same amount of the active ingredient does not mean the counterfeit medicine is exactly the same. If the drug has been stored incorrectly, is past the use by date, or uses active ingredients from a different source, the way the drug is absorbed by the body may differ from the original.
You may find that using a vacuum device requires some practice or adjustment. Using the device may make your penis feel cold or numb and have a purple color. You also may have bruising on your penis. However, the bruises are most often painless and disappear in a few days. Vacuum devices may weaken ejaculation but, in most cases, the devices do not affect the pleasure of climax, or orgasm.

Viagra can be used as frequently as once a day every day and usually works within thirty minutes. The effects last for about 4 hours. Viagra is the most well-known and popular of the erectile dysfunction medicines. It contains the active ingredient sildenafil, which is also available as unbranded sildenafil tablets and over-the-counter Viagra Connect.


Regardless of the underlying cause, most men with ED have comorbid emotional symptoms, such as depression or low self-esteem. ED is therefore most effectively treated with a holistic approach that combines pharmacological interventions with psychological (e.g. counselling), hormonal (e.g. testosterone investigations) and other interventions. Men who purchase counterfeit ED drugs therefore do not receive the most effective form of treatment, even if the drugs they purchase are good replicas of the originals (which usually they are not).
Effective treatment for erectile dysfunction is available, and for most men will allow the return to a fulfilling sex life. The side effects of the treatment for erectile dysfunction vary depending on the treatment that is used. Some may interrupt the spontaneity of sexual activity. For example, PDE-5 inhibitors typically need to be taken one hour before sex. Side effects may include headaches, indigestion, vasodilation, diarrhoea and blue tinge to vision. Other treatments such as penile injections may cause pain at the injection site, or an erection that will not go down. Treatment options need to be carefully discussed with your doctor to determine which one is best suited to you.

Metabolic syndrome, comprising central obesity, hypertension, increased fasting blood glucose levels and dyslipidaemia, has been linked with erectile dysfunction.15 While the worldwide prevalence of metabolic syndrome is increasing, erectile dysfunction has been reported in up to 80–95% of patients with metabolic syndrome.15 There are several pathways in which metabolic syndrome may impair erectile function, including hormonal changes, inflammation, endothelial dysfunction and atherosclerosis. Patients with metabolic syndrome may benefit from lifestyle modifications, pharmacological interventions or surgery. Treatment of metabolic syndrome may result in improvement in erectile function.
Currently, however, there are certain restrictions on what you can and cannot get for ED with an NHS prescription. Most people will be given a prescription for a course of unbranded treatment (usually Sildenafil) for the standard NHS prescription fee. Only certain people will be able to get branded drugs (Viagra, Cialis, Levitra or Spedra): for example, anyone who has diabetes. 

Choosing the treatment that is best for you comes down to preference and efficacy. Montague cites a study that surveyed three groups of men, all of whom were successfully using an ED treatment. One group was on oral medications, one was using injections and a third had surgically implanted pumps. The most satisfied users were those with the implanted prostheses.
Ginseng, specifically “red ginseng,” is known as the “herbal Viagra” that helps puts to rest men’s bedroom woes. Red ginseng is when the root has been steamed and then dried. The ginseng root is the part of the plant that is mostly used as a natural remedy when in its supplement form. However, the plant must be grown for a minimum of five years before it can be used. In a 2008 review, seven studies on red ginseng and ED, ranging in dosages from 600 to 1,000 milligrams three times a day, were found to provide evidence for the effectiveness of the herb in ED treatment.
Traditionally, the aetiology of erectile dysfunction is classified into organic, psychogenic or mixed. Organic causes include anatomical, vasculogenic (ie arterial or venous), neurogenic, endocrinological and drug-related side effects. Psychogenic aetiology may be generalised or situational. In reality, however, anxiety and depression commonly accompany erectile dysfunction, irrespective of the original aetiology.4 Consequently, nearly all organic erectile dysfunction will eventually become ‘mixed’. Risk factors for erectile dysfunction are listed in Table 1.

An Australian man was hospitalised in early 2010 with acute hypoglycaemia. The 54-year-old man denied recreational drug use and excessive alcohol consumption. Further questioning revealed that his condition occurred after consuming a PDE-5 inhibitor. Laboratory analysis confirmed the medicine to be a counterfeit masquerading as tadalafil.This is the first Australian case of severe hypoglycaemia induced by counterfeit ED drugs. It serves to remind the public that Australia is at risk of an outbreak similar in style to that which occurred in Singapore.

Erectile dysfunction (ED) is commonly called impotence. It’s a condition in which a man can’t achieve or maintain an erection during sexual performance. Symptoms may also include reduced sexual desire or libido. Your doctor is likely to diagnose you with ED if the condition lasts for more than a few weeks or months. ED affects as many as 30 million men in the United States.
×