Erectile dysfunction treatment options

The Bottom Line

  • Common drug treatments for erectile dysfunction are effective, but also have side effects.
  • A new ‘trade-off’ study can help men – and their doctors and partners – choose the drug that best meets their needs
  • Losing weight, improving your diet, and getting regular exercise (such as walking) may also boost sexual function, and avoid the side effects associated with drug treatment.

Judging by all of the ads for products like Cialis, Viagra and Levitra, a lot of men are having a hard ... er, difficult time achieving or maintaining an erection long enough for sex. Erectile dysfunction – or impotence as it used to be called – is indeed a very common condition that can affect men at any age but particularly as they get older (1). In fact, erectile dysfunction is an issue for about 50% of all men aged 40 to 70 (2) with potentially damaging impacts on their emotional well-being, relationships and quality of life.

That’s a downer, but there are simple and effective solutions, including the above mentioned pills. They are among seven different drugs commonly prescribed for erectile dysfunction. They all work in a similar fashion with some variation depending on the specific drug. Most are taken on an “as-needed” basis, an average of an hour before sex (3).

The good news is that they are easy to take, considered safe and work for the majority of people (4). But like most drugs, there can be bothersome side effects, the most common of which are headaches, facial flushing and indigestion (4).

So which one is best choice? A recent systematic review of the seven drugs analyzed 82 randomized controlled trials to measure effectiveness and another 72 randomized controlled trials to examine side effects (5). The review authors weigh the trade-offs between each drugs’ relative merits and drawbacks.

What the research tells us

Consistent with other studies, all seven of the drugs resulted in a reduction in erectile dysfunction compared with a placebo. In other words: they work! Unfortunately, there is no miracle pill that is both effective and free of side effects. In general, the review found that as the effectiveness of a drug increases, so does the risk of side effects.

In this review of the ‘trade-offs,’ the most effective drug treatment was the 50mg dose of sildenafil (the active ingredient in Viagra, and also sold in generic forms). However it also had the highest risk of side effects – on average, men taking this drug had 18% increased risk of side effects compared to men taking a placebo. If that’s a concern, the 10mg does of tadalafil (sold as brand name Cialis, as well as in generic form) may be a preferred option (just 10% increased risk of side effects), but it comes at the expense of being less effective. A decision about which drug to choose involves weighing the risks and benefits of each treatment. A chart comparing seven common drugs for erectile dysfunction is available in our evidence summary of this review.

An alternative to medication may be lifestyle changes. There is evidence that losing weight, improving diet, and getting regular exercise (such as walking) can improve sexual function (6,7,8).

The main point is that there are solutions and options to meet individual needs and preferences. The first step is to decide what’s important to you, then work with your doctor to plan your strategy for getting back in the game.

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Author Details


  1. Hatzimouratidis K, Eardley I, Giuliano F et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. [Internet] 2015. [cited August 2016]. Available from
  2. Johannes CB, Araujo AB, Feldman HA et al. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol. 2000; 163(2):460–463.
  3. Dorsey P, Keel C, Klavens M et al. Phosphodiesterase type 5 (PDE5) inhibitors for the treatment of erectile dysfunction. Expert Opin Pharmacother. 2010; 11(7):1109-1122.
  4. Yuan J, Zhang R, Yang Z et al. Comparative effectiveness and safety of oral phosphodiesterase type 5 inhibitors for erectile dysfunction: a systematic review and network meta-analysis. Eur Urol. 2013; 63: 902-912.
  5. Chen L, Staubli SE, Schneider MP et al. Phosphodiesterase 5 inhibitors for the treatment of erectile dysfunction: a trade-off network meta-analysis. Eur Urol. 2015; 68(4):674–680. 
  6. Kolotkin RL, Zunker C, Ostbye T. Sexual functioning and obesity: a review. Obesity (Silver Spring). 2012; 20(12): 2324-2333. 
  7. Gupta BP, Murad MH, Clifton MM et al. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med. 2011; 171(20):1797-1803.
  8. Begot I, Peixoto TC, Gonzaga LR et al. A home-based walking program improves erectile dysfunction in men with an acute myocardial infarction. Am J Cardiol. 2015; 115(5):571-575. 

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

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