ED Treatment Options — A Research Guide

Step 1 — Understand the cause

Erectile dysfunction is a symptom, not a single disease. Common contributors include vascular disease, diabetes, hormonal imbalance, neurological conditions, medication side effects, psychological factors, and pelvic surgery. A medical evaluation is the foundation of any treatment plan.

Step 2 — First-line, non-invasive options

• Lifestyle changes — cardiometabolic health, weight, sleep, smoking cessation, alcohol moderation, exercise.
• Oral medications (PDE5 inhibitors) — sildenafil, tadalafil, vardenafil, avanafil. Prescription-only. Not appropriate for all patients.
• Pelvic floor physical therapy — may help selected patients.
• Mental health support — anxiety, depression, and relationship factors can meaningfully affect function.

Step 3 — Second-line options

• Vacuum erection devices — non-pharmacologic, mechanical option.
• Intracavernosal injection therapy — prescribed and titrated by a clinician.
• Intraurethral therapy — alternative pharmacologic delivery.
• Hormone optimization — when laboratory evaluation identifies hypogonadism.

Step 4 — Surgical options when other treatments are inadequate

• Penile prosthesis — inflatable (two- or three-piece) or malleable. Considered when other treatments are not effective or appropriate.
• Vascular surgery — selected patients with discrete arterial injury.

Step 5 — Questions to ask any provider

• What is causing my ED?
• Have less-invasive options been adequately tried?
• What are the risks, recovery, and revision rate of any surgery you recommend?
• What does follow-up look like if a complication occurs?

Individual outcomes vary. Candidacy is consultation-dependent. Consultation with a qualified physician is required.