Erectile dysfunction is defined medically as the persistent inability to achieve or maintain a penile erection sufficient for sexual performance.
Common Causes of ED
Some of the most common issues that can lead to ED include: high blood pressure, diabetes, vascular disease, obesity, depression, performance anxiety, major life changes/stressors, relationship issues, poor diet/nutrition, smoking, excessive alcohol use, some medications, neurologic conditions, obstructive sleep apnea, chronic kidney disease/dialysis, prior pelvic surgery or radiation for colon/rectal/prostate/bladder cancers, as well as an acute exacerbation of other medical issues or sickness.
Sometimes no obvious cause can be identified, which can add to patient frustration. Low testosterone levels may be involved as well, but is not typically the sole cause of ED. The medical definition and treatment of ED does not include issues related to ejaculation (delayed, absent, low volume, painful ejaculation) or issues related to sexual pleasure or penile sensitivity/feeling.
Treatment Options
Treatments include: PDE-5 inhibitor medications, intracavernosal injections (ICI), psychologic therapy, testosterone supplementation, vacuum erection device (VED), intraurethral alprostadil (MUSE), and implantation of a penile prosthesis.
Contrary to some commercials or advertisements you may have seen, it is important to understand that achieving a normal or high level of testosterone does not guarantee resolution of ED, as the cause of ED is multifactorial.
PDE-5 Inhibitors (Medications)
| Medication | Available Doses | Notes |
|---|---|---|
| Viagra (Sildenafil) | 100mg, 50mg | Take 1 hour prior; lasts 4–6 hours |
| Cialis (Tadalafil) | 20mg, 10mg, 5mg, 2.5mg | 20mg lasts 24–36 hours; 5mg can be taken daily and also helps with BPH |
| Levitra (Vardenafil) | 20mg, 10mg | Difficult to find |
| Stendra (Avanafil) | 200mg, 100mg | Difficult to find |
These medications differ based on time of onset and how long they last in the body. One is not “the strongest” or “the best,” and their dosages are not comparable.
⚠️ “Rugiet Ready” is a marketing/advertising ploy that combines Sildenafil (Viagra) and Tadalafil (Cialis) into one pill with an additional medication called Apomorphine. This additive is off-label and has limited efficacy.
Side Effects & Important Warnings
Side effects include headache, flushing, nasal stuffiness, visual changes, hypotension/dizziness, and backache. These medications work better without having had a recent heavy, fatty meal. Do not take more than what has been prescribed.
Important Safety Information:
- If you experience an erection lasting more than 4 hours (Priapism), this must be treated urgently. Don’t wait — call the office for guidance.
- Don’t take these medications within 4 hours of Flomax (Tamsulosin) or Uroxatral (Alfuzosin).
- You cannot take these medications if you also take NITRATES for blood pressure or heart issues.
- If you have heart disease, please check with your cardiologist or primary care doctor before trying these medications.
Your insurance company may not always cover the full cost of any of these pills. We recommend using “GoodRx” to shop prices at local pharmacies, as some can offer these at considerably less cost (Publix & Costco tend to be significantly cheaper than CVS, Walgreens, or Walmart).
Intracavernosal Injections (ICI or “Trimix”)
- A combination of 3 medications injected by the patient into the side of the penis immediately prior to intercourse.
- This medication is made by a compounding pharmacy that we can order for you; we have no financial relationship with them.
- Insurance does not typically cover the cost, and the patient pays the compounding pharmacy directly for the medication.
- Once you have the medication and supplies, our staff can show you and teach you how to use it properly and safely.
Firm-X (Penile Neuromodulator Treatment)
- An in-office targeted penile neuromodulator treatment that improves erection quality and firmness without daily medication.
- One treatment can provide benefits for up to 6 months.
- To learn more, visit: Penile Neuromodulator Treatment or Firm-X Complete Guide
This information is provided for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of erectile dysfunction.