Sildenafil (Viagra) was the first oral phosphodiesterase type 5 (PDE5) inhibitor approved by the FDA in the United States for the treatment of erectile dysfunction (it is not approved for women). Sildenafil inhibits PDE5, which is an enzyme that destroys cGMP. By inhibiting the destruction of cGMP by PDE5, sildenafil allows cGMP to accumulate. The cGMP in turn prolongs relaxation of the smooth muscle of the corpora cavernosa. Relaxation of the corpora cavernosa smooth muscle allows blood to flow into the penis resulting in increased engorgement of the penis. In short, sildenafil increases blood flow into the penis and decreases blood flow out of the penis.
ICI Alprostadil may be used as a mixture with two other drugs to treat ED. This combination therapy called "bimix or trimix" is stronger than alprostadil alone and has become standard treatment for ED. Only the Alprostadil ingredient is FDA approved for ED. The amount of each drug used can be changed based on the severity of your ED, by an experienced health professional. You will be trained by your health professional on how to inject, how much to inject and how to safely raise the drug's dosage if necessary.

In some cases, however, these drugs may be unsuitable for patients with heart disease. If you are considering one of these drugs and you have heart disease, as many diabetics do, be sure to tell your doctor. In rare cases, the pills may create “priapism,” a prolonged and painful erection lasting six hours or more (although reversible with prompt medical attention).
If this treatment approach fails, it is useful, however frustrating, to start again from the beginning. Reassess the history to ensure that nothing was missed originally. Obtain labs and perform a PCDU. This will give the objective information that you might need in order to make a diagnosis of a known etiology for ED and to provide the patient reassurance that your evaluation has been thorough.
The prostaglandin E1 is contained in a small suppository located at the tip of an applicator. You should urinate first as this lubricates the urethra and makes it easier to insert the applicator into the tip of the urethra (urethral meatus, the opening at the tip of the penis that urine passes through). A patient can release the suppository into urethra by gently wiggling the applicator and pressing the button at the end. Rubbing the penis allows the suppository to dissolve, and the prostaglandin is absorbed through the tissue of the urethra into the penis. It takes 15 to 30 minutes for this occur. Once into the penis, the prostaglandin causes increased blood flow into the penis. The prostaglandin can be present in the ejaculate, and thus doctors recommend that men use a condom when having intercourse with a pregnant partner. Men may need to use a condom if vaginal irritation occurs in female partner.
In many of these cases, a discussion between the physician, the man with erectile dysfunction, and possibly his partner can help to resolve the issues leading to treatment failure. For men who experience severe side effects, can’t take the drugs for other reasons (such as taking medicines such as nitroglycerin), or don’t respond in spite of further education on the correct use of the drugs, there are other treatment options that can help most men remain sexually active.
There are four main prescription-only medicines which are used to treat erectile dysfunction in young men: Viagra (sildenafil), Cialis, Levitra and Spedra. You can purchase all of these erectile dysfunction medicines through our discreet online service. They all work in roughly the same way, by opening up the arteries which supply blood to the penis. This allows blood to fill the erectile tissue in the penis, and for an erection to be achieved and maintained.
For oral erectile dysfunction medicines to work as desired, they must be used properly in the first place. This means taking the medicine 30–45 minutes before engaging in sexual intimacy; taking the drug on an empty stomach or at least avoiding a heavy or high-fat meal before taking the drug (this is especially important when using sildenafil); and engaging in adequate genital stimulation before attempting intercourse. Drinking small amounts of alcohol (one to two drinks) should not compromise the effectiveness of erectile dysfunction medicines, but larger amounts of alcohol can diminish a man’s ability to have an erection.
Many men who suffer from erectile dysfunction feel guilty about being unable to please their partner. If the problem persists, the guilt becomes more than just a side effect – it can contribute to the ongoing cycle of ED as well. Guilt is often paired with low self-esteem, and not just in men with erectile dysfunction. Guilt and shame are feelings that are commonly linked to mental health issues such as depression. In fact, feelings of worthlessness and inappropriate guilt is one of the clinical criteria for major depressive disorder, according to the DSM-5.
And be aware that the vast majority of physical or psychological causes of erectile dysfunction are temporary. They may go away as quickly as they occurred. But if anything is bothering you or your partner, you should seek out confidential, professional advice. There is no point in worrying and not doing anything about it. It may just make the situation worse.
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Then you have to be able to make the right diagnosis. What is the basis for their erectile dysfunction? Is it psychogenic? Is it some sort of neurological or blood vessel or hormonal issue? So you have to make a diagnosis. You have to be able to make an assessment. And then only after those things are done, then you start to think about medications.
An alprostadil cream that patients apply into the tip of the penis (the urethral meatus, the opening that urine passes through) is currently available in the UK and Europe. It is currently under review by the U.S. Food and Drug Administration (FDA). After application of the cream, an erection occurs within five to 30 minutes, and the erection lasts one to two hours in men who respond to the cream. Doctors recommend that one use the cream for a maximum frequency of two to three times per week and no more frequent than once every 24 hours. It has essentially the same contraindications and side effects as the other formulations of alprostadil. The cream may cause vaginal burning in roughly 4% of partners. Men should not use alprostadil cream for sexual intercourse with women of childbearing potential unless a condom is used. Researchers have performed controlled trial studies to evaluate the safety and effectiveness of this drug. Overall, 52% of men reported improvement in their erections compared to 20% of men receiving placebo. A later analysis demonstrated that 36% of men using the alprostadil cream had a clinically relevant improvement in vaginal penetration ability and 31% clinically relevant improvement in ability to have successful intercourse to ejaculation.
 Other treatment options such as penile self-injection therapy, external vacuum pumps and the medicated urethral system for erection are on rare occasions an effective long-term treatment. A very small percentage of men will continue with these treatments as evidenced by a very high drop out rate and a very low refill rate for these treatments. These procedures require extensive planning which interfere with sexual spontaneity and are really not a realistic long-term treatment for young patients with permanent ED. 

Hormonal disorders, such as low testosterone, may contribute to ED. Another possible hormonal cause of ED is increased production of prolactin, a hormone produced by the pituitary gland. Additionally, an abnormally high or low thyroid hormone level can result in ED. Young men who use steroids to help build muscle mass are also at a higher risk for ED.

To understand what happens in ED, it's helpful to know some anatomical basics. When aroused by either sensory or mental stimuli, the brain sends a signal through the nerves to the penis, causing the muscles there to relax. This opens up space for blood to flow in and engorge the penis. A membrane within the penis traps blood inside to help maintain the erection, which subsides when the penile muscles contract, forcing blood back into the rest of the body. Any number of things can go wrong in this process, leading to erectile dysfunction.


An erection is a "neurovascular event" meaning that in order to have an erection there needs to be proper function of nerves, arteries, and veins. An erection involves the central nervous system, the peripheral nervous system, physiologic and psychological factors, local factors with the erection bodies or the penis itself, as well as hormonal and vascular (blood flow or circulation) components. The penile portion of the process leading to an erection represents only a single component of a very complex process.
Mental causes of sexual dysfunction include: depression, stress, anxiety and insomnia.  When one of these conditions leads to ED, usually once the condition is cured normal sexual behavior returns.  If you believe you have one of these conditions, see your doctor for an evaluation before beginning any treatment.  One side effect of antidepressants is erectile dysfunction.
Think of erectile dysfunction as your body’s “check engine light.” The blood vessels in the penis are smaller than other parts of the body, so underlying conditions like blocked arteries, heart disease, or high blood pressure usually show up as ED before something more serious like a heart attack or stroke. ED is your body’s way of saying, “Something is wrong.” And the list of things that cause erectile dysfunction can include:
Anxiety is the most common cause of erectile dysfunction in young men. This can include nervousness about getting your partner pregnant, losing your erection while putting a condom on, or your sexual performance. This often creates a negative spiral, because failure to achieve an erection causes yet more anxiety and stress. Depression, anxiety and stress can also cause ED by reducing libido.
The connection between diabetes and ED is related to your circulation and nervous system. Poorly controlled blood sugar levels can damage small blood vessels and nerves. Damage to the nerves that control sexual stimulation and response can impede a man’s ability to achieve an erection firm enough to have sexual intercourse. Reduced blood flow from damaged blood vessels can also contribute to ED.
Andrew McCullough, MD, associate professor of clinical urology and director, male sexual health program, New York University Langone Medical Center. Lecturer: Auxillium. Research grant: Pfizer. Data safety monitoring board: Pfizer. Consultant: Slate Pharmaceuticals. Clinical trials: Warner Chilcott, Vivus, Lilly, Bayer-GSK, ICOS, Timm, Schering Plough, Aeterna.

Getting (and maintaining) an erection requires a surprising amount of things to go right. You have to get aroused, then pass that signal from your brain, through your nerves and hormones, to your blood vessels and muscles before an erection can even happen. If one thing goes wrong in that complicated exchange between your cardiovascular, and nerve system, and your hormone levels, blood vessels, and even your mood the result is usually erectile dysfunction. In other words, getting an erection is hard.
Alcohol is a depressant, not an aphrodisiac or a libido enhancer. Excessive consumption can interfere with the ability to achieve an erection at any age, and even occasional drinking can make erectile dysfunction worse in older men. Feloney advises using alcohol in moderation: "In small amounts, alcohol can relieve anxiety and may help with erectile dysfunction, but if you drink too much, it can cause erectile dysfunction or make the problem worse."
Khoo, J., Piantadosi, C., Duncan, R., Worthley, S. G., Jenkins, A., Noakes, M., … Wittert, G. A. (2011, October). Comparing effects of a low-energy diet and a high-protein low-fat diet on sexual and endothelial function, urinary tract symptoms, and inflammation in obese diabetic men [Abstract]. The Journal of Sexual Medicine, 8(10), 2868-75. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21819545
The U.S. FDA (Food and Drug Administration) has a list of 29 OTC products that claim to treat erectile dysfunction. Patients should avoid these because many contain harmful ingredients. Other natural or herbal remedies such as DHEA, L-arginine, ginseng, and yohimbe are supplements that have been used but have not been proven safe and effective according to some researchers. Before using such compounds, individuals should consult their doctor. According to some experts, acupuncture does not effectively treat erectile dysfunction. Other home remedies for reducing ED symptoms include diet changes such as eating blueberries and citrus fruits and drinking red wine.
To avoid the dreaded whiskey d---, you don’t necessarily have to stop drinking alcohol. Just drink in moderation. The National Institute on Alcohol Abuse and Alcoholism defines moderate drinking as no more than two drinks a day for men, and one drink a day for women. The liver can only process 1 ounce of liquor or one standard drink in one hour. Consuming more than this will lead the system to become saturated, where extra alcohol will increase in the blood and body tissues, until the liver is ready to metabolize it again. Until then, high blood alcohol concentration will last for several hours and affect you physiologically.

In the popular media, it’s easy to find claims of a rising “epidemic” of erectile dysfunction in young men. For example, this article argues that the rate of ED in young men has increased 1000% in the last decade alone—though, problematically, no research is cited to back it up, which makes this a very questionable claim. So what does the science say on this subject? Are erectile difficulties really rising at a dramatic rate in young guys? Let’s take a look.
Natural treatments: Although natural remedies are increasingly available for sale over the counter, there is little scientific evidence to support their claims of improving ED. These remedies may produce adverse side effects or react negatively with other medications a man is taking. Before trying any over-the-counter treatments, it is essential to consult a doctor.
ED is easily and successfully treated! If your sex drive is unaffected, but you experience problems achieving or sustaining erection for a period of four to five weeks, you may have ED. Talk to your doctor immediately. Don’t delay—erectile dysfunction doesn’t “just go away!” Additionally, ED could be a sign of a serious, even life-threatening complication, such as congestive heart failure or kidney disease. Ignoring your ED because it’s embarrassing could jeopardize your health.
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