Addressing the Psychological Aspects of ED

Yet many men still approach ED drugs the wrong way.

Can Supplements Help Erectile Dysfunction?

Viagra, Cialis, vardenafil, and Stendra are considered to work equally well. There isn’t much data that directly compares them against each other. Most existing studies have only looked at how well each medication compares with a placebo (a pill with no medication in it). This means no one can definitively claim that one medication works better than the other for treating ED. But a systematic review and meta-analysis of a few hundred studies found that Viagra, Cialis, and vardenafil resulted in improved erections in 67% to 89% of people with ED.

Vitamins and supplements for ED

In comparison, about 30% had improvement with a placebo. All PDE5 inhibitors share common side effects. Most of these are mild and can include: With Viagra, there is a higher risk of vision changes than with Cialis. Among people who take Viagra, 3% get blue vision that lasts a few hours. On the other hand, Cialis has a slightly higher risk of muscle pain than Viagra and vardenafil.

Language matters

Overall, the immediate side effects of PDE5 inhibitors don’t last vigora 200 mg very long and aren’t much of a bother. But while the side effects of these medications are similar, the jury is still out on what the risks are of taking these medications long term over several decades. PDE5 inhibitors are generally safe for the heart. But there are two potentially serious side effects to know about: All PDE5 inhibitors can lower your blood pressure. This won’t necessarily affect you, but it may be a problem if you also take a blood pressure medication. Men feel their sex life is not good and see an ED drug as an easy, quick-fix solution. But more times than not, there are underlying issues at play that a pill can't help. While men might have other sexual issues, such as low libido, premature ejaculation, and the inability to achieve orgasm, ED pertains explicitly to not being able to get or maintain an erection.

ED drugs address only that issue, by improving blood flow into the penis and keeping the blood in place to maintain an erection. There are four ED drugs currently available: sildenafil (Viagra), avanafil (Stendra), tadalafil (Cialis), and vardenafil (Levitra). At least one ED drug works in about 70% of men, but results vary among individuals. Men who have nerves or arteries damaged by prostate surgery, diabetes, or cardiovascular disease often do not respond as strongly to ED drugs. Finding out is often fildena pill a trial-and-error approach. Many doctors first prescribe Viagra because it has been around the longest and has a high success rate. If one drug doesn't work after a predetermined period, your doctor may increase the dosage or prescribe one of the others. Sometimes, you have to try all of them before knowing whether ED drugs work for you. An ED drug kicks in within 15 minutes to an hour after you take it and can last anywhere from four to five hours up to 24 hours or longer depending on the drug.

(See "ED drugs: How soon and how long?") It's best not to take the pill with food or soon after a meal, which can block absorption. The most common side effects are headaches, upset stomach, nasal congestion, muscle pain, and facial flushing.

But most of these are relatively mild and go away after a few hours. ED drugs can make blood pressure temporarily drop, so never use them if you also take medications that contain nitrates. (Nitrates found in food don't pose a problem.) You also need to be careful if you take any other drugs that lower blood pressure. For example, alpha blockers - such as tamsulosin (Flomax) and alfuzosin (Uroxatral), which are used to treat symptoms of an enlarged prostate, lower blood pressure in some men. Make sure to take them at least four hours apart from an ED drug. It's important to realize that ED drugs don't increase sexual desire, and you have to be ready and sexually stimulated for them to work.

What Injections and Suppositories Treat Erectile Dysfunction?

Herbal products and dietary supplements that claim to be alternatives for ED aren’t regulated by the FDA. So it’s hard to determine which is best or if they’re even safe and effective. If you’re experiencing ED symptoms, it’s a good idea to speak with a healthcare professional about your treatment options. Like all medications, ED medications also carry a blue tablets risk of side effects. Speak with a healthcare professional about potential side effects and whether these medications would be safe for you to take.

ED overview

Phosphodiesterase 5 (PDE5) inhibitors are a class of medications used to treat erectile dysfunction (ED). The available PDE5 inhibitors include sildenafil (Viagra), tadalafil (Cialis), vardenafil (previously sold as Levitra and Staxyn), and avanafil (Stendra). Currently, one PDE5 inhibitor isn’t considered the best for ED. The best ED medication for you depends on many factors such as how often you plan to use it, potential side effects, and how much they cost. Plus, many people alternate between ED medications, depending on their individual needs.

The mental side of sex

Talk to a healthcare professional about which ED med would be the best choice for you. Effect of high-fat breakfast and moderate-fat evening meal on the pharmacokinetics of vardenafil, an oral phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction. Comparing vardenafil and sildenafil in the treatment of men with erectile dysfunction and risk factors for cardiovascular disease: A randomized, double‐blind, pooled crossover study. Oral phosphodiesterase-5 inhibitors and hormonal treatments for erectile dysfunction: A systematic review and meta-analysis. Erectile dysfunction (ED) drugs are more readily available than ever before, and in general, men have gotten past any stigma about needing them. The drugs won't work well if you are mentally or emotionally not ready for sex. You can't just take a pill, pay some bills or wash the dishes, and then go to the bedroom and think you'll be ready to go. When your mind is not there, you are not going to want sex, and no ED drug can fix that problem.

• Tadalafil is often preferred for daily use due to longer duration.
• Sildenafil and vardenafil require more precise timing around meals.
• Side effects are usually mild but may include flushing and upset stomach.
• Do not share tablets with others to avoid misuse and health risks.
• Erectile dysfunction can be an early sign of heart disease.
• Consult a healthcare professional if tablets have no effect.
• Avoid grapefruit juice when taking certain ED medications.
• Some medications may lose effectiveness over time; check with a doctor.

Before trying an ED drug, it's best to step back and analyze your sex life and when your ED occurs.

How are oral ED drugs different?

But high-fat foods can delay vardenafil's absorption and lower its effectiveness. Ideally, try to wait 1 to 2 hours after eating before you take it. If that’s not possible, stick to a light, low-fat meal. You can take it as needed for occasional ED symptoms. How fast it works: Vardenafil can start working in as quickly as 15 minutes, but peak effects can take up to 1 hour.

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

Then, it will keep working for 4 to 5 hours. Typical dose: The typical starting dosage of vardenafil is one 10 mg tablet. It can be cut back to 5 mg or increased to a maximum of 20 mg. Vardenafil is available as a traditional pill that you swallow and a rapidly dissolving pill (which gets to work faster). Stendra is a newer ED medication that works similarly to Viagra, Cialis, and vardenafil.

The best place to get medications for ED

How to take it: Avanafil comes in a pill, which food doesn’t affect. How fast it works: Avanafil works a little faster on average than the other ED medications. The usual starting dose of 100 mg works within 15 minutes. With a lower dose, you’ll need to wait about 30 to 45 minutes. Typical dose: The recommended starting avanafil dosage is 100 mg, but doses can range from 50 mg to 200 mg, depending on your need and response. Does it happen all the time or just in certain situations? Is it with only one partner or different ones? Does it ever happen when you masturbate? Are the problems associated with stress or alcohol?

• ED tablets can enhance confidence and intimacy.
• Not all men respond equally; some require alternative therapies.
• Psychological side effects like anxiety may decrease after use.
• Age and severity of ED influence medication choice.
• Using tablets without a prescription can be unsafe.
• Some underlying health issues may contraindicate certain medications.
• Combining ED medication with fitness programs improves results.
• Always follow medical advice for long-term erectile health.

Asking yourself these types of questions can help identify if your ED may be more psychological than physical. You might benefit from sex therapy with your partner, or you may need treatment for a specific condition that affects your desire and sexual arousal, like post-traumatic stress disorder, depression, or anxiety. As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Sildenafil (Viagra) is used to treat erectile dysfunction (impotence; inability to get or keep an erection) in men.

How and when to take the medications

A sudden drop in blood pressure can make you feel dizzy, fall, black out, or even cause more serious cardiac issues. All PDE5 inhibitors can lower your blood pressure. Nitrate medications, such as nitroglycerin (Nitrostat), can have dangerous interactions with PDE5 inhibitors. Nitrate medications are commonly given to people with heart conditions like angina or high blood pressure. If you take a nitrate medication, you should never take ED medications at the same time.

Sildenafil may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

There are ways to save on ED medications: Save with GoodRx: GoodRx can help you save significantly on the average retail price of the generic versions of ED meds. Generic sildenafil at certain pharmacies is as low as $11.70 for 30 tablets with a free GoodRx discount. You can find the same quantity of generic tadalafil and vardenafil for as low as $10.80 and $79.13, respectively. Exclusive GoodRx savings are also available for brand-name Viagra. Save with GoodRx: GoodRx can help you save significantly on the average retail price of the generic versions of ED meds.

Compare ED treatments

Save with GoodRx for ED: Get generic Viagra delivered directly to your door starting at $18 per month. Generic Cialis starts at $21 per month. Save with a copay savings card: If you’re eligible, you could save up to 50% off brand-name Viagra for up to 12 months using a manufacturer savings card. In general, ED medications work by relaxing smooth muscles and blood vessels in the penis. This improves blood flow, which allows for an erection to last longer. Sildenafil (Liqrev, Revatio) is used to improve the ability to exercise in adults (Liqrev, Revatio) and children 1 year of age and older (Revatio) with pulmonary arterial hypertension (PAH; high blood pressure in the vessels carrying blood to the lungs, causing shortness of breath, dizziness, and tiredness).