Erectile dysfunction medication: what you need to know about ED pills

Close up of man about to take a pill

Getting hard 101: your penis needs a healthy blood flow to achieve an erection. This can be more difficult after prostate cancer, but erectile dysfunction (ED) pills can help. By relaxing smooth muscle, ED pills make it easier for blood to flow into the penis.
You may already be familiar with the names of some better known erection pills like Viagra, Cialis, Levitra and Stendra. But what should you know before giving them a try? And if you do use ED pills after prostate cancer treatment, how can you make sure you get the most out of them?
We’ve got everything you need to know.

Your questions about ED pills, answered

What exactly are ED pills?

Erectile dysfunction pills are a medication that increases the amount of a chemical in your body that relaxes smooth muscle and widens blood vessels in the penis—allowing the necessary blood flow for an erection.

How are erection pills used after prostate cancer treatment?

ED pills are often used in regular, low doses shortly after prostate cancer treatment, as part of penile rehabilitation. The goal is to improve blood flow to the penis and keep the penile tissues healthy.

Later on in recovery, when you’re ready to engage in penetrative sex, ED pills can be taken to make erections hard enough for sex. If you’ve had surgery or radiation, the nerves responsible for erections will need a chance to recover before ED pills can be effective for sex.

What should I do if I want to try erectile dysfunction pills?

First, talk to your doctor to understand whether ED pills are a good option for you. Your doctor may want to try different pills, dosages and schedules to find one that works well. Depending on where you live, your choice of ED pill can be impacted by cost and health insurance. Work with your doctor to get the pill most effective for you at a cost you can afford.

Are erection pills easy to use?

Yes. The pills are taken by mouth. Your doctor should tell you how many to start with and when to take them. You might need to take them at lower doses to start with. When you are ready to have penetrative sex, you’ll usually take ED pills a couple hours before sex. The exact time may vary depending on the brand of pill.

Will I get an erection as soon as I take an ED pill?

It’s not like turning on a switch. ED medication will only give you an erection when you are aroused (turned on). Arousal usually involves your mind (thoughts of sex) and your body (physical touch)—for example engaging in foreplay with your partner.

All ED pills will work best about 90 minutes after taking them, and erections will last about as long as they did before prostate cancer treatment. They should soften after you climax the same way as before.

If you have an erection that lasts longer than 4 hours, see a doctor right away. This could be dangerous.

Do erection pills have side effects?

Like all medication, ED pills can have side effects. There may be some differences between individual brands, but the most common side effects include:

  • Slight drop in blood pressure and dizziness.

  • Flushing (redness or warmth in your face, neck or chest).

  • Blurry vision (usually slight, but can lead to dizziness).

  • Heartburn (a burning feeling in your chest or throat).

  • Headache.

  • Indigestion or upset stomach.

  • Muscle aches or back pain.

  • Cold symptoms like nasal stuffiness.

When these medications are used properly, these effects are rare and mild. If any of them last longer than 4 hours—or if you think you’re experiencing an allergic reaction or more severe symptoms—contact your doctor.

Are there situations when I can’t take ED pills?

Erectile dysfunction pills are not usually recommended if you’re on medications for heart problems. Certain health conditions and medications can also affect how well ED pills work or make some side effects worse. For example, if you’re on medications that contain nitrates (like those used to treat heart pain), taking ED pills can cause a life-threatening drop in blood pressure.

Be aware of issues such as a history of prolonged erection, history of myocardial infarction, arrhythmias, stroke, or eye disease. Erection pills can affect some other drugs you may be taking.

Before using ED medication, tell your doctor or pharmacist if you:

  • Are taking nitrates for chest pain or angina.

  • Have a kidney or liver disease.

  • Have had a heart attack or stroke in the past 6 months.

  • Have a medical condition that makes sexual activity risky. For example:

    - Uncontrolled high blood pressure

    - Severe low blood pressure

    - Severe liver disease

    - Unstable angina (chest pain)

To avoid drug interactions or other possible risks with use of erection pills, talk to your doctor about health conditions you have, like issues with your blood pressure or heart conditions, or other medications you are taking.

Things to keep in mind before starting erectile dysfunction pills

  1. How old are you?

    ED pills can be less effective the older you are. Older men take longer to get an erection, and more than one third (37%) have trouble keeping an erection.

  2. Did you have good erections before treatment?

    If you already had trouble with erectile function before prostate cancer treatment, ED pills will not achieve a higher level of erection than what you had previously.

  3. If you had surgery — how long has it been?

    If you’ve recently had surgery, chances are ED pills may not work for you right away. Some recovery time is usually required first. You also need to be able to get a 50% erection without pills in order for them to get you hard enough for penetration during sex. ED pills may become more effective over time, as your erections improve after surgery.

  4. If you had surgery — how much were the erectile nerves damaged (and how well have they recovered)?

    After prostate surgery, it can take up to 2 years for damaged nerves and reduced blood flow to recover. For some people, recovery can continue 3 to 4 years after treatment. You may want to keep trying ED pills as you recover — your nerves may be healing over time.

No one brand of ED pills works better than another, but some men respond better to a particular brand of erection pills compared to others, so you might try different pills to see which one works best for you. Some men have fewer side effects with one brand of ED pills compared to others.

Getting the most out of your ED medication after prostate cancer treatment

Choose the erection pill that’s right for you.

Keep a journal of your experience after taking your medication. This may seem silly, but it can help make sure you’re taking the erection pill that works best for you.

  • Track your erections. Note the quality of each erection after taking the pill and how long it took to get there.

  • Keep track of side effects. This can help you and your doctor choose one with the fewest side effects.

Get the timing right.

To be fair, there’s no one ‘right’ number of times to take ED pills. And more pills are not necessarily better. Instead, think of it this way:

  • Try to re-engage in sexual activity at a similar pace as before your prostate cancer treatment, whether it’s through self-stimulation if you’re going solo, or penetrative or non-penetrative activity if you have a partner alongside.

  • Use an ED pill during sexual activity as often as possible. But don’t feel like you have to use one every time.

    Regular use of ED pills can help you:

  • Get used to how they work

  • Work with your doctor to track your responses over time

Cost may be another factor. If buying ED pills is a burden, just use them from time to time to check if your nerves have sufficiently recovered to respond to erection pills.

Plan ahead when taking erection pills

You’ll need to wait 90 minutes to 4 hours after taking ED pills before you have sex. So you’ll want to plan ahead. It’s also important to:

  • Eat ahead of time. ED pills work best on an empty stomach. Wait at least 2 hours after eating before taking them.

  • Avoid alcohol. Drinking when taking erectile medication makes it less effective.

  • Get frisky. ED pills only work if you are sexually stimulated (aroused) or thinking sexy thoughts.

Change your sex routine

All this planning can make it tough to keep things interesting. Here’s one way you can change things up with the ‘morning routine’.

  • Set your alarm for one hour before your usual awake time.

  • Take an erection pill.

  • Reset your alarm for one hour and go back to sleep.

  • When your alarm goes off, engage in self-stimulation or masturbation, have a little morning rendezvous with your partner or retreat to the shower (the warm water helps increase blood flow to your penis).

The morning routine also helps you avoid food and alcohol restrictions. Plus you should be relaxed and well rested after a good night’s sleep.

Should I tell my partner I’m taking ED pills?

We get it. It can be awkward to say you’re taking the pill and equally awkward to ask your partner if you should take a pill—or if they ask you to take one. But the important thing is for you and your partner to start talking about it early.

  • You could decide it’s best to discuss taking the pill before any sexual activity, to minimize the chance of misunderstanding or letdown.

  • Your partner might want to leave the decision with you so they can enjoy a more spontaneous experience.

  • You could have a go at both approaches to see which works best.

What if you’re dating or just starting a relationship? We’ve got some tips for that, too .

What if I like sex to be spontaneous?

Sex after prostate cancer treatment can feel less natural and spontaneous when you have to plan everything ahead of time. So, it’s easy to see why even taking something as simple as a pill can interfere with the experience. You’re not alone. Struggling with the loss of spontaneity is one of the most common complaints from couples using ED pills.

The best way to overcome these barriers is to work as a team. Every couple is different. We can’t “prescribe” a right way or a wrong way of coping with the loss of naturalness and spontaneity. You will need to figure out what works best for the two of you.