Latest Treatments for Erectile Dysfunction: Medications, Topicals, Implants and More

Most men have trouble getting or keeping an erection at some point in their lifetime. But if this problem happens often or lasts long enough to interfere with satisfying sex, it may be a sign of erectile dysfunction (ED). 

ED is common. Between 30 and 50 million men in the U.S. have ED. As many as 5% of men under the age of 20 have ED, and the rate increases with age. In fact, more than 70% of men have ED by the age of 70. 

The good news is that lifestyle changes and medical treatments can improve the symptoms of ED. Let’s take a look at the different treatment options and help you find which ones might be right for you.

What are the latest treatments for erectile dysfunction?

Researchers are spending time and resources to develop new treatments for erectile dysfunction. Several new treatments are being studied and may offer fewer side effects and better results than current treatments. 

Here are some of the promising therapies under investigation:

• Stem cell therapy: Stem cells are a special type of cell that can turn into any other type of cell and help repair tissues. Stem cells taken from umbilical cords or fat tissue show promise for improving ED when injected into the erectile tissue of the penis.

• Low-intensity shock wave therapy (LISW): Shockwave therapy isn’t yet FDA-approved for ED, but some healthcare professionals are using it. This treatment uses sound waves to help grow new blood vessels in your penis. New blood vessels help supply your penis with enough blood to get an erection.

• Low-intensity pulsed ultrasound (LIPUS): LIPUS is similar to shock wave therapy. It uses sound waves applied to the penis over several sessions. Studies show that both LIPUS and LISW therapy may offer a non-invasive treatment for ED.

• Melanocortin receptor activator: This treatment option has been studied as an injection or nasal spray. It has shown promise by increasing sexual desire and improving erection, even without sexual stimulation, in men who have failed typical treatments. One form, Vyleesi (bremelanotide), is FDA approved for women with hypoactive sexual disorder.

• Guanylate cyclase activator: In animal studies, this treatment relaxed smooth muscle in the penis, allowing more blood flow and stronger erections in mice. Human studies are needed to see if they’re effective for men with ED.

• Nitric oxide (NO) donors: NO donors, like L-arginine, have been shown to improve erections, especially in combination with medications like Cialis or Viagra. These treatments increase nitric oxide levels, which help improve blood flow and stronger erections.

What other treatments are available for erectile dysfunction?

There are many FDA-cleared and FDA-approved treatment options for ED. These include oral, topical, and injectable medications. There are also handheld devices and surgical interventions. The most common include:

• Phosphodiesterase (PDE5) inhibitors: These oral medications include sildenafil (Viagra, Revatio), tadalafil (Cialis, Adcirca), and vardenafil. All PDE5 inhibitors are equally safe and effective. Depending on your personal circumstances and cost, one option may be a better fit for you.

• Eroxon gel: Eroxon gel is an over-the-counter (OTC) topical product for ED. It’s applied to the head of your penis and works by stimulating nerves to help create an erection. It’s the first OTC gel to get FDA clearance for ED.

• Intracavernous injection: Medications like alprostadil (Caverject, Edex) and Trimix (a compound medication that usually has alprostadil, phentolamine, and papaverine) are injected into your penis just before intercourse.

• Vacuum erection devices: These devices pull blood into the penis by creating a vacuum around your penis. A ring placed at the base of your penis helps keep the blood inside and prolongs your erection.

• Penile prosthesis implants: The current recommendation is to consider a penile implant only after failing medical therapy and vacuum devices. These may be an inflatable or a metal rod implant allowing for erection on demand. Once you have an implant, you’ll no longer be able to achieve an erection naturally. 

Which erectile dysfunction treatments are typically recommended?

ED treatment depends on what’s causing the dysfunction, what other medical conditions you have, and which medications you take. What works great for one person might not work for you. A healthcare professional can help you decide which treatment to try for your ED. 

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In most cases, the first treatment recommended is usually an oral medication, such as a PDE5 inhibitor like Viagra or Cialis. These medications are often used along with lifestyle changes, weight loss, and nutritional supplements like L-arginine. If blood tests show low testosterone levels, testosterone therapy can be used, especially if libido is low.

Which erectile dysfunction treatments are most effective?

For most people, nonsurgical ED treatments like PDE5 inhibitors are considered highly effective options. Overall, about 70% of men with ED are able to get an erection with PDE5 inhibitors. If oral medications don’t work, intracavernous injections are the next best option.

The most effective ED treatment for getting and keeping an erection on demand is a penile implant. Penile implants can provide long-term sexual satisfaction and often work for up to 20 years. Implant users in general have a satisfaction rate of over 95%. But this is often considered a last resort, depending on what’s causing your ED. 

Which erectile dysfunction treatments have the fewest risks?

The ED treatment with the fewest risks depends on your personal medical history, the medications you take, and other lifestyle factors. All FDA-approved PDE5 inhibitor medications are considered safe and effective, but they do carry the risk of:

• Headaches

• Flushing

• Stomach pain

• Nasal congestion

• Low blood pressure

• Vision or hearing changes

• Priapism (a painful erection that lasts too long)

Topical ED treatments tend to cause side effects only where they’re applied. These include:

• Burning sensation

• Redness

• Skin irritation

• Headaches

Penile injections and vacuum devices also carry some risks, like:

• Priapism

• Pain, bruising, or bleeding

• Infection

• Scarring 

• Dizziness or fainting

There are also some drawbacks to penile implants. These include:

• Risk of infection

• Implant failure

• Incorrect sizing

• Need for additional surgery

Talk to your healthcare team about the risks and benefits of ED treatments to find one that’s right for you. In general, the goal is to find a treatment that has the most benefit with the least risk based on your medical history and treatment goals. 

Are there any natural remedies for erectile dysfunction?

Natural remedies such as herbs and supplements aren’t regulated by the FDA. So, there’s not a lot of data on their safety and efficacy. But there are some things you can do to improve symptoms of ED without surgery or medication: 

• Avoid drugs, alcohol, and nicotine. These can make ED worse.

• Manage your weight. Being overweight contributes to ED and raises your risk of Type 2 diabetes. It also raises your risk of heart disease, which is associated with ED.

• Exercise regularly. Aerobic exercise has been shown to improve ED. It can also improve ED risk factors, like excess weight, Type 2 diabetes, and metabolic syndrome.

• Get checked for sleep apnea. Low oxygen levels from obstructive sleep apnea (OSA) can increase your risk for ED. Treatments can help improve OSA.

• Manage your other medical conditions. Keeping your cholesterol, blood pressure, and weight in check are good for your overall health and can help reduce symptoms of ED.

• Try sex therapy. A sex therapist will work with you and your partner to address issues that may be contributing to ED. They’ll offer suggestions for behavioral changes to improve your sexual satisfaction.

• Reduce your stress. Stress can be a major contributor to ED. Identifying and managing stressors can often improve ED symptoms.

When should you seek treatment for erectile dysfunction?

You should seek treatment for ED if it happens often, lasts for an extended period of time, or is having a negative impact on your life. ED can have a serious negative impact psychologically and emotionally. It can also be a sign of a serious underlying medical condition. In some cases, ED is the first sign of an untreated condition, like high blood pressure or diabetes. 

If you’re having trouble with erections on a regular basis, you should see a healthcare professional for an evaluation. They can help sort out the cause and the best treatment plan for you.

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Written by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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