Impotence medication (erectile dysfunction drugs) — evidence-based overview. This article is for educational purposes only and does not replace medical advice.

Quick summary

• Impotence, also called erectile dysfunction (ED), is the ongoing difficulty in getting or keeping an erection firm enough for sex.
• The most studied and commonly prescribed medications are PDE5 inhibitors (such as sildenafil, tadalafil, vardenafil, and avanafil).
• These drugs are effective for many men, but they are not suitable for everyone—especially people taking nitrates for heart disease.
• Lifestyle factors (smoking, obesity, inactivity) and chronic conditions (diabetes, high blood pressure) strongly affect outcomes.
• Psychological factors can contribute and may require counseling in addition to medication.

What is known

1. What causes erectile dysfunction?

Erectile dysfunction is usually caused by reduced blood flow to the penis, nerve problems, hormonal imbalance, psychological stress, or a combination of these factors. According to major guidelines from the American Urological Association (AUA) and the European Association of Urology (EAU), common risk factors include:

• Cardiovascular disease (atherosclerosis, hypertension)
• Diabetes
• Obesity and metabolic syndrome
• Smoking
• Depression and anxiety
• Low testosterone (in some cases)

ED can also be an early warning sign of heart and blood vessel disease. Because penile arteries are smaller than coronary arteries, symptoms may appear earlier.

2. How impotence medications work

The main group of drugs for ED are called phosphodiesterase type 5 (PDE5) inhibitors. These include:

• Sildenafil (commonly known by the brand Viagra)
• Tadalafil (Cialis)
• Vardenafil
• Avanafil

They work by enhancing the natural nitric oxide pathway, which relaxes smooth muscle in penile blood vessels. This increases blood flow during sexual stimulation. Importantly, these medications do not cause automatic erections; sexual arousal is still required.

3. How effective are these medications?

Large clinical trials and systematic reviews show that PDE5 inhibitors improve erections in approximately 60–80% of men, depending on the underlying cause. Effectiveness may be lower in men with severe diabetes or after prostate surgery.

Tadalafil has a longer duration of action compared to sildenafil and vardenafil, which may provide more flexibility. However, overall effectiveness among the drugs is broadly similar when used appropriately.

4. Safety and common side effects

According to regulatory agencies such as the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA), common side effects include:

• Headache
• Flushing
• Nasal congestion
• Indigestion
• Dizziness

Serious side effects are rare but may include vision or hearing changes and prolonged erections (priapism). Immediate medical care is required if an erection lasts more than four hours.

These medications must not be combined with nitrates (used for chest pain) because the combination can cause a dangerous drop in blood pressure.

5. Other medical treatments

When tablets are ineffective or unsuitable, other options supported by evidence include:

• Vacuum erection devices
• Penile injections (e.g., alprostadil)
• Intraurethral suppositories
• Penile implants (surgical option)

Testosterone therapy may be considered if a man has confirmed low testosterone and symptoms, but it does not treat ED directly unless deficiency is present.

What is unclear / where evidence is limited

• Herbal supplements: Many over-the-counter products claim to improve potency. Evidence is often weak, inconsistent, or absent. Some products have been found to contain hidden prescription drugs.
• Long-term cardiovascular impact: While PDE5 inhibitors are generally safe, long-term effects in certain high-risk populations continue to be studied.
• Psychological-only ED: The best combination of psychotherapy and medication is still being refined in research.
• Regenerative therapies: Treatments such as platelet-rich plasma (PRP) or shockwave therapy show mixed results and are not universally recommended in guidelines.

Overview of approaches

1. Oral medications (first-line treatment)

Clinical guidelines from the AUA and EAU recommend PDE5 inhibitors as first-line therapy for most men without contraindications. Choice of drug depends on:

• Duration of action desired
• Side-effect tolerance
• Cost and availability
• Other medical conditions

Specific dosing information should always be taken from official prescribing information approved by national regulatory authorities (e.g., FDA, EMA, or NHS guidance).

2. Lifestyle modification

Evidence consistently shows that improving cardiovascular health can improve erectile function. Recommended measures include:

• Regular aerobic exercise
• Weight reduction if overweight
• Smoking cessation
• Limiting alcohol intake
• Managing blood pressure and blood sugar

In some men, lifestyle changes alone significantly improve symptoms.

3. Psychological support

If stress, anxiety, or relationship issues contribute, cognitive behavioral therapy (CBT) or couples counseling may help. Medication and therapy can be combined.

4. Second-line and surgical options

Men who do not respond to oral medications may benefit from specialist referral for alternative therapies such as injections or implants.

Evidence summary table

Practical recommendations

When to see a doctor

• If erection problems persist for more than 3 months.
• If you have diabetes, heart disease, or high blood pressure.
• If ED appears suddenly or is worsening.
• If you experience pain, penile deformity, or prolonged erections.

How to prepare for consultation

• List all medications and supplements you take.
• Note when symptoms started and how often they occur.
• Be ready to discuss lifestyle habits honestly.
• Mention stress, mood changes, or relationship concerns.

Safe general measures

• Do not buy prescription ED medication from unverified online sources.
• Avoid combining ED drugs with nitrates or recreational “poppers.”
• Be cautious with supplements marketed as “natural Viagra.”

For broader health education materials, see our uncategorized health updates, evidence summaries in the Review section, or explore condition background in our Brand overview. International readers may also check regional resources in Noticias.

Sources

• American Urological Association (AUA). Erectile Dysfunction Guideline.
• European Association of Urology (EAU). Guidelines on Sexual and Reproductive Health.
• U.S. Food and Drug Administration (FDA). Drug Safety Communications for PDE5 inhibitors.
• National Health Service (NHS). Erectile dysfunction overview.
• World Health Organization (WHO). Cardiovascular disease risk factors and prevention materials.