Tips to Live By

Treating Erectile Dysfunction: 5 Options Beyond ED Pills

June 15, 2021

What happens in the bedroom typically stays in the bedroom, with one major exception being when things aren't going well in there.

"In terms of sexual health, erectile dysfunction (ED) is the most common problem men report to their doctor," says Dr. Nathan Starke, urologist specializing in men's health at Houston Methodist. "Most often, men are prescribed an oral medication such as 'the blue pill' or one of its closely related alternatives."

But treating ED doesn't have to begin and end with oral medications — which can come with unwanted side effects. In addition, it's unsafe for some men to take these medications, including those who have severe heart disease/heart failure or low blood pressure, as well as those who take nitrate drugs to treat chest pain. And, finally, these medications often fail to work in some men altogether.

"Fortunately, there are several other ways to treat ED," adds Dr. Starke.

5 ways to treat ED that eliminate the need to take a pill

For men who don't want to take a pill or for those who simply can't, Dr. Starke is here to explain your options.

1. VED (Vacuum Erection Device)

Often called a penile pump, a VED works by manually pulling blood into your penis using suction. Once the erection is formed, a tension ring is slipped to the base of the penis, which helps maintain an erection for about 30 minutes.

"While many men do not love the concept of suction and ring compression to get and maintain erections, it is a reliable option that works for many couples to restore erection function without medication," says Dr. Starke.

Side effects of using a penile pump include:

  • Mild bruising
  • Restriction of ejaculation
  • The penis feeling cold to the touch when used for an extended period

2. Testosterone replacement

"ED is commonly caused by temporary stress or chronic cardiovascular conditions that reduce blood flow to the penis. But, low testosterone can contribute to issues with forming and maintaining an erection," says Dr. Starke. "Your doctor can help you understand if your testosterone levels are low and whether starting testosterone treatment may help alleviate your ED symptoms."

Though testosterone replacement is not recommended as a first-line, single treatment for ED, your doctor may recommend it or try it in combination with another ED treatment option, depending on your individual symptom profile.

3. Urethral suppository

Intraurethral therapy involves inserting a small drug pellet into the tip of the penis.

"With this therapy, it only takes about 10 minutes for an erection to form — which can then last anywhere from 30 to 60 minutes," says Dr. Starke. "However, side effects of using a urethral suppository can include a burning sensation or very minor bleeding from the tip of the penis."

4. Penile injections

"Though a universally scary concept, penile injections involve a medicine that improves penile blood flow much better than the oral alternatives. The medicine is injected at the base of the penis using a very small needle. This is a self-injection, of course, although we routinely teach patients proper technique and perform the first injection in the clinic," says Dr. Starke.

Side effects of this treatment, include:

  • Minor pain or bleeding at the injection site
  • Prolonged erection that can last longer than desired
  • Formation of scar tissue within the deeper tissues of the penis, primarily seen in long-term users of this therapy

5. Penile implant

A penile implant involves a 30- to 45-minute surgical procedure that places a water-based device into the erection chambers of the penis, which enables you to reliably control exactly when and how long an erection lasts. Dr. Starke says this is the closest option to a cure that exists for ED.

"A penile implant does involve a short surgical procedure, so whether or not you're willing or able to undergo the procedure can be a determining factor in whether it's the right option for you," explains Dr. Starke. "For men who do choose an implant, the vast majority (greater than 90% of men and their partners) report great satisfaction with it."

(Related: 5 Things to Know If You're Considering a Penile Implant)

Addressing underlying health conditions and minimizing stress can also reduce symptoms of ED

"ED isn't always caused by increasing age, and it rarely occurs alone. In fact, it's often linked to — and even caused by — one or more underlying health conditions that a man may not even know he has," says Dr. Starke. "In particular, high blood pressure, heart disease and anxiety or depression can contribute to the symptoms of ED."

Aside from the various treatment options for ED, Dr. Starke points out that simply taking steps to better your heart health and mental health may help alleviate your symptoms.

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