Erectile dysfunction: Nonoral treatments

One of the main treatments for erectile dysfunction, also called ED, is oral prescription medicine. This is medicine that you take by mouth.

But oral medicines aren't safe or effective for everyone with ED. If that's the case for you, your doctor or other health care professional might recommend nonoral treatments. These don't involve taking erectile dysfunction medicines by mouth.

Learn why you might choose a nonoral treatment for ED and how each kind works.

When oral medicines might not be safe

Not everyone can safely take oral medicine for erectile dysfunction. These medicines include avanafil (Stendra), sildenafil (Viagra), tadalafil (Cialis) and vardenafil.

Oral medicine for ED might not work or might be dangerous if you already take:

• Nitrate medicines often prescribed for chest pain, also called angina.
• Alpha-blocker medicines commonly prescribed for an enlarged prostate.
• Medicine that affects an enzyme called CYP3A4.

Oral medicine for ED also might not be safe or effective if you have:

• A recent history of heart or blood vessel problems. This includes a heart attack, stroke or a serious heart rhythm disorder in the past six months.
• Very low blood pressure, called hypotension.
• Uncontrolled high blood pressure, called hypertension.
• Severe liver disease.
• An inherited eye disease that affects the retina.
• Kidney disease that needs to be treated with dialysis.

Some people with ED also might choose another treatment so they don't get side effects caused by certain oral medicines.

Other types of medicines

Nonoral medicines for erectile dysfunction are the kinds that you don't take by mouth. They include:

• Self-injections. These are shots of medicine that you give yourself to get an erection. You use a fine needle to inject a prescription drug into the base or side of your penis. Often, this causes little pain. Some of the medicines used for self-injections are alprostadil (Caverject, Edex) and phentolamine (OraVerse).

  The goal of this treatment is to produce an erection that lasts about 20 to 30 minutes. If an erection lasts longer than one hour, you'll need to have the medicine or dose changed. This lowers the risk of long-term health problems.

  Self-injections can cause side effects. You might have bleeding from the shot. Or you might develop a painful erection that lasts over four hours, called priapism. Fibrous tissue also could form within the penis or at the injection site.

• Alprostadil urethral suppository (Muse). This is a tiny, medicated pellet, called a suppository, that goes inside your penis. You use a special device to insert the suppository into your urethra, the tube through which urine leaves the body.

  The erection usually starts within 10 minutes and lasts between 30 and 60 minutes. Side effects can include pain, a burning feeling and minor bleeding in the urethra.

• Testosterone replacement. Some people have erectile dysfunction due to low levels of the hormone testosterone. In this case, you might benefit from testosterone replacement therapy. Most often, this treatment is prescribed along with ED medicine that you take by mouth.

  Testosterone replacement therapy comes in many forms, including a shot, patch and pill. Talk to your health care team about your preference and the possible side effects.

Penis pumps, surgery and implants

If medications don't work or aren't right for you, a different type of treatment might help. Other treatments include:

• Penis pump. This also is called a vacuum erection device. It's a hollow tube with a hand-powered or battery-powered pump. The tube is placed over the penis. Then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into the penis.

  Once you get an erection, you slip an elastic ring or band around the base of your penis. This helps hold in the blood and keeps the penis firm for up to 30 minutes. You then remove the vacuum device.

  The erection often lasts long enough for a couple to have sex. You remove the tension ring after you have sex. Bruising of the penis can be a side effect. Ejaculation will be restricted by the ring or band. Your penis might feel cold to the touch.

  If a penis pump sounds like a good option, ask your care team to recommend a specific model that will work well for you.

• Penile implants. This treatment involves surgery to place devices into both sides of the penis. There are two main types of implants. One type uses rods that you can inflate. These let you control when and how long you have an erection. Another type of implant uses semirigid rods, which often are made of silicone. They keep the penis firm but bendable.

  Often, penile implants aren't recommended until other methods have been tried first. Implants have a high degree of satisfaction among people who have tried other treatments that haven't worked. As with any surgery, there's a risk of complications, such as infection. And if a part of the device stops working, you'll likely need more surgery to replace it.

• Blood vessel surgery. Rarely, erectile dysfunction is treated by bypassing arteries that have trouble bringing enough blood to the penis. This surgery is recommended for only a small percentage of people with ED. In general, you need to be younger than 55, a nonsmoker and in otherwise good health.

Psychological counseling

Sometimes, erectile dysfunction is caused by stress, anxiety or depression. ED also can create stress and relationship tension. If any of these issues affects you, seeing a psychologist or counselor might be a good next step. You also could think about asking your partner to join you for sessions with a certified sexual therapy counselor.

Don't ignore the underlying cause

It's key to get treatment for any medical issue that causes erectile dysfunction. This can help prevent related health problems and improve erections. Conditions that can cause ED or make it worse include:

• Heart disease.
• Diabetes.
• Chronic kidney disease.
• Obesity.
• Depression, ongoing stress and other mental health conditions.
• Alcohol or drug use disorders.
• Tobacco use.

Some prescription drugs also can cause or play a role in ED. These include certain medicines for depression and high blood pressure. Don't stop or change any prescription medicines you take unless your provider tells you to.

If you have erectile dysfunction, you're not alone — and you have many treatment choices. Work with your health care team to find out which ED treatment might work best for you.