Men with erectile dysfunction can benefit from treatment that focuses on the patient’s goals for sexual intimacy and pleasure. Medications and other treatments, including penile implants that consist of inflatable or malleable rods, are effective in most cases.

While ED is more common as men age, it’s not an inevitable part of aging.

1. Medications

If ED is due to a physical problem, such as a lowered blood flow to the penis (arterial erectile dysfunction), medication can help. A doctor may also ask about other health conditions that can cause ED, such as heart disease, high cholesterol or blood pressure, diabetes, and smoking.

Oral medications treat ED by enhancing the effect of nitric oxide, a natural chemical that helps relax muscles in the penis and increase blood flow to allow an erection to form. Men who can’t take oral medications may use an intraurethral medication, which goes into the opening in the penis with a special applicator.

Counseling is also an appropriate treatment for ED that stems from psychological factors, such as depression or anxiety about sex. Therapists can teach couples techniques to focus on sensation and pleasure during sexual activity, and decrease performance anxiety. Your doctor may recommend a psychiatric or psychologist who specializes in sexual disorders.

2. Sex Therapy

Erectile Dysfunction can lead to relationship problems and distress. Therapy can help couples understand each other’s sexual needs and improve communication about sex. It can also teach breathing exercises and relaxation techniques that help reduce anxiety and stress, which may contribute to ED.

Sex therapy can be useful in treating underlying psychological issues that may contribute to EP, including feelings of shame or embarrassment, lack of interest in sex, relationship conflicts or anxiety, fear or avoidance of intimacy, or failure to reach orgasm. For some, sex therapy can provide a nonjudgmental space to discuss these concerns, which can increase openness and support within a couple.

Some men with ED have found that sex therapy can improve their relationships, especially if they involve their partner in sessions. But it’s important to know that sex therapy isn’t a replacement for medical treatment, and you should always talk to your doctor about the best approach for you. They might recommend you try oral medicines like sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra) or a medical device like vacuum erection devices or penile injections.

3. Surgery

Men who cannot get an erection using PDE-5 inhibitors or other medications may benefit from a surgical treatment. However, it is generally recommended that other treatments be tried before pursuing surgery.

One option is a penile implant. These devices are designed to inflate for a rigid erection and deflate for a flaccid state. The surgery is usually done on an outpatient basis. Strenuous activity should be avoided for about a month after the procedure.

Some insurance companies and Medicare will cover erectile dysfunction surgery. But it is important to have proof that other medications and lifestyle changes have failed.

Another surgical option involves bypassing blocked penile arteries. This involves connecting an artery in the abdomen to a blood vessel near the tip of the penis. Unfortunately, this procedure doesn’t seem to be effective over the long term. Lastly, doctors sometimes perform a procedure called vascular reconstruction in younger patients who have suffered damage to a blood vessel in the genital area from trauma or disease.

4. Other Options

In addition to medications, a doctor may also recommend physical therapy or counseling. Some erectile dysfunction is caused by underlying health conditions such as heart disease or diabetes. Your urologist might run blood tests to screen for these and other conditions.

Some ED symptoms, such as losing an erection quickly, are actually early signs of atherosclerosis or other heart-related problems. Your urologist might test your blood pressure or cholesterol to identify these problems.

Other treatments for erectile dysfunction include injections of drugs that increase blood flow to the penis, such as alprostadil (available as an oral tablet or as a suppository). There are also surgical implants for people with spinal cord injuries and neurological disorders that affect erections. These implants are made of semi-rigid rods that can be manipulated into an erect position for sexual activity. Though they don’t provide a rigid erection, these implants still allow many men to achieve satisfaction and orgasm during sex.