What Is The Latest Treatment For Erectile Dysfunction

Erectile dysfunction (ED) is a common condition affecting 30 million¹ in the United States. Although common, it is not normal and can cause problems with your sex life. 

Fortunately, several ED treatments are available, and researchers are also designing potential future treatments.

What is erectile dysfunction?

ED is the inability to get or maintain a firm erection during sexual intercourse. 

An erection occurs when nitric oxide and hormonal factors relax the smooth muscles in the penis, filling the erectile tissue with blood. This compresses the veins, making the penis rigid and erect. 

It’s normal to have occasional trouble with erections. However, it could be a sign of ED when it happens regularly. 

Symptoms and causes

Symptoms

The main symptoms of ED include:

• An inability to get an erection

• Short-lasting erections

• Sometimes getting an erection but not when you want to have sex

• Reduced sexual desire 

Causes

ED often occurs as a result of underlying issues, including:

• Vascular diseases, such as atherosclerosis

• Neurological disorders, such as multiple sclerosis

• Psychological stress, such as depression, anxiety, and relationship problems

• An injury to the penis, spinal cord, prostate, bladder, or pelvis

• Chronic kidney disease 

• Medications, including: 

  • Diuretics

  • Blood pressure medications

  • Prostate cancer drugs

  • Muscle relaxants

  • NSAIDs

  • SSRIs

• Peyronie’s disease

• Misuse of alcohol, marijuana, nicotine, and recreational drugs

• Type 2 diabetes

• High blood pressure (hypertension)

• Low testosterone levels 

Lifestyle factors, such as inactivity, smoking, poor diet, and being overweight, are also associated with ED. 

Diagnosis

The first step in getting a diagnosis is to see your doctor. 

They will ask you some questions about your sex life and sexual history, including:

• Your confidence in your ability to get and maintain an erection

• How often your erections are hard enough for penetration

• How frequently you can maintain an erection during sexual intercourse

• How difficult it is to keep an erection to the completion of sexual intercourse

• How often sexual intercourse is satisfactory for you 

They will then carry out some tests, including 

• A physical examination of your penis, testicles, and body hair

• Pulse and blood pressure checks

• Blood and urine tests for low testosterone and signs of other conditions

• Doppler ultrasound to examine the blood vessels that supply the penis with blood 

Potential treatments for erectile dysfunction

Many potential treatments work by restoring the function and structure of the erectile tissue rather than only treating ED symptoms. 

Stem cell therapy

Stem cells can differentiate into specialized cells, such as endothelial, neuronal, or smooth muscle cells. 

Researchers believe that by injecting stem cells into the penile tissue, they could repair penile tissue damage. It’s believed to be particularly helpful for diabetes-induced ED. 

Animal and early human studies² have yielded promising results, but we need more advanced clinical trials.

Platelet-rich plasma

Platelets³ help the blood clot and are essential for wound healing and tissue regeneration. 

Platelet-rich plasma can treat several medical conditions. Based on experimental studies, platelet-rich plasma injected into the penis may have a positive short-term effect on ED. 

More research is necessary before determining whether platelet-rich plasma is an effective ED treatment. 

Vascular stent

A stent keeps an artery open to maintain blood flow. Researchers⁴ believe that stents can restore blood flow to the penis, allowing erections to occur. 

If you have atherosclerosis, vascular stents could be a particularly effective ED treatment. 

So far, vascular stents are recommended only for younger patients with an isolated vascular injury. Research has not yet determined the long-term effectiveness. 

Penile transplantation

Researchers are looking into penile transplantation⁵ to treat genitalia loss and injury. This may restore urination and sexual function if you’ve sustained genital injuries. 

Currently, penile transplants are not an established treatment for ED, as this surgery has only been performed a few times. 

Shockwave therapy

Shockwave therapy aims to restore the mechanism of an erection so it can occur naturally and spontaneously. 

Low-intensity shock waves interact with the deep tissue of the penis, releasing proteins that support the growth of blood vessels in the tissue. This improves the blood supply to the penis. 

In a study⁶ of 20 men, 15 had an increase of more than five points on the International Index of Erectile Function. After six months, ten men still had spontaneous erections without needing oral medications. 

Further clinical trials are required before shockwave therapy can become an established treatment for ED. 

Current treatments for erectile dysfunction

Most established treatments for ED treat the symptoms. 

Oral medication

A group of ED medications called phosphodiesterase type 5 (PDE5) inhibitors relax your smooth muscles and increase blood flow to the penis. They don’t directly produce an erection, and you’ll still need sexual stimulation. 

PDE5 inhibitors include: 

• Sildenafil (Viagra) 

• Vardenafil (Levitra)

• Tadalafil (Cialis) 

• Avanafil (Stendra)  

People who take nitrate medications should not take PDE5 inhibitors at the same time. To protect your heart function, leave a gap of one to two days between doses.

If you take alpha-blockers, you may not be able to take PDE5 inhibitors. With frequent monitoring and approval from a healthcare professional, it may be safe for you to take them together. 

Injections

Doctors can inject some medications into the erection chambers of the penis. 

Injections are useful when psychological conditions and nerve or blood vessel damage cause ED. They’re also helpful if your body hasn’t responded to oral medications. 

Some examples include:

• Alprostadil (Caverject Impulse)

• Papaverine (Papacon)

• Phentolamine (Regitine)

Side effects may include:

• Penile scarring

• Brushing, swelling, or bleeding at the site of injection

• Dizziness

• High or low blood pressure

• A painful erection that lasts longer than four hours (priapism) 

Alprostadil suppositories or cream

Using an applicator, you can insert a solid pellet-like alprostadil suppository into your urethra. Alprostadil relaxes the smooth muscles in the penis and increases blood flow. 

An erection can occur within ten minutes and can last 30–60 minutes. 

It’s best to use alprostadil before sexual activity when you’re having trouble with an erection. Don’t use it more than twice in 24 hours. If you’re having sex with a woman who can get pregnant or is already pregnant, make sure to use a condom. The effects of alprostadil on a fetus are unknown, and animal studies have indicated it can be toxic to embryos. 

Suppositories can cause narrowing, scarring, and swelling in the tip of the penis. 

Alprostadil cream is also a safe and effective treatment for mild to severe ED cases, especially if you can’t use oral medications. It has an efficacy of up to 83%,⁷ and more than ten countries have approved it. 

Testosterone replacement

This is a suitable option if you have low circulating testosterone levels. Testosterone replacement can improve mild ED, although it’s less effective for severe cases.

Improving testosterone levels could help your body better respond to PDE5 inhibitors. 

Penis pump

A penis pump, or a vacuum pump, is a non-invasive and less risky ED treatment. 

A penis pump is a vacuum device that uses suction to increase blood flow to the penis. It has three components:

• A plastic tube that you place over the penis

• A pump attached to the plastic tube

• A ring that sits on the base of the penis, maintaining an erection 

Some people should check with their doctor before using a penis pump. This includes if you have a blood disorder such as sickle cell anemia or take blood-thinning medications (e.g., warfarin) and are at an increased risk of bleeding.

Possible side effects include pain and bruising of the penis, tiny red dots due to bleeding under the surface of the penile skin, and numb, cold, or blue skin. 

Surgery

Your doctor may suggest surgery when medications and other treatments haven’t worked. 

Inflatable penile implant

The most common penile implant is a water-based inflatable device. This involves your surgeon implanting a fluid-filled reservoir under the abdominal wall, two inflatable cylinders in the penis, and a pump with a release valve in the scrotum.

Pumping the fluid from the reservoir into the cylinders inflates the device and generates an erection. Releasing the valve deflates the device, and fluid flows back into the reservoir. 

Studies⁸ have shown that scores on the International Index of Erectile Function and Erectile Dysfunction Inventory of Treatment Satisfaction improved at six and 12 months following surgery. 

Risks include infections, mechanical failures, and erosion. 

Malleable penile implant

Less common semi-rigid devices use a central core to bend the penis up for sexual activity and down for concealment. 

Penile revascularization

Penile revascularization⁹ can restore blood flow to the penis if you’ve sustained traumatic pelvic injuries that have blocked the blood vessels. 

Your surgeon bypasses the blocked penile arteries by connecting an artery in the lower abdomen to an artery at the top of the penis. 

Psychological counseling

Counseling can help if psychological problems are contributing to ED. In counseling, you’ll learn how to reduce anxiety and stress, and it’s a great outlet for talking honestly about how you feel. 

Psychological counseling can include you and your partner. Your partner can provide support, and the shared experience may spark healthy and honest communication, improving any relationship problems. 

External penile prosthesis

An external penile prosthesis could be suitable if other treatments have failed or surgery is not possible. 

An external prosthesis consists of an artificial penis that sits in a harness and resembles an erect penis. It can be personalized to match the size and shape of your actual erection. 

Although only limited studies¹⁰ on external penile prostheses as an ED treatment is available, they’re a suitable therapeutic option that’s much less invasive than surgery. 

Lifestyle changes

Lifestyle and nutrition can influence nitric oxide production, testosterone levels, inflammation, and erectile function. 

Making healthy lifestyle changes can ease ED, increase the benefits of ED therapy, and improve your mental health. 

Lifestyle changes to consider include:

• Stop smoking and using drugs.

• Reduce your alcohol intake (one to two drinks per day).

• Maintain a healthy weight: Weight loss of 5–10% and a BMI less than 30 can improve erectile function.

• Exercise regularly to increase blood flow through the body. Thirty minutes a day of moderate-intensity aerobic exercise is beneficial.

• Control glycemic levels if you have diabetes.

• Eat a healthy diet of whole grains, unsaturated fats, legumes, vegetables, and fruit; limit red meat, full-fat dairy, and added sugar.

• Reduce stress as much as possible.

The lowdown

If you have ED, you’re not alone. Researchers have established successful treatments and investigated lifestyle changes for normal erections and satisfactory sexual intercourse. Speak to your doctor to work out the best treatment plan for you.