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Viagra is a well-known treatment for erectile dysfunction — but many other medications and approaches can help with achieving and maintaining erections.

Research indicates that erectile dysfunction affects over 12 million men in the United States each year. Although the prevalence of this issue increases with age, it is not confined to older adults.

A range of treatments and strategies can improve or reverse erectile dysfunction. The options include drugs and other medical treatments, lifestyle changes, and alternative approaches.

In this article, we look into various alternatives to Viagra, answer some frequently asked questions, and discuss when to contact a doctor.

Beyond Viagra, several medications can help with having and keeping erections. We describe some below.

Oral medications

blue pills

Oral drugs, including Viagra, may be the first approach to treatment for erectile dysfunction.

Viagra is effective because it slows the action of phosphodiesterase type 5 (PDE5), an enzyme in the walls of blood vessels.

Other prescription-only PDE5 inhibitors include:

  • Vardenafil: Sold under the brand names Levitra and Staxyn, this drug is available in regular and disintegrating tablet forms. A person takes it 1 hour before sex, and it can be effective for up to 7 hours.
  • Tadalafil: Available under the brand names Adcirca and Cialis, a person takes this 1–2 hours before sex. Each dose can last up to 36 hours.
  • Avanafil: Marketed in the U.S. as Stendra, a person takes this drug 15–30 minutes before sex, and the effects can last up to 6 hours.

Non-oral drugs

Alternatives to pills and tablets include:

Penile self-injections

Certain medications, such as alprostadil (Caverject), papaverine, and phentolamine (Regitine), can be injected directly into the side or base of the penis. These can help achieve or maintain an erection for up to 40 minutes. They work by expanding the blood vessels.

Pros:

  • usually works very quickly
  • highly efficient

Cons:

  • side effects include swelling, pain, and stinging
  • can cause permanent damage if not used correctly

Urethral suppositories

A person can use a special applicator to insert very small alprostadil suppositories into the urethra. Within 10 minutes, this can stimulate an erection that can last for up to 60 minutes.

Pros:

  • works quickly
  • can be self-administered

Cons:

  • could affect the fetus if a sexual partner is pregnant
  • can cause side effects
  • not as effective as other methods

Testosterone replacements

A doctor may recommend this approach if they believe that erectile dysfunction is linked with low levels of testosterone. A person can take synthetic testosterone via pills, patches, and injections.

Pros:

  • increased energy
  • increased muscle mass
  • increased libido

Cons:

  • physical changes that may be unwanted, such as swollen breast tissue
  • risk of prostate health issues
  • risk of reducing sperm count

Other medical treatments

Drug-based treatments may be unsuitable, possibly due to another ongoing health issue. When this is the case, a doctor may recommend:

Vacuum erection devices

These are hollow tubes also known as penis pumps. They are attached to a hand- or battery-operated pump and work by drawing blood into the penis. The person can then maintain the erection with a tension ring.

Pros:

  • no known side effects
  • generally safe to use
  • effective

Cons:

  • risk of injury if improperly used
  • can be bulky
  • can be inconvenient

Wearable devices

One example is Eddie by Giddy, a nonprescription, Class II medical device used to help treat erectile dysfunction. The makers say that it uses constriction and tension to help maintain erections.

The Food and Drug Administration (FDA) has registered the device, but no scientific studies have evaluated its effectiveness.

Pros:

  • the treatment is typically long term
  • no known side effects
  • cost-efficient

Cons:

  • helps with maintaining erection, not getting one
  • must be properly sized
  • can be tricky to use and uncomfortable

Penis implants

Implants are inflatable or bendable rods that a surgeon implants into the erection chambers of the penis. Doctors typically only recommend this as a last resort.

Pros:

  • allows for control over erections
  • typically a long-lasting solution
  • typically effective, even when other methods are not

Cons:

  • invasive and requires recovery time
  • a risk of injury
  • a risk of infection

Herbs and supplements

Several dietary supplements, herbal preparations, and food products are sold as remedies for erectile dysfunction.

Some alternative herbal treatments, including the following, are also marketed for this purpose:

However, as the FDA reports, at least 300 supplements and foods that supposedly enhance sexual function contain undisclosed drug ingredients. Supplements are not monitored by the FDA for quality or purity.

It is crucial to receive advice from a healthcare professional before opting for a supplement. Anyone who does so should choose a brand with third-party testing and certification.

exercise combats ED

Certain lifestyle changes may help improve erectile function:

Eating a balanced diet: Flavonoid-rich foods, such as blueberries, strawberries, blackberries, and citrus fruits may reduce erectile dysfunction for some people.

Maintaining a healthy body weight: Having overweight or obesity may cause or worsen erectile dysfunction.

Getting regular exercise: Physical activity can improve circulation, reduce stress, and contribute to a healthy body weight.

Quitting smoking: Research indicates a strong link between cigarette smoking and erectile dysfunction.

Avoiding heavy drinking and Illegal use of substances: Doing so may improve sexual function.

Seeking help for mental health conditions: Addressing anxiety, depression, and sources of sustained stress, for example, may help.

The generic name for Viagra is sildenafil. The drug also has another brand name: Revatio. It works by slowing down the action of PDE5, an enzyme in blood vessel walls.

This enzyme breaks down a substance that is responsible for blood flow in the penis. Inhibiting the enzyme increases blood flow to the area, helping a person with a penis have and keep an erection.

However, sildenafil can only help maintain an erection that is also physically stimulated.

Common side effects of the drug include headache, facial flushing, indigestion, nasal congestion, and a blue tint to the field of vision.

heart disease erectile dysfunction

Erectile dysfunction can result from physical, psychological, and emotional factors.

Medical conditions that may cause erectile dysfunction include:

Mental health conditions and factors that may contribute include anxiety, depression, guilt, stress, and low self-esteem.

Other factors that may play a role include:

  • alcohol and illegal drug use
  • overweight or obesity
  • low levels of exercise
  • smoking

Below, we give answers to frequently asked questions about other treatments for erectile dysfunction.

Do I need a prescription for erectile dysfunction pills?

Viagra is available over the counter in the United Kingdom. A person in the U.S., for example, needs a doctor’s prescription for this and similar drugs.

Do natural Viagra alternatives work?

There is not enough scientific evidence to suggest that herbs and other supplements can treat erectile dysfunction. However, various lifestyle changes, such as quitting smoking, may help.

Can I purchase Viagra alternatives online?

Some companies employ licensed medical professionals to help determine if a potential customer may benefit from a Viagra alternative. If the healthcare professional approves, the company can then ship the treatment to the person’s front door.

Anyone with symptoms of erectile dysfunction that last for at least a few weeks should contact a healthcare professional.

This is particularly important for people who suspect that an underlying health issue, such as heart disease, may be causing their erectile dysfunction.

This health issue can be a side effect of certain medications, so a doctor may address the issue by changing an ongoing treatment plan.