Taking Drugs for Erectile Dysfunction? Do These 5 Things to Get More Bang for Your Buck

Rena Malik, MD, is a board-certified urologist specializing in Sexual Medicine, Hormone Health and Urogynecology. With over 400 million YouTube views and 2.5 million social media followers, she is renowned for dispelling medical misinformation and making complex urological topics accessible. In the first of a new series of columns for Men’s Health, Malik shares her expert insight on erectile dysfunction drugs, cutting through the stigma and noise to explain how they work —and what they might be able to do for you.

ERECTILE DYSFUNCTION, DEFINED as the inability to sustain an erection that is firm enough for penetrative intercourse, is estimated to affect 322 million men worldwide, and 52% of men over the age of 50. Medications to treat ED are exceedingly popular, with sildenafil (sold under the more commonly known brand name Viagra) being the 157^th most commonly prescribed medication in the United States. Despite the wide use of these drugs, many individuals struggle with them being ineffective, while others have concerns about potential side effects, long term consequences, and concerns about dependency. But are these fears founded in reality?

Before delving into the specifics of these medications, it’s essential to understand the basic physiology of an erection. The process begins with arousal, which can be triggered by seeing, smelling, hearing or touching someone or something that you find erotic. This leads to the production of nitric oxide from your blood vessels and nerves, staring the ignition for your erection.

Once nitric oxide is released, it sets off a cascade of chemical messengers, including cyclic guanosine monophosphate (cGMP). These messengers allow the smooth muscles in the penis to relax, blood flows into the penis causing engorgement and ultimately an erection. This goes away because of three major things: the trigger for your arousal disappears leading to an absence of nitric oxide, the breakdown of cGMP, or the nervous system response to ejaculation, causing the penile muscles to contract and blood to exit the penis.

ED drugs like sildenafil and tadalafil function by blocking the enzyme phosphodiesterase type 5 (PDE5), responsible for breaking down cGMP. This means cGMP remains active longer and the erection subsequently lasts longer. Ultimately, these medications help relax blood vessels, increasing blood flow to the penis when you have sexual stimulation. (Yes, you need sexual stimulation for it to work: contrary to depictions in the media, it does not just give you a random erection.)

These medications can be a game-changer for men who are struggling with ED, but they don’t always work, especially if you don’t know how to use them. If you fall into this category, here are some tips to make sure they work for you.

5 Ways to Make ED Drugs Work for You

Don’t Give Up

Studies have shown that the first and second time you take a medication like sildenafil, success rates are roughly 54%-64%, respectively. However, by the eighth try, that success rate jumps to 86%. Perseverance pays off.

Give it Time to Work

You should take these medications at least 30-60 minutes before you want to have sex, so they have time to get absorbed and broken down into their active form.

Don’t Eat a Fatty Meal

In particular with sildenafil or vardenafil, a high-fat meal can slow down absorption, making it less effective, but you can still get side effects, which is less than ideal. If you like to have sex after dinner, consider trying tadalafil, which doesn’t need to be taken on an empty stomach.

Increase the Dose

Typically, your doctor will start you on a lower dose of the medication, so make sure to ask if there’s a higher dose available, and go up if needed. Hint: The maximum dose for sildenafil is 100mg, and 20mg for tadalafil.

Don’t Forget about the Important Stuff

The number one cause of ED is blood flow or vascular problems like high blood pressure, high cholesterol and diabetes. To improve your erections, you need to improve your blood flow and overall health. If you only take medications and do nothing to change your lifestyle, then over time they will stop working, not because you’ve become dependent on them but because, with age, those blood flow issues tend to worsen. To prevent this, make sure to do all the things your doctor tells you to do for your health – eat right, exercise and get sleep. In fact, research has shown that 150 minutes of aerobic exercise a week can be as effective as sildenafil in improving erections.

Are ED drugs safe?

GENERALLY, THESE MEDICATIONS are safe for the majority of people. The only people who can’t take them are men taking any sort of nitrate medication. A common one is nitroglycerin, which is prescribed for chest pain. Also, if you have kidney or liver issues you may need to take a reduced dose. Generally speaking, if your cardiologist or primary care doctor hasn’t told you to stop having sex because your body can’t handle the physical demands of the act, then you’re in the clear to take medications for your ED. Most commonly, men taking these medications can complain of headaches, flushing, nasal congestion and with sildenafil blue-green color vision changes (if this happens you should stop the medication and talk to your doctor), and in rarer cases, nosebleeds and muscle aches with tadalafil.

These medications will not negatively affect your heart. In fact, sildenafil was developed initially for high blood pressure. While it wasn’t effective in that regard, the researchers realized that participants weren’t coming back to return the study drugs at the end of the trial: that was because because instead of better blood pressure, they were getting better erections. Also, while everyone will caution you about having an erection that lasts longer than 4 hours, this is extremely unlikely to happen if you’re taking the medications as prescribed.

However, there are some exceedingly rare side effects which I have yet to see a case of in my career, but which you should be aware of. One is called non-ischemic optic neuropathy, or sudden vision loss caused by reduced blood flow to the optic nerve. Before you freak out, it’s estimated that if you take these medications weekly there might be three cases of this for every 100,000 men over the age of 50.

Despite these rare occurrences, these medications are effective, safe and incredibly successful in allowing people to have better, more confident sex lives. If you’re one of the many men struggling with ED, remember that sexual health is health, so make sure to talk to your doctor and get help today.