Erectile Dysfunction (ED): A Complete Guide

Thrones health

Medically reviewed by Dr. Antonio Abreu, DNP
Written by Thrones Editorial Team

couple in bed

Erectile Dysfunction or impotence is one of the most common sexual health concern for most men. For any man, the inability to raise the flag or even sustain a pitched tent can be embarrassing. However, there should be no shame if there comes a time when you can’t rise to the occasion or sustain an erection before or during sexual intercourse as there are various solutions and therapies available.

The first step in solving this dilemma is by admitting you have a problem. The second is to seek professional help. The third is to remain calm. Too much stress is one factor why men may experience erectile dysfunction (ED) as we will discuss further as you read on.

Common Causes of Erectile Dysfunction

The most common cause of erectile dysfunction is that the penis is not getting enough blood flow to sustain an erection. When aroused, signals from the brain are sent to blood vessels and nerves in the penis filling it with blood, making the penis firm, and causing an erection.

As men advance with age, ED becomes more common, although findings show that being old is not always a key indicator of causing ED. There are men who can still function and perform sexually well beyond their senior years.

Mentioned earlier, another key factor where ED can happen is when the patient is under too much stress or experiencing emotional setbacks. ED can also be a manifestation of a more serious health problem/s.

Organic Causes

Although some ED cases observed among younger men are caused by psychological factors such as performance anxieties, depression, and traumas, most ED cases are organic in nature. This means that the patient may have underlying health problems such as, but not limited to:

* Hypertension

With hypertension, extreme blood pressure can damage arteries causing the hardening and narrowing of its walls. This can reduce blood flow to the penis. Additionally, certain antihypertensive medications can cause ED.

* High cholesterol

The waxy cholesterol is essential in building new tissue, producing sex hormones and bile. Of its two types: high-density lipoprotein (HDL) and low-density lipoprotein (LDL), two much of the latter can cause problems. LDL can stick to artery walls and harden into plaque. This, in turn, narrows the arteries making it difficult for blood to normally pass through.

* Heart disease

Though too much plaque-causing LDL was initially cited as why erectile dysfunction often precedes heart diseases, it is now believed by experts that damage to the inner lining of blood vessels causes reduced blood flow to the heart as well as impaired flow to the penis.

* Obesity

More than having too much body fat, being obese can cause inflammation and hormonal imbalances which raises your chances of having ED as well as acquiring other chronic medical conditions.

* Diabetes

Sexual arousal causes the body to release nitric oxide into the bloodstream. When a diabetic’s blood sugar is high, not much of this chemical is released. Nitric oxide tells your arteries and penile muscles to relax, in turn allowing more blood to flow into the penis.

* Thyroid dysfunction

Similar to obesity, thyroid dysfunctions can cause hormonal imbalances in the body such as decreased testosterone levels. These hormonal imbalances make it difficult for men to keep an erection. Thyroid problems contribute to the interference of regulating the production of testosterone as well as blood vessel regulation in the penis.

* Abdominal, pelvic, and/or spinal injuries or surgeries

Abdominal aortic aneurysm (AAA), is the most common type of aneurysm presented for treatment. Acquired factors in 90% of cases are caused by smoking. Other factors include the use of hypersensitive drugs and high plasma fibrinogen which can increase a person’s risk of having blood clots.

Of course, we know that messages from the brain travel down to our nerve endings via our body’s main highway for communication, the spinal cord. Since physical sexual responses traverse this highway, any disruption caused by injury or surgery may hamper the delivery of these messages which can cause problems, including ED.

* Most recently, there is a finding that COVID-19 could be a potential cause for ED.


Apart from organic causes that might induce erectile dysfunctions, certain habits contribute to the exacerbation of these organic causes that lead to ED. Keeping these habits in check such as:

* Bad diet

A bad diet can not only affect your body’s energy levels, but it can also lead to the ingestion of too much fat, cholesterol, and too many carbohydrates which can cause many of the organic causes mentioned above.

* Smoking

There is no other recourse to this than to quit. If you do, you will reduce your risk significantly in experiencing erectile dysfunction.

* Inactive lifestyle

Consider choosing an active lifestyle. Exercise can help in alleviating stress and contribute to increasing your energy level.

* Imbibing too much alcohol

Too much booze impairs blood circulation and can numb nerves. By now you should know that these two factors contribute to sexual arousal. Though the problem abates once you sober up, excessive alcohol drinking can lead to ED.

* Stress

Pardon the pun, but we can’t stress this enough. Too much stress can hamper a man’s ability to engage in satisfying sex.

* Personal issues and Psychological issues

It is difficult and quite a frustrating when you can’t achieve erections. These issues must be settled by talking to your partner in resolving these issues whether they be anger or resentment. Seeking professional help is also the most viable solution.

Treatment Options for Erectile Dysfunction

Once you consider getting treatment for erectile dysfunction (ED), your doctor will most likely ask about your health history and your lifestyle.

It is crucial that you provide all the information necessary including your vices and medications and or drugs you take. These are invaluable for your doctor to formulate a treatment plan suited for you.

You should best be informed that non-invasive treatments are most often tried first before other treatment options are explored. There are various treatment options available for treating ED such as:

  • Taking erectile dysfunction medication such as: Viagra, Cialis, Levitra, Stendra
  • Testosterone Therapy
  • Penile Injections
  • Intraurethral medication
  • Vacuum erection devices (Penile Pump)
  • Penile Implants
  • Penile vascular surgery

Erectile Dysfunction Medications

Of the ED treatments available listed above, we shall from this point, focus on ED oral medications for now. There are various medications available in the market for ED but we will focus on the four mentioned above.

We shall discuss what they are and how they work, how they should be taken, and their side effects. All these medications assist in providing adequate blood flow to the penis for it to alleviate difficulties in gaining and maintaining an erection.

Viagra (Sildenafil)

The granddaddy of erectile dysfunction medications was initially developed as an antianginal medication that has vasodilatory effects, which simply means, it widens blood vessels. Its intended purpose was modest at best, however, patients started reporting a surprising “side effect” of having erections.

Take Viagra (sildenafil) only as prescribed by your doctor. Follow specific instructions and do not take Viagra in larger or smaller doses or for longer periods as prescribed or more than once a day. It can be taken from 30 minutes up to 1 ½ hours before sexual activity.

Viagra (sildenafil) comes in 20, 25, 50, or 100 mg doses and it is starting to start a dose at 50 mg. The medication starts working 30 to 60 minutes after dosing and can last for 3 to 5 hours. It doesn’t mean you will have an erection for that long, after an orgasm the muscle in the penis will relax due to the release of oxytocin. Because the drug is still in your system, you may notice a shorter refractory period. Which means, a short time till you can perform again.

Common side effects of Viagra (sildenafil) may include: dyspepsia (indigestion), epistaxis (nose bleed), flushing, visual disturbance, headache, heartburn, insomnia, rhinitis, and nasal congestion. It is best to immediately seek medical attention in the event you encounter dizziness, nausea, pain and numbness, or you feel tingling in your arms, neck, jaw, and chest.

Cialis (Tadalafil)

Cialis (tadalafil) apart from being used to increase blood flow to the penis, is also used to treat enlarged prostate. It can deliver a longer-lasting erection than that of Viagra (sildenafil). Cialis (tadalafil) can remain active for up to 72 hours making it the longest-acting ED drug in the market, this depends on the dose. There are two ways to take Cialis (tadalafil) as needed (like Viagra prior to sex) and daily Cialis.

Daily Cialis (tadalafil) dose is 2.5 or 5 mg and is taken once a day (think always ready to go). As needed, Cialis includes 2.5, 5, 10 and 20 mg. The recommended starting dose for Cialis (tadalafil) is 10 mg. The highest dose is 20 mg and has been affectionately called “the weekender” as it can last up to 72 hours but commonly last about 48 hours.

However, unlike Viagra which can manifest its effect within 30 minutes to one hour of ingesting, Cialis may take up to two hours before its full effect can be had. Cialis has the same side effects as that of Viagra. However, it can also cause back pain and muscle aches.

Levitra (Vardenafil)Levitra (Vardenafil)

Another ED drug is similar to Viagra and Cialis. Levitra (vardenafil) works faster than Viagra but its effect can last for the same amount of time.

Take Levitra (vardenafil) only as prescribed by your doctor. Like the previous ED medications, this can be taken with or without food. It can manifest its effect within an hour of its ingestion. Levitra (vardenafil) is for people who want a longer effect than that of Viagra but do not want more than 36 hours than what Cialis can provide.

Levitra (vardenafil) comes in 2.5, 5, 10 or 20 mg doses. It is recommended to start a dose at 10 mg. Levitra starts working within 30 – 60 mins after dosing and can work up to four to five hours.

Levitra has the same side effects as Viagra and Cialis. However, it can also cause color blindness.

Stendra (Avanafil)

Stendra (Avanafil) is the newest and considered a second-generation erectile dysfunction (ED) drug in the market. Its claim to fame is that it may work in the shortest time after ingestion. Researchers claim that it may work within 15 to 30 minutes and can last up to six hours.

Stendra (avanafil) can likewise be taken with or without food. It is available in 50, 100, or 200 mg doses. The recommended starting dose is 100 mg taken orally as needed as early as approximately 30 minutes before sexual activity.

Like its predecessors, its side effects are very much the same as those of older ED drugs. However, since the drug is selective in its target, it has a lower risk of causing side effects.

Final Notes

  • Remember to consult your doctor before taking any of the erectile dysfunction medications above and follow dosing instructions.
  • These drugs are not cures but treatments to ED.
  • Remember to not drink alcohol with any medication.
  • These erectile dysfunction drugs will not give you an instant erection. Stimulation is still needed to cause an erection.
  • These ED drugs are not protection against sexually transmissible diseases (STDs).
  • In the event of side effects it would be prudent to immediately contact your doctor.
Viagra (Sildenafil)Cialis (Tadalafil)Levitra (Vardenafil)Stendra (Avanafil)
Standard Dosages20, 25, 50, or 100 mg once daily as needed10 or 20 mg once daily as needed
2.5 or 5 mg once daily
​10 or 20 mg once daily as needed​50, 100, or 200 mg once daily as needed
Recommended time to take before intercourseOne hour.1-2 hoursOne hour15 minutes
Efficacy after dosing30 minutes60 minutes30 minutes15 minutes
Duration of drug effectivity3 to 5 hours17.5 hours but can last up to 72 hours4 to 5 hours5 to 6 hours
Can I eat?No. It will not work if you take them after a meal. It is recommended to be taken at least 1 to 2 hours after eating, or with a low-fat meal.Yes. It can be taken with food.Can be taken without regard to food but has been shown to be more effective on an empty stomachYes. It can be taken with food.
Common Side EffectsHeadache, flushing, nasal congestion, indigestion, abnormal visionHeadache, flushing, nasal congestion, indigestion, less vision change but with more muscle painHeadache, flushing, nasal congestion, indigestion, abnormal visionThroat irritation, stuffy nose, backache, temporary redness of face and neck, headache

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