Getting the best out of drug treatments for erectile dysfunction

If you are reading this, you may have erectile dysfunction (ED) and be thinking about taking Viagra or one of the other similar drug treatments.

Perhaps you have already tried it?

Perhaps you didn’t get that great response you were expecting?

Read on and find out about some helpful tips about how best to use drug treatments for ED.

Which is the most commonly prescribed drug to treat ED?

ViagraThe most commonly prescribed drug to treat ED, is Viagra (sildenafil), sometimes sold as Viagra Connect.

Viagra has been taken by over 20 million men world wide – it has been extensively studied, showing it to be generally safe and to produce excellent effects on penile function.

Does Viagra work for everybody?

Viagra is highly effective, but unfortunately it doesn’t work for everyone.

Viagra works by causing the muscles in the penis to relax and allowing the penile tissues to fill with blood. This means the penis becomes hard and you now have an erection.

How effective is Viagra?

Medical studies have shown that Viagra is very effective. Viagra improves erections in around 75% of users.

In well conducted research studies, men with ED took either Viagra or a dummy pill, but the men themselves and the study investigators were unaware which product they were taking (a double blind study). Viagra was statistically significantly more effective in producing an erection satisfactory for sexual intercourse than the dummy pills.

Use of Viagra also improved men’s confidence and overall sexual performance, as well as resulting in improved sexual relationships and increased satisfaction for the sexual partner.

These studies included men with a range of risk factors or medical conditions underlying their ED, such as older men, men with high blood pressure, diabetes, angina, heart attacks and strokes, raised cholesterol, spinal cord surgery, depression and extensive prostatic surgery (radical prostatectomy). The results showed conclusively that Viagra not only produces benefits in healthy men, but also could show benefit to men in these categories.

Why might Viagra not work for me?

Your individual response to any prescribed drug, is never guaranteed. The human body is complex, and there are a variety of reasons why a drug may work well for one person and not so well for somebody else. Read on and see what you can do to increase your chances of success with Viagra.

Forty percent of men achieve a satisfactory erection with their first dose of Viagra. But others have to try Viagra several times before they had the desired effect – sometimes up to eight times.

What can I do to increase my chances of success with Viagra?

Your first step

If you have not taken Viagra before, arrange a face-to-face consultation with a doctor. You are strongly recommended to make an appointment with your doctor. Although this may feel embarrassing, your doctor is very experienced and will be there to listen and to help you.

The medical consultation is important because although most men do not have a physical cause for ED, there are medical conditions which may be associated. By identifying these you will have the best opportunity to manage these conditions, reduce your long term health risks and give ED the best chance to improve naturally.

Also, if you want to take Viagra, the doctor will assess whether there are any reasons in your medical history why this might be harmful for you.

They will also consider your current medication. Some types of medication can actually be the cause of ED. Other types of medication may interact with Viagra.

You are also able to purchase Viagra, Viagra Connect, or generic sildenafil online, for example at Dr Fox Online Doctor and Pharmacy. This is a safe and highly convenient service.

At Dr Fox Online Doctor and Pharmacy, you will still be asked to fill in a medical questionnaire online. You will also be strongly encouraged to see your GP within 6 months of having the prescription.

Your second step

Once you have been assessed and decided to have drug treatment for ED, your doctor will help you decide which drug is your best option.

Viagra is a phosphodiesterase type 5 inhibitor (PDE5 inhibitor).

There are several different types of PDE5 inhibitor – Viagra is only one of them. These all vary in terms of how you take them, how long they take to be effective and how long they will be effective for.

Your third step

When you have decided which PDE5 inhibitor you want to take, read the instructions on how to use the product, and follow these carefully.

If you don’t stick to the rules, then the drug either may well not work at all, or not work as well as you might have liked!

How to take Viagra and get the best results

Evidence suggests that many men taking Viagra are not following the correct advice when taking the medication.

The following advice applies to Viagra, Viagra Connect, and to generic sildenafil:

  • Viagra does require sexual stimulation – it will not just produce an erection out of nowhere! – so, you do need to plan a romantic night in!
  • Viagra must be taken at least one hour before food. If you take it with food, this delays absorption from your stomach into the blood stream and means it will take a lot longer for the effects to become apparent and not be as effective. Fatty food should be avoided.
  • Swallow the tablet whole with water. Do not crush it, or split it in pieces.
  • You can drink alcohol with Viagra, but try not to drink too much as this in itself can reduce your ability to have an erection – remember Brewer’s droop!
  • You must take Viagra at least thirty – sixty minutes before you plan any sexual activity, but it can be taken up to four hours in advance. Once in your system, it works for around twelve hours. Don’t rush things – take things slowly!
  • Viagra may slightly lower your blood pressure, so be aware of this. Drink plenty of water, don’t get too hot, and if you feel at all faint or dizzy, sit or lie down and elevate your feet until it passes.
  • Viagra is available in 3 different doses 25mg, 50mg, and 100mg. Most often you will be prescribed the 50mg dose to start with.
    If after several attempts with the 50mg dose, you have not been successful, your doctor may increase you to the 100mg dose.
    Similarly, if the effect is too strong, or if you have marked side effects, your doctor may suggest the lower dose of 25mg.
    Viagra seems to be most likely to be most effective at the higher 100mg dose. From clinical trials the following percentages of men responded to the three different doses as follows:

    Viagra (sildenafil) 25mg dose 62%
    Viagra (sildenafil) 50mg dose 74%
    Viagra (sildenafil) 100mg dose 82%

    At the 100mg dose, Viagra also significantly reduces anxiety about sexual performance.

  • If the first attempt with Viagra is not successful, don’t despair. This is common. It is important to try more than once. In clinical studies forty percent of men responded the first time they took Viagra, but many of those who didn’t went on to respond at another attempt, occasionally needing to try it up to eight times! So don’t despair too early!
  • The most common side effects are headache, nausea, indigestion, facial flushing, blocked nose and visual colour disturbance.
    You can treat some of these side effects with simple remedies such as paracetamol /ibuprofen for headache, and/or antacids for indigestion.
    If you are concerned you may have other side effects from Viagra you must discuss these with your doctor.
  • Only take a maximum of one Viagra tablet per day.
  • A rare but painful and very serious side effect of Viagra is called priapism. This is an erection which refuses to go away. It means the blood supply to the penis is impaired and it is a surgical emergency.
    If you have a painful erection which lasts for four hours or more you must seek urgent help by ringing 999, or go immediately to the Emergency Department (A&E).
  • Viagra is only suitable for men, aged over 18, who have had erectile dysfunction for over one year. Do not take Viagra if this does not apply to you.
  • Do not take Viagra from a friend, or give your Viagra tablets to anyone else.
  • It is important to consider lifestyle factors. Many of these are modifiable. If you can make lifestyle changes, this can lead to considerable improvements in erectile function, irrespective of taking any ED drug treatments.
  • If, as is often the case, there is no apparent medical cause for your ED, you may benefit from some Psychosexual Therapy, either instead of or, as well as using Viagra.
  • Viagra does not protect you from Sexually Transmitted Infections (STI’s). These infections are transmitted by penile penetration, but also by mixing body fluids for example intimate genital skin-to-skin contact and heavy petting. The only way to prevent acquiring or passing on an infection is to use a condom before any sexual contact. STI’s are spread by oral, vaginal and anal sex. With Viagra, you should get a good enough erection to use a condom.

Does a higher dose of Viagra – 100mg – work best?

There are published studies which demonstrate the superior effect of Viagra (sildenafil) at the 100mg dose compared to the 50mg dose.

For example a 2009 clinical trial was undertaken in which a group of men with ED were randomly assigned to take either Viagra 50mg, Viagra 100mg or a dummy pill (placebo). Neither the investigators nor the men knew what they were taking – this was a double blind study. After four week, they were switched to either Viagra 50mg or 100mg.

The results clearly showed that Viagra was significantly better than placebo at improving erections and improved sexual function.

56% of men on the 100mg dose felt no anxiety at their next attempt to have sexual intercourse, compared to 36% on the 50mg dose. Viagra at both doses significantly improved erectile function, sexual function and reduced anxiety, but Viagra at the 100mg dose performed statistically significantly the best.

Additional Therapy – Psychosexual Therapy for ED

  • There is a large psychological component to erectile dysfunction. Our minds and bodies work closely together. For the best results, sexual problems should be not be considered in isolation, but seen in the context of what else is going on in your life. To make big improvements with sexual function, you are most likely to benefit from a multi-factorial approach.
  • Psychosexual Therapists are highly trained. They aim to find the root causes of a sexual problem, and will explore the personal, emotional context of this and how it is affecting all aspects of your life and relationships. The sessions are person-centred around you, and not clinical. For more information about Psychosexual Medicine.
  • Remember there are two of you in the relationship. Best results are likely if your partner attends the therapy sessions with you. See NHS – What Does a Sex Therapist do?
  • Many men feel embarrassed to go down the route of psychosexual therapy and it is understandable to want to take Viagra and just fix the problem. But sometimes medication is not the only solution.
    If you feel there are issues you need to discuss, or relationship problems, or perhaps your partner has some sexual problems too, it’s a good idea to consider seeing a Psychosexual Therapist.
  • If Viagra fails, even at the 100mg dose, and after several attempts having followed all the instructions, a Psychosexual referral is something that may well help you. You can discuss referral with your GP, or you can find a Psychosexual Therapist privately.
  • Men who have pelvic surgery, cancer treatments and in particular extensive prostate surgery are recommended to have some Psychosexual Counselling.

How to find a Sexual Therapist

For more information:

Don’t forget your partner!

There are two of you in the relationship. Female partners of males with erectile dysfunction do seem more likely to have sexual difficulties themselves, than females whose partners have normal erectile function.

Undoubtedly erectile dysfunction affects relationships, causing anxiety and depression on both sides. Anger, frustration and lowered self esteem are common in the female partner. In her blog post ‘Impotence Imposes on Your Partner’, Carol Sorgen discusses three groups of couples with ED: ‘the overcomers’, ‘the resigners’, and the ‘avoiders’.

Talking about your sexual problems is very important. Communication is the key. Don’t shut your partner out. Make sure they are fully informed about what is happening, how you are feeling, and any medical causes. See A Partner’s Guide to Erectile Dysfunction for further advice on this subject.

An interesting new approach to sexual problems in older couples has been given the term ‘Couplepause‘. This concept is all about considering the affect on a couple as they age, and not focusing on each individual. Both parties within the couple need to understand the effects of ageing on both bodies, the hormonal changes, the skin changes and each others’ intimacy needs.

This joined up, holistic approach to the biosocial effects of sex in the older couple, can dramatically help a couple improve their sexual satisfaction.

How often is it best to have sex?

Various studies have suggested that men who have sex less often are more likely to have erectile dysfunction. This maybe a sort of ‘use it, or lose it!’ phenomenon. Men who have sex more often are keeping their nerve function and blood flow channels within the penis in good working order. Masturbation may be helpful, but the jury is out on this.

Men who have regular sex tend to be healthier and live longer than men who don’t. Having sex is a form of cardiovascular exercise, and male ejaculation has been compared to sprinting up two flights of stairs!

Men who have regular sex tend to be live longer than men who don’t. In this study the risk of death showed a statistical reduction in line with the number of annual orgasms!

The benefits of being in a close and loving relationship with a partner should not be underestimated. Our minds and bodies are enriched daily from caring for our partner. There are well known, beneficial effects of touching and intimacy, all of which contribute to our emotional well-being and daily functioning.

There seems to be no consensus of opinion on how often is optimal to have sex. Studies suggest that most couples are having sex once or twice a week, but this frequency falls with age. Most couples believe quality is more important than quantity.

Having sex once every one to three days tends to be the norm, giving both partners recovery time. However some couples do have sex every day. For men with ED, it may be important not to feel under pressure, and to accept that sex once a week is quite normal, and especially in an older man, is enough to achieve good health benefits.