8 Treatment Types for ED

Contents

• Oral ED medication
• Injectable ED medication
• Urethral ED medication
• ED rings
• ED pumps
• Penile splints and rigidity devices
• ED shockwave therapy
• ED surgery and penile implants

Treatment options for erectile dysfunction have expanded substantially over the past 25 years. In the Massachusetts Male Aging Study, 52% of men aged 40 to 70 reported some degree of erectile difficulty. Many try more than one approach; others move from one option to another when side effects, cost, or declining effect make the current one unusable.

Not every clinician discusses the full range. Knowing the main options — cost, effectiveness, and side effects — helps a patient ask better questions.

Oral ED medication

Oral PDE5 inhibitors, introduced in the late 1990s, remain the most common first treatment. They are relatively inexpensive, have a manageable side-effect profile for most users, and are effective for many men.

Cost: Moderate. Roughly $10–$20 per use, depending on drug and source.

Effectiveness: High. In a meta-analysis of randomized trials, 79% of 517 men on dose-adjusted sildenafil reported improved erections, compared with 21% of 524 men on placebo (Moore, Edwards, and McQuay, BMC Urology, 2002). Effectiveness tends to diminish in older men.

Side effects: Usually mild. Vision changes, muscle pain, low blood pressure, headache, flushing, gastrointestinal symptoms. A small percentage stop because of side effects.

Injectable ED medication

Intracavernosal injections were FDA-approved in 1995. In a six-month self-injection study of 683 men, men reported being able to have sexual activity after 94% of injections. Men rated the sexual activity satisfactory after 87% of injections, and their partners after 86% (Linet and Ogrinc, New England Journal of Medicine, 1996).

Side effects can include fainting, dizziness, and low blood pressure. Pain, infection, bruising, and scarring can occur when the injection is hard to administer. In the Linet and Ogrinc study, 50% of men had penile pain, usually mild, at some point, after 11% of injections. In a survey of 1,116 men who had chosen injection therapy (72.5% responded), about 40% had stopped, most within six months. The main reasons were inadequate rigidity, cost, penile discomfort, and lack of spontaneity (Purvis, Egdetveit, and Christiansen, International Journal of Impotence Research, 1999).

Cost: Moderate. Roughly $10–$20 per use.

Effectiveness: High. Sexual activity was possible after 94% of injections in the Linet and Ogrinc study.

Side effects: Moderate. Penile pain is common. About 40% of men in the Purvis survey had stopped treatment.

Urethral ED medication

Pellet medication was FDA-approved soon after injectable medication. A vasodilator pellet is inserted into the urethra with a Medicated Urethral System for Erection (MUSE) and absorbed there.

It costs more per use than oral or injectable medication. It is sometimes used when oral medication fails and the patient cannot or will not inject.

Cost: Expensive. MUSE is about $60 per use.

Effectiveness: In a placebo-controlled trial of 1,511 men, 65.9% had an erection sufficient for intercourse during clinic testing. At home, 64.9% of these responders given alprostadil had intercourse at least once, compared with 18.6% given placebo (Padma-Nathan et al., New England Journal of Medicine, 1997).

Side effects: Moderate. In the same trial, mild penile pain followed 10.8% of treatments. Less common effects include bleeding, spotting, low blood pressure, and dizziness. Female partners can experience burning or itching, possibly from contact with the medication.

ED rings

ED rings are elastic rings or loops that constrict the base of the penis to slow venous outflow (venous leak). Because they act on outflow, they can complement oral, injection, and urethral medications, which primarily raise inflow. They are also used with vacuum erection devices; most pumps ship with some form of constriction ring. See the ED rings guide.

Cost: Inexpensive on a per-use basis. Even higher-priced rings are reusable.

Effectiveness: Moderate. Few rings have clinical trial data. A clinical trial of Xialla found improved erectile function in 14 of 21 men (66%) with moderate to severe ED (Littlemore, Laing, and Bella, Journal of Sexual Medicine, 2017).

Side effects: Minimal compared with drugs. Temporary discomfort or numbness can occur, especially with the wrong size. Follow wear-time limits: maximum 30 minutes continuous wear; remove before sleep; remove immediately if numb, cold, discolored, or painful.

ED pumps

Vacuum erection devices create a vacuum that draws blood into the penis. They are used alone or with medication, injections, or implants.

Cost: Moderate. Medical-grade pumps often cost several hundred dollars, but are reusable at a low cost per use.

Effectiveness: Variable. In a series of 216 men, 84% of the 115 men who replied at a median of 29 months were satisfied (Cookson and Nadig, Journal of Urology, 1993). In a prospective study of 129 men assessed for vacuum therapy, 35% were satisfied and kept using the device long term; 65% stopped, half of them within a month (Dutta and Eid, Urology, 1999).

Side effects: Usually mild. Possible effects include priapism (a persistent, sometimes painful erection) and mild subcutaneous bleeding from excessive vacuum pressure.

Penile splints and rigidity devices

External penile support devices are flexible structures that hold the penis erect during intercourse. Inexpensive options come in standard sizes; some premium models are custom-fitted from measurements.

These devices are relatively new as an ED option. The National Center for Biotechnology Information has noted that some designs may be relevant for patients who want to avoid invasive or pharmacological treatment. No published clinical trial has measured how well these devices treat erectile dysfunction.

Cost: Moderate. Around $300, reusable.

Effectiveness: Unknown. No documented clinical trials establish efficacy.

Side effects: Vendors report minimal side effects; independent data are limited.

ED shockwave therapy

Research into ultrasound or shockwave treatment for ED began in the 1990s. The premise is that acoustic energy can stimulate endothelial cells that regulate vascular tone, and that more endothelial activity might improve erectile function.

A small pilot study of 20 men in 2010 and a larger study of 67 men in 2012 reported measurable improvement in erectile function and penile rigidity. The Class II device used in those early studies is not generally available outside trials. Consumer shockwave treatments today typically use Class I devices that have not been shown to deliver a therapeutic benefit for ED.

Cost: High. Often $2,500 or more, and usually not covered by insurance because the therapy is not an approved ED treatment in this form.

Effectiveness: Unknown for currently marketed consumer devices. Early Class II trials were promising; more research is needed, and those results do not transfer automatically to Class I devices.

Side effects: Minimal in early pilots, including skin bruising and skin infections.

ED surgery and penile implants

Penile implants date to the 1970s. Surgery places inflatable or malleable rods in the penis, with a pump in the scrotum for inflatable models. It is usually reserved for men who do not get adequate results from less invasive options.

Satisfaction rates are consistently high. A 2019 study of 149 men who received three-piece inflatable implants before 2001 reassessed 51 of them after a median of 17 years (Chierigo et al., Journal of Sexual Medicine, 2019). From these 51 men, the authors estimated that 53% of devices were still working 20 years after surgery and that 41% of men were still using theirs. Men still using the device reported high quality-of-life scores.

Cost: Very high. Roughly $16,000–$19,000.

Effectiveness: High. A meta-analysis of 83 studies with 12,132 men found an overall patient satisfaction rate of 83% (Corona et al., Andrology, 2025).

Side effects: Mostly surgical: infection, bleeding, and scar tissue. Rarely, a device malfunctions and needs further surgery.

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