Erection problems

Drug treatments

You've probably heard of Viagra. It's the brand name of a drug called sildenafil. And there are two other drugs that work in a similar way. They're called tadalafil (brand name Cialis) and vardenafil (Levitra). You take them as tablets. You need to take them between half an hour and an hour before you want to have sex.

There's lots of research to show that these drugs work. They help about 7 or 8 out of 10 men have firmer, longer-lasting erections. They may also help you and your partner enjoy sex more. These drugs seem to work no matter what's causing your erection problems. They'll probably help even if you have heart problems, prostate cancer, diabetes or an injury to your spinal cord.

Some men get side effects, but they're usually mild. You may get a headache, heartburn or turn red in the face. The side effects aren't usually bad enough for men to stop taking their treatment. There have been rare cases of men losing some of their sight while taking these drugs. There isn't enough research to say whether these drugs could damage your sight. But you should get help straight away if you have problems with your vision while you're taking them.

It's dangerous to take sildenafil, tadalafil or vardenafil together with drugs called nitrates. You could get very low blood pressure or even die. Nitrates are used to treat a heart problem called angina. Some examples are isosorbide dinitrate, isosorbide mononitrate and glyceryl trinitrate (sometimes called nitroglycerin).

Apomorphine (Uprima) is another drug for erection problems. It works in a different way to Viagra. You take it as a tablet that you dissolve under your tongue, about 20 minutes before you want to have sex.

Apomorphine works for about half the men who take it. There's no research comparing it with Viagra or similar drugs. But one advantage is that it doesn't seem to cause any serious problems for men taking nitrate drugs.

About 1 in 10 men who take apomorphine feel sick. But this side effect tends to wear off after they've used the drug for a while.

A drug called alprostadil also can help, but you have to inject it into the base of your penis or put it in your penis as pellets. The pellets come in an automatic dispenser. You put a thin tube into your penis, then press a button to release the pellet. Brand names for alprostadil injections include Caverject and Viridal Duo. The brand name for the pellets is Muse. If your doctor suggests this treatment, he or she will explain how to use it properly.

Alprostadil injections work for about 9 in 10 men. The pellets help 6 or 7 out of 10 men. Some research found that alprostadil injections worked just as well as Viagra.

Alprostadil can have side effects. Some men get pain or an ache in their penis. Giving yourself an injection can be painful. A few men who take alprostadil as an injection get a lump of thickened tissue in their penis.

Drug treatment and the NHS

Drug treatments for erection problems aren't always free on the NHS. They're free if you have erection problems because of some illnesses, an injury or as a side effect of an operation. You may also get free drug treatment if you're suffering severe distress because of your erection problems. For example, you may be having trouble in your relationship, or find it hard to socialise or go to work.

Even if you don't qualify for NHS treatment, you can still be prescribed drugs for erection problems by your usual doctor. But you'll have to pay for the drugs at the chemist. Prices vary, so it's worth phoning a few local chemists to see where's cheapest.

It's legal in the UK for a pharmacy to sell drugs on the Internet. But you'll still need a doctor's prescription. Lots of companies sell treatments for erection problems on the Internet, and it isn’t always easy to tell which ones are reliable. If you choose an online pharmacy, make sure they're registered with the Royal Pharmaceutical Society. You can check at their website (http://www.rpsgb.org.uk).

Some chemists have started to sell Viagra over the counter. You won't need a doctor's prescription, but you'll have a detailed check-up with a pharmacist. But this isn't available in most parts of the UK.

Talking treatments

If your erection problems are linked to your thoughts or emotions, and not a physical problem, your doctor may suggest a talking treatment (psychotherapy). You can see a therapist on your own or with your partner.

If you have psychosexual therapy (also called sex therapy), a counsellor listens to your problems and makes suggestions. For example, they may help you find ways of being relaxed with your partner, or teach you to understand the feelings you get from your body during sex. Interpersonal therapy involvestalking about your relationships and important events in your life. Cognitive behaviour therapy is a practical treatment that helps you find ways of coping with problems and avoid unhelpful ways of thinking.

There's not much research on talking treatments for erection problems. In one study, interpersonal therapy and psychosexual therapy both helped. About 8 in 10 men who had interpersonal therapy were still better after a year, compared with 4 in 10 men who had psychosexual therapy. But the study was too small to be sure about how well these treatments work.

It can be difficult to get talking treatments on the NHS. An organisation called Relate offers counselling for all kinds of relationship and sexual problems. You can contact them through their website (http://www.relate.org.uk).

Other treatments

Ginseng and yohimbine are both herbal remedies for erection problems. A pure version of yohimbine is available as a prescription drug. There's some research to suggest these treatments can help, but it's a good idea to talk to your doctor before you try them. Herbal treatments can have side effects and interfere with other drugs that you're taking.

You shouldn't take yohimbine if you're taking antidepressants, have heart, liver or kidney problems, or have high blood pressure. Between about 1 and 3 in 10 men get side effects such as feeling anxious, getting headaches or needing to urinate more often. In one small study of yohimbine, one man stopped taking it because he got high blood pressure. Another stopped because he got heart palpitations (an abnormal heartbeat). The research on ginseng didn't talk about side effects.

Vacuum pumps have a plastic tube that's connected to a pump. You fit the tube over your penis and push it against your groin. Then you work the pump. This sucks blood into your penis and gives you an erection. You need to put a special elastic band around the base of your penis to keep it firm while you have sex. You shouldn't keep this band on for more than about half an hour.

There's not much research on vacuum pumps. One small study found that they helped men get erections but not necessarily enjoy sex more. After using a pump, some men got pain, bruising or damaged skin on their penis. In one study, 1 in 6 men stopped using the pump, or used it less often, because of the side effects.