Pills for erectile dysfunction: everything to know

A Black man tipping pills from container onto one hand

Your penis needs a healthy blood flow to achieve an erection. ED pills make it easier for blood to flow into the penis by relaxing smooth muscle. You may already be familiar with the names of some better known ED pills like Viagra, Cialis, Levitra and Stendra.

What exactly are ED pills?

ED pills are also known as PDE-5 inhibitors. This is because they block an enzyme called phosphodiesterase (PDE-5), which in turn increases the amount of a chemical that relaxes smooth muscle and widens blood vessels in the penis—allowing the necessary blood flow for an erection.

When are ED pills used after prostate cancer surgery?

Soon after surgery, ED pills are often used in regular low doses—as part of penile rehabilitation. The main purpose in using the pills 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.

For ED pills to work, you’ll need some level of current nerve function. So, the nerves responsible for erections will need to recover from surgery, to some extent, before these pills can be effective.

How do I get started using ED pills?

First, talk to your doctor to understand whether ED pills are a good option for you to try. Your doctor may want to try different pills to find one that works well, and figure out the best dose and how often to take them. Depending on where you live, your choice of ED pill can be limited by cost and health insurance benefit limits. Work with your doctor to get the pill most effective for you at a cost you can afford.

Here are some other things to consider when trying to figure out how helpful ED pills might be for you and when’s the best time to start.

  • When did you have prostate cancer surgery?

    If you’ve recently had prostate cancer surgery, chances are the erection pills may not work for you right away. Some recovery time after surgery and a 50% erection without the pill is usually required before these pills will work to give you an erection firm enough for penetration. This is why these pills often are not helpful right after surgery. However, over time as your erections improve, erection pills may become more effective.

  • How much were the erectile nerves damaged during surgery?

    After prostate cancer surgery, it is common for it to take up to 2 years for the damaged nerves and reduced blood flow to recover. In some people, recovery can continue in the 3rd and 4th year after treatment.

  • How well have your erectile nerves recovered after surgery?

    Each person will respond differently to erection pills. This depends on how well your erectile nerves have recovered after surgery. For example, for some people, erection pills may not work 6 months after surgery, but may work after 18 months. Keep trying erection pills as you recover from surgery—your nerves may be recovering over time.

  • How old are you?

    Erection pills can be less effective the older you are. Older men take longer to get an erection and 37% have trouble keeping an erection.

  • Did you have good erectile function before surgery?

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

No one brand of ED pills works better than another but some men respond better to a particular brand, 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.

Are ED pills easy to use?

Yes, they are pills taken by mouth. Your doctor should tell you how many pills to start with and when to take them. You might need to take them at lower doses regularly when they are being used soon after surgery for penile rehabilitation. And when you are ready to have penetrative sex, you usually take ED pills a couple hours before you have sex. The exact amount of time may vary between different brands of the pills.

Do ED pills have side effects?

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

  • Slight drop in blood pressure and dizziness

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

  • Blurry vision (also called distorted vision) — which is 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 for longer than 4 hours, contact your doctor. You should also contact your doctor if you think you’re experiencing an allergic reaction or more severe symptoms.

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

ED pills are not usually recommended if you are on medications for heart problems. And certain health conditions and medications can affect how well ED pills work or make some of the side effects worse.

For example, if you are taking medications that contain nitrates (like those used to treat heart pain), as well as ED pills, this can create a life-threatening drop in blood pressure. This is because the drop in blood pressure that can come after taking ED pills can be made worse as nitrates also lower blood pressure.

Consider your medical history or current health conditions

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

    Before you use an ED pill, tell your doctor or pharmacist if you:

  • Are taking nitrates for chest pain or angina

  • Have kidney or liver disease

  • 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 ED 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.

Learn tips for success in using ED pills

Working out which pill is going to best suit you is a matter of trying out the different types and choosing one that seems most effective with the least bothersome side effects. Your doctor will help you with this process and you can also read through our tips for success.

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