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What is Erectile Dysfunction?

Erectile dysfunction (ED) is the inability to get or keep an erection firm enough for intercourse. It is very common and affects patients of all ages including young men. Although older men are more likely to suffer from ED, about 40% of men will experience ED by age 40. While it may happen to any man occasionally, if the issue becomes persistent, it may require treatment.

Learn more about treatment with the medication Sildenafil and ED causes, prevention, and more below.

About Sildenafil

Sildenafil is a medication used to improve men’s erections. It works by expanding the blood vessels that go to the penis and delivering better blood flow. That in turn leads to better erections. Sildenafil was originally known as Viagra. The two medications are identical, with Sildenafil being a generic, cheaper, and more available option.

Depending on the severity of your ED, you may be prescribed 20,50, or 100 mg dose. It is not safe to take more than 100 mg at a time or per 24 hr period

How to Take Sildenafil

The following recommendations will help ensure Sildenafil works for you: 

  • Take it about one hour prior to intercourse
  • Take it on an empty stomach (at least 2 hr after a meal), with a full glass of water and preferably without alcohol. Taking Sildenafil immediately after a meal or with alcohol will worsen its absorption and will not allow the medication to work as well. 
  • Take it when you will have sexual stimulation. Sildenafil works best when there is sexual stimulation, with or without a partner. It will not work well without stimulation.

Possible Side Effects of Sildenafil

Side effects with Sildenafil are not common, but may include flushing, headaches, upset stomach, and dizziness. Rarely vision changes may occur. 

If you experience persistent or worsening side effects, you should stop the medication and check in with your doctor.

 Very rarely Sildenafil may lead to painful erection that lasts longer than 3-4 hours or does not go away (Priapism). That is considered a medical emergency and you must seek medical help (go to the ER) immediately. 
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, or trouble breathing.

Reasons To Consider Switching Medication

If you have persistent side effects, negative interactions with your other medicines, or the medication lacks the desired effect you should talk to your provider about switching medication. 

Alternative Treatments and Prevention

Your erections are a reflection of your overall health. The healthier you are, the better your erections are going to be. Besides medication, consider the following to improve erections. 

  • Mental Health Treatments
    • Stress and anxiety are well known risk factors for ED. Try stress reductions at home and at work. Click here to learn some techniques to help with performance anxiety.
    • Untreated depression can also affect your erections. If you think you may be struggling with depression, please discuss this with your K Health physician.
  • Lifestyle Modifications
    • Sleep: Lack of sleep has negative effects on your mental health and can affect your erections. Here are some sleep tips from the CDC.
    • Weight loss:. If you are overweight, consider making weight loss a priority. Obese men are 50% more likely to suffer from ED.
    • Diet and exercise: The World Health Organization (WHO) recommends 150 minutes of moderate intensity activity per week for adults 18-64 years old.
    • Stop smoking: Smoking significantly affects your blood vessels and makes getting an erection more difficult
  • Hormone Replacement
    • For men with low testosterone levels, testosterone replacement may improve erections. 
  • Advanced options such as injections or surgery
  • If you have diabetes, try to control it with diet, exercise, and medications as best as you can. Diabetes, when not treated, leads to nerve and blood vessel damage, worsening ED

When to See a Doctor In Person

If you are taking Sildenafil and any of the following occur, please seek out care in person. 

  • You develop a painful erection or an erection lasting longer than four hours – this is a condition called Priapism and is an emergency
  • You feel like you might pass out after taking the prescribed medication, or develop sudden vision or hearing loss
  • You have chest pain
  • You experienced painful bending of your penis during intercourse with bruising and sudden loss of erection

What Causes Erectile Dysfunction

During sexual arousal a man’s brain and nerves deliver signals to the blood vessels of the penis to expand. That in turn, delivers more blood to the penis. Blood fills spongy parts of the penis called Corpus Cavernosum leading to an erection. 

In order to have a healthy and strong erection multiple parts of man’s body must work well together. That includes nerves, blood vessels, hormones, muscles, and brain. ED can result from a dysfunction in any of those. Most common causes of the ED are the following:

  • Diabetes. Men with diabetes have a higher chance of having damaged nerves and blood vessels which will lead to poor erections or no erections at all. History of poorly controlled diabetes is one of the main risk factors for ED. 
  • Heart or vascular disease. Men with cardiac or vascular disease (including high blood pressure and high cholesterol) are at a higher risk for ED 
  • Obesity
  • Neurologic diseases. Those include any back/spinal cord issues, multiple sclerosis (MS), Parkinson’s disease, diabetic neuropathy, etc. Neurologic diseases affect nerves that go to the penis causing worsening of the erections. 
  • Smoking 
  • Alcoholism or any other substance abuse
  • History of prostate cancer and treatment for prostate cancer
  • Depression, stress, and sleep disorders
  • Low testosterone 
  • Previous surgeries or injuries to the pelvis or spinal cord
  • Certain medications 
  • Older age

Natalya Lopushnyan, MD

Dr. Natalya Lopushnyan is a board certified Urologist specializing in Men's Health. She earned her degree in Biochemistry from University of Massachusetts Boston, graduating Summa Cum Laude. Her MD is from Yale. She completed Urology Residency at the University of Washington in Seattle.