Erectile Dysfunction Treatment
Find the cause first. Treat the whole picture.

Erections depend on healthy blood vessels, nerves and hormones. ED can appear years before heart disease, so it deserves a medical evaluation, not just a prescription.

History and exam, blood pressure, blood sugar (A1c), cholesterol, morning testosterone, a review of medications that can cause ED (some blood pressure medicines and antidepressants, among others), sleep, stress, and pelvic floor or nerve problems.

• Treat the drivers: blood pressure, blood sugar, weight, sleep, alcohol and smoking, and medication changes with your other doctors.
• FDA-approved oral medicines (PDE5 inhibitors): sildenafil (Viagra), tadalafil (Cialis), vardenafil and avanafil (Stendra). They are not safe with nitrate heart medicines.
• Low testosterone is treated when it is confirmed (see Testosterone Replacement Therapy).
• Pelvic floor rehabilitation when pelvic floor dysfunction contributes.
• Other FDA-approved options when pills do not work or are not safe, such as alprostadil injections or vacuum devices, with referral to urology for implants or Peyronie's disease.

Low-intensity shockwave therapy and PRP injections are not FDA-approved for ED, and the evidence is still limited. We explain what is known before any decision.