Oral medications
Oral medications available to treat ED include:

Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)
The Food and Drug Administration (FDA) approved Viagra in 1998, and it became the first oral medication for erectile dysfunction on the market. Since then, Levitra and Cialis have been approved, providing more options for oral therapy.

Viagra, Levitra and Cialis work in much the same way. Chemically known as phosphodiesterase inhibitors, these drugs enhance the effects of nitric oxide, a chemical messenger that relaxes smooth muscles in the penis. This increases the amount of blood and allows a natural sequence to occur — an erection in response to sexual stimulation. These medications don't automatically produce an erection. Instead they allow an erection to occur after physical and psychological stimulation. Many men experience improvement in erectile function after taking these medications regardless of the cause of their impotence.

These medications share many similarities, but they have differences as well. They vary in dosage, duration of effectiveness and possible side effects. Other distinctions — for example, which drug is best for certain types of men — aren't yet known. No study has directly compared these three medications.

Not all men benefit
Although these medications can help many people, not all men can or should take them to treat erectile dysfunction. If you've had a heart attack, stroke or life-threatening heart rhythm during the last six months, don't take these medications. If you've been told that sexual activity could trigger a cardiac event, discuss other options with your doctor. In addition, don't take Viagra, Levitra or Cialis with nitrate medications, such as the heart drugs nitroglycerin (Nitro-Bid, others), isosorbide mononitrate (Imdur) and isosorbide dinitrate (Isordil). The combination of these medications, which work to widen (dilate) blood vessels, can cause dizziness, low blood pressure, and circulation and heart problems.

Don't expect these medications to fix your impotence immediately. Dosages may need adjusting. Or you may need to alter when you take the medication. Before taking any medication, make sure to discuss with your doctor its potential benefits and side effects.

Prostaglandin E (alprostadil)
Two treatments involve using a drug called alprostadil (al-PROS-tuh-dil). Alprostadil is a synthetic version of the hormone prostaglandin E. The hormone helps relax smooth muscle tissue in the penis, which enhances the blood flow needed for an erection. There are two ways to use alprostadil:

Needle-injection therapy. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. This generally produces an erection in five to 20 minutes that lasts about an hour. Because the injection goes directly into the spongy cylinders that fill with blood, alprostadil is an effective treatment for many men. And because the needle used is so fine, pain from the injection site is usually minor. Other side effects may include bleeding from the injection, prolonged erection and formation of fibrous tissue at the injection site. The cost per injection can be expensive. Injecting a mixture of alprostadil and other prescribed drugs may be a less expensive and more effective option. These other drugs may include papaverine and phentolamine (Regitine).
Self-administered intraurethral therapy. This method's trade name is Medicated Urethral System for Erection (MUSE). It involves using a disposable applicator to insert a tiny suppository, about half the size of a grain of rice, into the tip of your penis. The suppository, placed about two inches into your urethra, is absorbed by erectile tissue in your penis, increasing the blood flow that causes an erection. Although needles aren't involved, you may still find this method painful or uncomfortable. Side effects may include pain, minor bleeding in the urethra, dizziness and formation of fibrous tissue.
Hormone replacement therapy
For the small number of men who have testosterone deficiency, testosterone replacement therapy may be an option.

Vacuum devices
This treatment involves the use of an external vacuum and one or more rubber bands (tension rings). To begin you place a hollow plastic tube, available by prescription, over your penis. You then use a hand pump to create a vacuum in the tube and pull blood into the penis. Once you achieve an adequate erection, you slip a tension ring around the base of your penis to maintain the erection. You then remove the vacuum device. The erection typically lasts long enough for a couple to have adequate sexual relations. You remove the tension ring after intercourse.

Vascular surgery
This treatment is usually reserved for men whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery may also be used to correct erectile dysfunction caused by vascular blockages. The goal of this treatment is to correct a blockage of blood flow to the penis so that erections can occur naturally. But the long-term success of this surgery is unclear.

Penile implants
This treatment involves surgically placing a device into the two sides of the penis, allowing erection to occur as often and for as long as desired. These implants consist of either an inflatable device or semirigid rods made from silicone or polyurethane. This treatment is often expensive and is usually not recommended until other methods have been considered or tried first. As with any surgery, there is a small risk of complications such as infection.

Psychological counseling
If stress, anxiety or depression is the cause of your erectile dysfunction, your doctor may suggest that you, or you and your partner, visit a psychologist or psychiatrist with experience in treating sexual problems.

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