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Health A-Z

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Harvard Medical School

Treatment

There are many effective treatments for impotence. The most popular is a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors. These include sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis) and avanafil (STENDRA). These drugs are taken in pill form. They work in most men. But they are less effective in men with neurological causes of impotence.

The PDE5 drugs are generally safe. But always review the risks with your doctor. PDE5 drugs can interact with other medications and cause dangerously low blood pressure. For example, you should not take PDE5 drugs if you use nitroglycerin or other nitrate medications.

The most worrisome side effects are sudden onset of vision or hearing loss. This occurs very rarely but requires immediate medical attention. PDE5 drugs can cause other side effects, such as flushing and headache.

If PDE5 drugs don't work or cannot be used because of potential side effects, your doctor can recommend other therapies. The drug alprostadil (Caverject, Edex, Muse) allows blood to flow more freely in the penis, leading to an erection. The drug can be injected with a tiny needle into your penis. Or, a small pellet (suppository) can be inserted into the opening of the penis. Suppositories and injections are effective in the majority of men.

Taking extra testosterone will not improve ED. For men who have abnormally low levels of the hormone, testosterone replacement may enhance sexual desire.

Psychological therapy can be effective in men whose impotence is caused primarily by psychological factors. This might include counseling, behavioral therapy or couples' therapy.

Men who do not benefit from medical or psychological treatment often have success with mechanical or prosthetic devices. External products, known as vacuum erection devices, are safe and highly effective. But many men and their partners find them unappealing.

Another option is a surgically placed penile implant. Only a small number of men with impotence choose this option.

Vascular (blood vessel) surgery sometimes is recommended for young, healthy men who develop impotence after trauma to the groin. Unfortunately, the long-term success rate of this surgery is not known.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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