Topical Creams and Gels for Managing Erection Problems

Erectile dysfunction is a common side effect of many prescription drugs. Common medications that list ED as a potential side effect include: Substances that have addiction potential may cause ED, including: These substances can affect and suppress your central nervous system. They can also cause severe damage to your blood vessels, which may lead to permanent erectile dysfunction. Fear of sexual intercourse or intimacy (genophobia). Conditions that affect your body’s ability to deliver blood to your penis are the most common cause of ED. You may have a greater risk delayed ejaculation pills of getting ED if you: Have a body mass index (BMI) over 25. A healthcare provider can diagnose ED and determine its cause.

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They’ll review your medical history and perform a physical exam. They’ll also ask you questions about your personal and sexual history. These questions may make you feel embarrassed or awkward. But it’s important to be honest with the provider in order to quickly determine the cause. Are you currently taking any medications, including prescription drugs, over-the-counter drugs, herbal supplements, dietary supplements and nonmedical drugs?

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Erectile dysfunction (ED) is the inability to get or maintain an erection long enough to have sexual intercourse. There are many different causes, which may include conditions that affect your blood vessels, neurological conditions, mental health conditions and injuries. A healthcare provider can diagnose and treat erectile dysfunction. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission.

Nerve disorders

We do not endorse non-Cleveland Clinic products or services. Erectile dysfunction (ED) is a type of penile disorder. It affects your ability to get and maintain an erection firm enough for sexual intercourse. Your feelings play a major role in getting and maintaining an erection. Feeling relaxed, confident and aroused is essential. Has a healthcare provider ever diagnosed you with depression or anxiety? How often are you able to get erections? How long are you able to maintain an erection?

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Do you lose your erection because you ejaculate sooner than you would like? When did you first notice symptoms of erectile dysfunction? What exactly happened when you first had erectile dysfunction symptoms? Do or did you experience erections at night or during the morning? What sexual positions do you regularly engage in? The provider may also ask to talk with your sexual partner. Your partner may be able to offer additional insight on potential causes. The provider may order tests to confirm their diagnosis and determine the cause of your ED. It depends on what your healthcare provider suspects is causing erectile dysfunction. Tests that measure if the nerves in your penis respond to vibrations (penile biothesiometry). Drugs that temporarily make your penis erect (vasoactive injection). Before testing, your provider will explain what’s involved with a test and answer any questions you have.

Get a Personalized Treatment Plan to Help You Feel Your Best.

Your penis needs adequate blood flow to become erect and maintain an erection. Your penis also relies on a series of valves to close when it fills with blood — in some cases, these valves stop working as they should. Your nervous system includes your brain, spinal cord and nerves. They work together to send electrical impulses that help your body move and feel, including your penis. Your endocrine system includes the glands that create and release hormones.

ED medications without side effects

Hormones help tell your body to perform certain functions. Testosterone may help open up (vasodilate) your blood vessels, which helps blood flow to your penis. Injuries (trauma) to your penis and surrounding areas can also cause ED. Injuries to your pelvis bones (hip bones, sacrum and tailbone), bladder, prostate and spinal cord. Pelvic surgery, including prostate, colon or bladder cancer surgery. If you don’t feel comfortable, you can decide not to do the test at any time. The first step in treating erectile dysfunction is identifying the underlying cause. A healthcare provider will help determine the best treatment for you.

• Diazepam: Benzodiazepine for anxiety, seizures, muscle spasms.
• Lorazepam: Anxiolytic and sedative for anxiety and seizures.
• Alprazolam: Short-acting benzodiazepine for panic disorder.
• Clonazepam: Used for seizures and panic attacks.
• Temazepam: Short-term management of insomnia.
• Midazolam: Used for anesthesia and sedation.
• Chlorodiazepoxide: Historically used for anxiety and alcohol withdrawal.
• Oxazepam: For anxiety and alcohol withdrawal.
• Triazolam: Short-acting hypnotic for insomnia.
• Flurazepam: Used for long-term insomnia.
• Estazolam: For short-term treatment of insomnia.

Vigorous cardiovascular exercise for at least 45 minutes three times per week may help reverse some cases of mild ED. Cardiovascular exercises may include vardenafil cost brisk walking, jogging, swimming, bicycling and jumping rope.

What is erectile dysfunction (ED)?

This can happen because of trauma, pelvic surgery, radiation therapy or neurologic conditions like stroke, spinal stenosis and multiple sclerosis (MS). Hormonal ED refers to ED that happens as a result of testosterone deficiency, or in some cases as a result of thyroid issues. Psychogenic ED involves psychological conditions (conditions that affect your thoughts, feelings or behavior) that can cause ED. Erectile dysfunction is the most common sex-related condition that males report to healthcare providers, especially as they age and develop other health issues. Providers and medical researchers estimate that erectile dysfunction affects over 50% of males between the ages of 40 and 70.

Mechanical devices and procedures

And those numbers may be higher — many don’t seek help for the condition due to embarrassment or shame. Only sometimes being able to get an erection before sexual intercourse. Being able to get an erection before sexual intercourse but not being able to maintain it during sexual intercourse. Requiring a lot of stimulation to maintain an erection. There are many possible causes of ED, including conditions that affect your: Your circulatory system includes the blood vessels that carry blood throughout your body. For men with mild ED, quitting smoking can lead to improvement after several months. Oral medications that help increase blood flow to your penis, including sildenafil (Viagra®), vardenafil (Levitra®), tadalafil (Cialis®) or avanafil (Stendra®). Oral medications start to work within an hour. Penile low-intensity focused shockwave therapy (LiSWT). This noninvasive treatment improves blood flow by using sound waves. It can take two months to see improvement. Medications you inject directly into your penis to create an erection, including alprostadil (Caverject®), papaverine (Papacon®), phentolamine (Regitine®) or a combination of multiple medications. Injectable medications start to work within 10 minutes. Penis pumps start to work almost immediately.

How is ED diagnosed?

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. ED is often an early warning sign of underlying cardiovascular disease, such as clogged arteries (atherosclerosis). "It can predate a diagnosis of cardiovascular disease by at least a few years," Dr. Liou says.

What the doctor does

We don't have strong proof yet that starting to live a healthier lifestyle can reverse erectile problems, but it can't hurt. Read 5 natural ways to overcome erectile dysfunction. As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Testosterone replacement therapy, which is available as a gel, injection, patches and pellets. Testosterone replacement therapy starts to work within four weeks. A penile implant is a procedure in which a surgeon places a device into your penis to make it hard.

Which ED Drug Works Fastest?

But it’s normal to sometimes have erection issues. Erection problems can occur if you feel nervous, sex medicine anxious, frustrated or tired. Drinking alcohol and/or using substances can also have an effect. It can also result from other conditions or as a side effect of certain medications or cancer treatments. If you’re having difficulty getting or maintaining an erection, it’s a good idea to schedule an appointment with a healthcare provider for further discussion.

Intraurethral or Transurethral Medications

In many cases, ED can be the first symptom of another underlying problem, including heart disease. It’s important to talk to a healthcare provider if you have problems getting and maintaining an erection. Healthcare providers separate ED into several categories: Vascular ED includes causes that affect the blood vessels that send blood to the tissues in your penis that allow you to get and maintain an erection, or the valves in the penis that normally hold blood inside. Vascular ED is the most common type of ED. Neurogenic ED occurs as a result of nerve problems, which prevent signals from traveling from your brain to your penis to create an erection. The device doesn’t affect sensation, peeing or orgasm. ED will not likely go away on its own without changes to your lifestyle or some kind of treatment. The outlook for ED is good and it’s a very treatable condition. Though there aren’t cures for some causes of ED, many treatment options can help you get and maintain an erection hard enough for sexual intercourse. Certain lifestyle changes can help lower your risk of developing erectile dysfunction, including: Being more physically active, especially doing cardiovascular exercises like running, jogging or bicycling. Eating healthy foods with low saturated fats, such as fruits, vegetables and whole grains. Talk to a primary care physician or a urologist if you suspect you have erectile dysfunction. They can help diagnose ED, identify its cause and recommend the best treatment option for you. A urologist is a healthcare provider who specializes in diagnosing and treating conditions that affect your reproductive system and urinary system. Go to your nearest emergency room if you’re taking medication for erectile dysfunction and have a painful erection that lasts longer than two to four hours.

• Penicillin: An antibiotic used to treat bacterial infections including syphilis and pneumonia.
• Amoxicillin: A broad-spectrum penicillin effective against ear, nose, throat, urinary tract infections.
• Ciprofloxacin: A fluoroquinolone used for urinary, respiratory, and gastrointestinal bacterial infections.
• Metronidazole: An antimicrobial for treating bacterial and parasitic infections like giardiasis and bacterial vaginosis.
• Doxycycline: A tetracycline antibiotic used for respiratory infections, Lyme disease, and acne.
• Ceftriaxone: A cephalosporin antibiotic for severe infections like meningitis and gonorrhea.
• Vancomycin: Used to treat serious Gram-positive infections, including MRSA.
• Azithromycin: A macrolide antibiotic for respiratory infections, chlamydia, and skin infections.
• Clindamycin: Effective against anaerobic bacteria and certain protozoal infections.
• Levofloxacin: A fluoroquinolone used for pneumonia, urinary tract infections, and skin infections.
• Trimethoprim-Sulfamethoxazole: Combines antibiotics for urinary tract infections and certain pneumonia cases.

This may be a sign of priapism, which can cause permanent damage to your penis without treatment. Is it normal to have erectile dysfunction?

• Vacuum pump types: Include manual pumps, battery-operated pumps, and FDA-cleared devices.
• Constriction ring materials: Made from silicone, leather, or metal; must be timed.
• Pump sizing: Important to choose the correct cylinder size for effective use.
• Implant surgery: Procedure typically takes 1-2 hours under general or spinal anesthesia.
• Implant recovery: Involves several weeks of healing and learning to use the device.
• Implant risks: Include infection, mechanical failure, and erosion, though rare.
• Implant satisfaction: Has very high patient and partner satisfaction rates.
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• Three-piece inflatable implants: Include cylinders, a pump, and a fluid reservoir.