How Effective Are Erection Treatments?

All of us struggle to get an erection at some point in our lives. Not fun. But if you’re feeling like it’s happening more often – and those days of award-winning erections are in the past – it’s time to fix it. Because we all deserve good sex.

“There’s lots of common myths around erectile dysfunction (ED),” explains Dr Earim Chaudry. “There’s an idea that ED only affects older men or that it is part of growing old. Then there’s the one that a man gets ED because he is not attracted to his partner. Thankfully, these myths are gradually becoming debunked by the medical profession.”

According to Michael Blaha, a medical professor of the Johns Hopkins School of Medicine, erectile dysfunction is a potent indicator of underlying cardiovascular diseases.¹ A study performed with participants who had ED revealed they are twice more likely to experience cardiac arrests, heart attacks, and sudden death from cardiac failures. Strokes of the fatal and sometimes non-fatal nature occur more in patients with ED.

The takeaway? If you’re suffering from ED go and see your GP. They can get you checked out. And rule out any serious medical conditions. Peace of mind, basically.

“There’s an idea that ED only affects older men or that it is part of growing old. Then there’s the one that a man gets ED because he is not attracted to his partner. Thankfully, these myths are gradually becoming debunked by the medical profession.” Dr Earim Chaudry

Pop a pill? Try injections? Get penile implants? There are numerous solutions to ED. It’s just a matter of finding the one or ones that work for you.

“The effect and impact of numerous treatment strategies for ED have proved to be different for each man due to increasingly unique and dynamic factors such as the cause and severity of the ED,” says Dr Chaudry.

Makes sense. And another reason why you want to keep your GP in the loop. Here’s our guide to the main treatments for ED and how effective they really are.

Ready for the science bit? These are phosphodiesterase type 5 inhibitors or PDE5 inhibitors. They work by inactivating or limiting phosphodiesterase type-5 enzymes. This enhances the effects of nitric oxide, which relaxes the blood vessels in the penis. The result? More blood flows into the penis and stays there, causing a stronger erection in response to sexual stimulation.²

They are: Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra) and Avanafil (Spedra). And here is how they work…

Speed

When it comes to sex, spontaneous is always best. So timing is everything.

• Vardenafil can start working at 10 minutes. Although the manufacturer advises to wait 25 to 60 minutes before sex. The duration of action is between 5 and 7 hours, with a maximum duration of 12 hours.
• Avanafil works within 10-12 minutes, depending on the dosage. It is marketed as the fastest acting ED drug – with the instructions to take it 15 to 30 minutes before sexual activity. Keep in mind that only 29% of males that tried that quickly succeeded. So 30-45 minutes is safer.
• Tadalafil  will get you ready for sex after 20 minutes. It should be taken 30 minutes before intercourse, but 52% of men that attempted intercourse before then succeeded.
• Sildenafil, despite its popularity as Viagra, comes last for start up speed, at 30 minutes. It works best if you wait an hour after taking it.
  

Duration

Because who doesn’t want to last the distance?

• Tadalafil comes first in duration, with a whopping 3 days as the maximum! Even average effectiveness lasts 24-36 hours. Keep in mind that it only allows the ability for an erection, and doesn’t force one for a day or more. Because. Stressful.
• Avanafil is the newest in ED treatments and so information on its maximum duration is still unavailable. However, between 59%-89% of males who took Avanafil were able to have intercourse after 6 hours. And with an average lifespan of 10 hours it seems that it will last about as long as Sildenafil and Vardenafil.
• Vardenafil lasts 5-7 hours on average. Its max is 12 hours.
• Sildenafil has a duration of  4-6 hours, and last a maximum of 12 hours.

Effectiveness

Do they really work? Because this is what matters.

• With Avanafil, 70% of men studied were able to have sex in 15 minutes.
• Studies show that 85% of men needing Sildenafil achieved erections good enough for sex.
• “Sildenafil (Viagra) was the first treatment to be clinically approved to treat erectile dysfunction. Since then a number of similar medications have come onto the market, such as Cialis, Levitra, and Spedra. In a review of 82 trials covering over 47,000 patients, Sildenafil 50mg was found to be the most effective of all other comparable medications,” explains Dr Chaudry.

Side Effects

Another reason you should always read the small print.

• According to studies, while there are side effects for these treatments many are rare or uncommon.
• Out of the most common, these are 5 side effects you might worry about: headaches, myalgia, back pain, dyspepsia, and flushing. The most common one for each treatment differs.
• Sildenafil has a headache rate of 16-57% of patients, diarrhea 3-15%, nausea 25%, dyspepsia 7-17%, epistaxis at 9-13%, flushing at 10%, and all other symptoms are below 10%.
• Taladafil has a smaller headache rate, at 3-42% of patients. 1-14% experienced myalgia, 1-13% dyspepsia, 1-13% pharyngitis, 2-13% an infection, flushing at 1-13%, and all others below 13%.
• Avanafil has found that patients that experience headaches were about 5.1-12.1% of the total, flushing 3.2-10.1% pharyngitis 0.9-5.1% nasal congestion 1-3.4%, and back pain 1.1-3.2%. Avanafil is the best tolerated of the ED treatments.
• Vardenafil patients that experienced headaches were 14.4-15%, flushing 7.6-11%  rhinitis 9%, dyspepsia 2.8-4%, and nasal congestion at 3.1%. 

Don’t fancy popping a pill? Penis pumps are another option. They’re typically cylindrical tubes attached to a pump mechanism, which can be manually or battery-operated.³ Penis pumps draw out the air from tubes resulting in a vacuum that pulls arterial blood into the penis leading to a stronger erection. After using one to get an erection, it’s usually maintained with a constriction band or tension ring worn on your penis.⁴

“You can also treat ED using vasoactive substances such as alprostadil which are injected directly into the base of the penis by the use of a small needle to elicit an erection,” explains Dr Chaudry.

The majority of vasoactive substances used to treat ED are synthetic hormones, which relax penis muscles. These vasoactive substances improve blood flow for stronger erections.⁵

This is a surgical operation that places devices into both sides of the penis.  The objects used for penile implants are malleable (known as a semi-rigid prosthesis) or inflatable rods. The two inflatable devices allow you to have control over when, and for how long you have an erection. Malleable rods/implants keep a penis firm but bendable, according to the Mayo Clinic.

“Shock wave therapy is part of some of the new treatment approaches being implemented to help men manage and treat ED,” says Dr Chaudry. “The administration of shock waves stimulates erectile tissue by clearing formed plaques out of blood vessels, thus improving penile blood flow and endothelial function. This results in a restoration of natural erectile function.”

Expect 1500 shocks twice a week for 3–6 weeks.⁶ Clinical trials of shockwave therapy for ED have had encouraging results and the process has been well tolerated by patients.⁷ A word of warning though: shockwave therapy is still considered an experimental treatment.

Stem cells which are capable of renewing and repairing tissue – thanks to their capacity for division and differentiation – can help with ED.⁸ “The treatment of ED by use of stem cells derived from different sites including adipose tissue-derived stem cells, bone marrow mesenchymal stem cells and muscle-derived stem cells,” Dr Chaudry explains. Again, this is a relatively new advance in ED treatment.

How does it work? Well, according to research the gene therapy treatment for ED is an injection of genetic material into the penis. This replacement of proteins may result in improvements or correction of the erectile function.⁹ Note: the use of gene therapy is undergoing trials and may take a long time to get regulatory approval and public acceptance. So you may have to be patient with this one.