The five types of PDE-5 inhibitors available in Ireland are:
- Viagra (active ingredient: sildenafil)
- Cialis (active ingredient: tadalafil)
- Levitra (active ingredient: vardenafil)
- Generic sildenafil
- Spedra (avanafil)
Viagra and Levitra are erectile dysfunction treatments, which work for between four and eight hours after you take them. Cialis lasts for longer – about a day and a half – so is more suited if you need a longer-lasting treatment, for example, over a full weekend. All three erectile dysfunction treatments start working within half an hour to an hour. The medication will work faster if you take it on an empty stomach. You can then eat an hour after taking it without affecting its effectiveness.
You should talk to your doctor about which erectile dysfunction treatment might be best for you, depending on whether you have taken one before and how often you intend to have sex.
If you find that PDE-5 inhibitors don’t work, you might want to consider whether you waited long enough for the erectile dysfunction treatment to kick in, whether you waited too long for the medication to kick in, whether you had a high enough dose, and whether you felt sexually aroused. You still need to feel sexually stimulated to get an erection when taking an erectile dysfunction treatment.
Alternative Treatment Options
There are different types of treatment depending on the causes of your impotence.
The most common types of treatment include:
- Lifestyle changes
- Complementary therapies
- Pelvic Floor Muscle exercises
- Psychological therapies: cognitive behavioural therapy
- psychosexual therapy, sensate focus, counselling
- Medication: Viagra, Cialis, Levitra and Alprostadil
- A vacuum pump
- Hormone therapy
- Surgery
Read on for more advice on coping strategies if you have erectile dysfunction.
How to treat erectile dysfunction with lifestyles changes
You can often improve the erectile problems by switching to live a healthier lifestyle.
Some changes that you can make yourself include:
- Stop smoking
- Exercise often
- Don’t drink too much alcohol
- Don’t take drugs
- Try to lower your stress levels
- Lose weight (if you need to)
Treating erectile dysfunction due to underlying health issues
If you are suffering from erectile dysfunction as a result of an underlying health condition, you’ll usually need to treat the underlying condition first, before you embark upon a course of treatment for impotence. You may then find that by treating the underlying condition, this solves the problem of your erectile dysfunction too. Speak to your doctor about the fact that you are struggling with ED as well as your underlying condition, so that they can factor this into your treatment plan.
If you are taking medication for another condition and you think that this is causing erectile dysfunction, have a chat with your doctor about it. It may be that they can suggest an alternative type of medication. Make sure that you talked to your doctor or healthcare professional before you stop taking any medication that you’ve been prescribed.
Psychological Treatment Options
Counselling can be very helpful for people who have erectile dysfunction that is caused by psychological problems like anxiety or depression. Another type of treatment for people who have ED that has a psychological cause is called Sensate Focus.
Sensate focus is a type of sex therapy. You and your partner agree not to have sex for a set period of time. During this time, you can still touch each other, but you agree not to touch each others’ genitals (or a woman’s breasts). During the agreed timeframe, you then set aside time to spend together as a couple to explore each others’ bodies without having sex. Clothed or naked, you can massage each other, explore touch, and stroke each other. Once the agreed timeframe has passed, you can then start to touch each others’ genitals, you can start to use your mouth as a way of exploring each others’ bodies through kissing or licking your partner, for example. Gradually, you can then build up to penetrative sex together.
Psychosexual counselling is a talking therapy. It has mixed results and can take a while to work, but many people find it really helps. It provides space for you and your partner to talk about any issues that might contribute to or cause your erectile dysfunction. The aim of talking it through is to help you feel less worried or anxious, so that you can overcome your problems. The counsellor can also offer advice on sex, like practical foreplay techniques and how you might like to incorporate other treatments for erectile dysfunction into your plans to improve your sex life.
Cognitive Behavioural Therapy can also be helpful in treating impotence. Cognitive Behavioural Therapy explores the link between the way we think and how we feel. It aims to change the way you think about and react to a situation, to help you feel happier. A CBT therapist can work with you to identify factors that are contributing to your erectile dysfunction. They will look for unhelpful thoughts or thought patterns that might be linked to: your self esteem, your sexuality or your personal relationships. With the therapist, you can then work to change these by practicing different ways of thinking.
Complementary therapies
Like acupuncture claim to improve impotence. The evidence of whether this is effective is limited. If you decide to try to treat your erectile difficulties with complementary therapies, speak to your doctor first because sometimes they can interact with other medicines.
Pelvic Floor Muscle Exercises
The pelvic floor muscles are grouped under the bladder, around the rectum and at the base of the penis. The exercises strengthen and train the muscles used to urinate and to control the anus (back passage). There is some evidence to suggest that for some people, exercising these muscles can improve erectile dysfunction. If you think this might help you, have a chat with your GP who might refer you to a physiotherapist so that you learn how to do the exercises correctly.
The vacuum pump
A vacuum pump is made up of a clear plastic tube connected to a hand or battery activated pump. You put your penis into the tube and pump out all of the air. This increases the blood flow to your penis so that you can get and sustain an erection. You then put a rubber ring around the base of your penis to keep the blood there. Using this, you will be able to sustain an erection for about 30 minutes. It can take a bit of practice to get used to using the pump properly, but 90% of men who used it found that they were able to sustain an erection (regardless of the cause of their impotence).
Cautions
You shouldn’t use the vacuum pump if you have a bleeding disorder or take anti-coagulant (blood thinning) drugs. Under a third of people find that they experience side effects of pain or bruising using the pump.
Alprostadil
If you find that your erectile dysfunction is not responding to your course of treatment, or if you can’t use Viagra, Cialis, Levitra or the vacuum pump, then your doctor might suggest you try Alprostadil (a synthetic hormone that increases the flow of blood to the penis given either as injection into the penis or as a pellet placed inside the urethra). You can be trained in how to inject or insert the pellet of Alprostadil. It usually takes effect within five to fifteen minutes. The length of time that the erection lasts for varies with the dose. If your partner is pregnant, you’ll need to use a condom during sex.
Alprostadil when placed in the urethra is effective in 2 out of 3 men with ED. Alprostadil injections worked for just over 8 out of 10 men who found that Viagra, Cialis and Levitra didn’t work for them.
Cautions, risks, side effects, interactions
Men with the following conditions should not use Alprostadil:
- men at risk of priapism, e.g. if you have sickle cell anaemia
- men using other erectile dysfunction medications
- men with a penile implant
- men who have been told to avoid sexual activity
Men with the following conditions should not use Alprostadil:
- some men with anatomical problems with their penis; or
- some men with infections of their penis.
Alprostadil can cause the following side effects: changes in your blood pressure, dizziness, headache, pain in your penis, urethral burning or bleeding, reactions at the site of the injection, such as swelling. You should always read the patient information leaflet.
Hormone therapy
If your doctor thinks that your erectile dysfunction is related to your hormones, chances are you will be referred to a hormone specialist (an endocrinologist) who will look to rebalance your hormone levels (probably with a series of hormone injections.)
Surgery
Surgery is a last resort for treating impotence. It is normally only recommended for younger men who have seriously injured their pelvic area or men who have an anatomical problem with their penis.
It used to be the case that if a man had a blockage in the blood vessels leading to the penis, then surgery could be used as a way to unblock these to allow the blood to flow again. However, evidence shows that this surgery is often not successful in the longer term, so it is now rarely used to treat this problem.
Penile implants are another type of surgery.
There are two types of penile implant:
- Semi-rigid implants – can be appropriate for older men who don’t have regular sex
- Inflatable implants – made up of two or three parts that are inflated to maintain a more natural erection. They are often very expensive.
About 5% of men who have penile implants experience mechanical issues with the implants within five years.
Natural cures for erectile dysfunction
Please read our article on natural cures for erectile dysfunction for more information.
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