Oral medications aren't the only way to treat erectile dysfunction. Know the full range of treatment options and how they work. By Mayo Clinic Staff

If you have erectile dysfunction and can't take certain oral medications, you have other treatment options, including medications that are injected into or placed in the penis, penis pumps, and surgically placed penis implants.

Understand why you might choose a nonoral treatment for erectile dysfunction and how these different treatments work.

Not all men can safely take erectile dysfunction oral medications, such as sildenafil (Viagra), vardenafil (Levitra, Staxyn) and tadalafil (Cialis). Medications for erectile dysfunction might not work or might be dangerous if you:

  • Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) or isosorbide dinitrate (Dilatrate-SR, Isordil)
  • Take blood-thinning (anticoagulant) medications, alpha blockers, antibiotics, anti-seizure medications or anti-arrhythmic heart medications
  • Have heart disease or heart failure
  • Have had a stroke
  • Have uncontrolled low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension)
  • Have eye problems, such as retinitis pigmentosa, or a family history of certain eye problems
  • Have severe liver disease
  • Have kidney disease that requires dialysis

Some men might also choose another treatment option to avoid the side effects caused by certain oral medications.

Nonoral medications for erectile dysfunction include:

  • Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) or a combination of medications that includes alprostadil into the side of your penis. Each injection generally produces an erection that lasts about an hour. Because the needle used is very fine, pain from the injection site is usually minor. Side effects can include bleeding from the injection, prolonged erection and formation of scar-like (fibrous) tissue at the injection site.
  • Alprostadil penis suppository. Alprostadil intraurethral (Muse) therapy involves placing a tiny alprostadil suppository in your penis. You use a special applicator to insert the suppository into the tube that carries urine from your bladder (the urethra). An erection usually starts within 10 minutes and lasts between 30 and 60 minutes. Side effects can include pain and minor bleeding in the urethra.
  • Testosterone replacement preparations. Some men have erectile dysfunction caused by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended. Testosterone replacement therapy can be delivered via injection, patch, gel, gum and cheek (buccal cavity), or oral medication. Talk to your doctor about your personal preference and the possible side effects.

If medications aren't effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include:

  • Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis. Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device. The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation might not be as forceful. Your doctor might recommend or prescribe a specific model.
  • Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or semirigid rods. The inflatable devices allow you to control when and how long you have an erection. The semirigid rods keep your penis firm but bendable. This treatment is usually not recommended until other methods have been tried first. As with any surgery, there's a risk of complications, such as infection.
  • Blood vessel surgery. Rarely, obstructed blood vessels can cause erectile dysfunction. In this case, surgical repair is needed.

If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.

Getting proper treatment for the underlying cause of erectile dysfunction might help prevent related health problems and improve sexual function. Conditions that can cause or worsen erectile dysfunction include:

  • Heart disease. In some cases, erectile dysfunction is the first sign of heart problems.
  • Diabetes. Over time, diabetes can damage blood vessels and nerves, making it more difficult to get or keep an erection.
  • Psychological issues. Depression and anxiety can increase the risk of sexual problems.
  • Obesity. Being obese increases the risk of erectile dysfunction. Increased physical activity and losing weight can improve your overall health and sexual function.
  • Low testosterone. Men who have low testosterone levels (hypogonadism) might need testosterone replacement therapy to increase sex drive and sexual performance.
  • Lifestyle choices. Unhealthy habits such as drinking too much alcohol, smoking, using illegal drugs and not being physically active can cause or contribute to erectile dysfunction.

If you have erectile dysfunction, you're not alone — and you have many treatment options. Work with your doctor to find which erectile dysfunction treatment might work best for you.

May 23, 2013