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The first treatment usually offered to men with erectile dysfunction is a prescription medication, such as sildenafil (Viagra^®), tadalafil (Cialis^®), or vardenafil (Levitra^®). Generally taken 30 to 60 minutes before sexual activity, these medications work by improving blood flow to the penis during arousal.

Erectile dysfunction medications like Viagra^® should not be used by men who take nitrate medications to treat the symptoms of heart disease. Erectile dysfunction medications can cause a drop in blood pressure. When combined with nitrates, which dilate or open up the arteries to the heart to increase blood flow, there is the potential for a severe drop in blood pressure.

Some 35 percent of men do not respond to oral medications for erectile dysfunction. A smaller percentage of men may experience uncomfortable side effects, such as flushing or feeling suddenly warm, changes in vision, upset stomach, or heartburn. If, after several months, you have not seen an improvement in these side effects, your doctor may offer other medical treatment options.

Intraurethral medication is often used as an alternative in men who don’t respond well to oral medications for erectile dysfunction. This is a suppository inserted through the opening in the penis. Using a narrow, prefilled plastic applicator, the man inserts the medicine directly into the urethra 5 to 10 minutes prior to sexual intercourse. The medication causes the muscles of the penis to relax and the arteries to widen, enabling adequate blood flow for an erection.

Some men experience side effects from intraurethral medications, such as dizziness, a burning sensation in the urethra, or an aching feeling in the penis, legs, and pelvis. These generally go away when the medication leaves the body. Because some men experience dizziness and, rarely, fainting, within an hour of using these medications, your doctor may recommend that you refrain from driving or operating heavy machinery.

Penile self-injections were the first medication approved by the U.S. Food and Drug Administration for the treatment of erectile dysfunction. These are prescribed for men who don’t respond well to oral medications.

An �ٺ���Ƶ urologist performs the first injection in the doctor’s office, in order to determine the dose of medication needed. Your doctor then instructs you on how to safely inject the medication, which is supplied in vials with syringes, for use at home. Typically, a man injects the medication into the shaft of the penis 10 to 20 minutes before sexual activity to achieve an erection. Side effects can include an aching sensation in the penis, which generally goes away in a few hours.

In some men, medical treatments for erectile dysfunction may occasionally cause a prolonged erection. If an erection lasts for more than four hours, you should seek care at an emergency room, where doctors can administer a medication to reverse this effect.