Erectile Dysfunction Treatment: Medicines, Diet & Management

How is Erectile Dysfunction Diagnosed?

Doctors usually diagnose erectile dysfunction by discussing your symptoms, medical history, and sexual health. They may also perform a physical examination to check the penis, testicles and assess nerve function. Doctors may even ask about medicines you take and any underlying health conditions that could contribute to erectile problems.

When diagnosing underlying causes, doctors may perform blood/urine tests, ultrasound, psychological evaluations, or Nocturnal Penile Tumescence (NPT) testing to differentiate between physical and psychogenic causes. This helps detect stress, anxiety, or other mental health issues which may be contributing to erectile dysfunction.

How is Erectile Dysfunction Treated Based on Severity?

The table below shows the recommended treatment approach according to the severity and cause of erectile dysfunction:

Clinical Severity	Treatment Approach
Mild Erectile Dysfunction	Lifestyle changes, such as regular exercise, weight management, stopping smoking, reducing alcohol intake, first-line oral PDE5 inhibitors and addressing stress or anxiety.
Moderate Erectile Dysfunction	Lifestyle changes, along with oral medicines, such as phosphodiesterase type 5 (PDE5) inhibitors, and treatment for underlying conditions that may be contributing to erectile dysfunction.
Severe Erectile Dysfunction	Prescription treatments such as PDE5 inhibitors, self-injection medicines, urethral medication, vacuum erection devices, or testosterone replacement when medically appropriate.
Persistent Erectile Dysfunction	More specialised treatment, which may include penile implants or psychological counselling when emotional or relationship factors contribute to the condition.

Types of Erectile Dysfunction and Their Treatment

Take a look at different types of erectile dysfunction and their treatment:

Type of Erectile Dysfunction	Treatment
Vasculogenic Erectile Dysfunction	Lifestyle changes and management of cardiovascular risk factors, along with erectile dysfunction treatment such as PDE5 inhibitors. Low-intensity shockwave therapy may be considered in selected patients with mild vasculogenic erectile dysfunction.
Neurogenic Erectile Dysfunction	PDE5 inhibitors are recommended as first-line medical treatment. Intracavernous injections or mechanical devices such as vacuum devices may also be used, while penile prostheses may be considered when conservative treatments fail.
Hormonal Erectile Dysfunction	The underlying hormonal problem should be addressed. Testosterone therapy may be considered when clinically indicated in men with low or low-normal testosterone levels and related sexual symptoms.
Drug-Induced Erectile Dysfunction	The healthcare professional may assess whether a medicine or substance is contributing to erectile dysfunction and manage the underlying cause. Other appropriate erectile dysfunction treatments may be used based on the individual's condition.
Psychogenic Erectile Dysfunction	Psychotherapy, psychosexual counselling, or cognitive behavioural therapy may be used. Combining psychological treatment with medical erectile dysfunction therapy may improve treatment outcomes.
Mixed Erectile Dysfunction	A personalised combination of treatments may be used because multiple physical and psychological pathways can contribute to erectile dysfunction.

Oral Medications for Erectile Dysfunction Treatment

The medicines specified below may be prescribed for treating erectile dysfunction:

Sildenafil: A PDE5 inhibitor that helps increase blood flow to the penis during sexual stimulation.
Tadalafil: A PDE5 inhibitor that can help improve erections and may be taken as needed or, in some cases, daily.
Vardenafil: A PDE5 inhibitor that helps improve blood flow to the penis and supports achieving an erection during sexual stimulation.
Avanafil: A PDE5 inhibitor that works by increasing blood flow to the penis and is taken before sexual activity.

Note: Erectile dysfunction medicines should only be taken on the recommendation of a doctor. PDE5 inhibitors are strictly contraindicated with nitrates (such as nitroglycerin), as combining them can cause a sudden, life-threatening drop in blood pressure.

Topical Treatments for Erectile Dysfunction

These are two topical treatment options used in the management of erectile dysfunction:

Topical Alprostadil Cream: Creams containing alprostadil may be applied to the tip of the penis to help increase blood flow and produce an erection.
Topical Erectile Dysfunction Gels: Topical gels containing agents such as glyceryl trinitrate or other topical formulations are being studied as alternative treatments for erectile dysfunction.

Other Treatments for Erectile Dysfunction

Apart from oral medicines, doctors may recommend the following other treatment options for erectile dysfunction based on its underlying cause and individual needs:

Vacuum Erection Devices A vacuum erection device uses a tube placed over the penis to create a vacuum that draws blood into it. A tension ring may then be placed at the base of the penis to help maintain the erection.
Injections and Urethral Medicines In some cases, doctors may prescribe medicines (such as alprostadil) that are injected into the penis or inserted into the urethra to help increase blood flow and produce an erection.
Surgical Procedures In severe cases of erectile dysfunction, or when other treatments do not work, doctors may recommend surgical procedures such as penile implant surgery, in which an inflatable or malleable device is placed inside the penis to help achieve an erection. Penile vascular surgery may also be considered in selected cases to repair blood vessels and improve blood flow to the penis.
Psychological Counselling If stress, anxiety, depression, or relationship problems contribute to erectile dysfunction, counseling or therapy may help address these factors. Psychological treatment may also be combined with other erectile dysfunction treatments.

Ayurvedic and Alternative Treatments for Erectile Dysfunction

Listed below are some Ayurvedic and complementary treatment options that may help support sexual health and manage factors contributing to erectile dysfunction:

Ashwagandha: This Ayurvedic herb may be used to manage erectile dysfunction and support male sexual health.
Vajikarana Therapy: This Ayurvedic therapy uses different herbal formulations, including vrihani gutika, vrishya gutika, upatyakari shashtikadi gutika, medadi yoga, and vajikaranam ghritam.
Cinnamomum Cassia: Cinnamon has been studied for its potential effects on erectile tissue, although more research is needed.
Yoga: Yoga may help reduce stress and improve factors such as blood circulation, muscle strength, and sexual stamina.

Note: Consult a qualified healthcare professional before trying Ayurvedic or alternative treatments for erectile dysfunction.

Home Care for Managing Erectile Dysfunction

The simple home-care measures for managing erectile dysfunction are given below:

Get plenty of rest and take time to relax.
Practise relaxation techniques, such as deep breathing, to help manage stress.
Avoid recreational or illegal drugs.
Keep track of when erection problems occur.
Avoid smoking and alcohol consumption.
Practice pelvic floor exercises (kegels).
Adopt a healthy-heart diet.

Latest Treatment for Erectile Dysfunction in India

Recent advances in erectile dysfunction treatment have focused on newer and less invasive options for men who do not respond adequately to standard oral medicines. These include low-intensity extracorporeal shockwave therapy (Li-ESWT), which may help improve erectile function in selected men with vasculogenic erectile dysfunction, although its use remains dependent on appropriate patient selection.

Other newer approaches being studied include regenerative treatments such as platelet-rich plasma (PRP) and stem cell therapy. However, these treatments are still in a state of development, and further clinical evidence is required before they can be regarded as a standard treatment for erectile dysfunction.

How Long Does Erectile Dysfunction Treatment Take?

Take a look at the approximate duration of different types of erectile dysfunction treatments:

Treatment	Duration
Oral Medicines	30 minutes to 1 hour before sexual activity, depending on the medicine prescribed.
Penile Injection Medicines	An erection lasting up to 1 hour, depending on the prescribed dose.
Intraurethral Medicines	Erection starts within 10 minutes, lasts between 30 to 60 minutes.
Penile Implant	Long-term treatment, as the implanted device is intended to remain in place.

Erectile Dysfunction Treatment Side Effects

The medicines and other treatments prescribed for erectile dysfunction may cause side effects such as:

Headache
Flushing
Upset stomach
Stuffy nose
Back pain or muscle aches
Changes in vision
Burning sensation
Prolonged or painful erection (priapism)
Pain or bruising at the injection site (with penile injections)
Low blood pressure, particularly when erectile dysfunction medicines interact with nitrates or alpha-blockers.

Note: If erection lasts more than 4 hours, it is recommended to seek immediate emergency medical care to prevent permanent structural damage to penile tissue.

Lifestyle Changes for Managing Erectile Dysfunction

The lifestyle changes given below may help improve erectile function and support overall treatment:

Maintain a healthy weight.
Exercise regularly.
Follow a healthy, balanced diet.
Quit smoking or avoid tobacco use.
Limit alcohol consumption.
Manage and reduce chronic stress.
Keep underlying health conditions, such as diabetes and high blood pressure, under control.

Factors That Can Worsen Erectile Dysfunction

Certain health conditions and factors can contribute to erectile dysfunction or make existing symptoms worse. These include:

Stress and anxiety
Depression
Smoking
Excessive alcohol intake
Diabetes
High blood pressure
Heart disease
Obesity
Low testosterone

Erectile Dysfunction Treatment Cost

The cost of treating erectile dysfunction in India depends on the underlying cause, treatment method, hospital, and city. Treatment expenses can range from a few thousand rupees for non-surgical options to several lakhs for surgical treatment. For example, vacuum erection devices may cost around ₹4,000 to ₹18,500, while psychotherapy may cost approximately ₹1,500 to ₹9,500 per session. Shockwave therapy may cost around ₹14,000 to ₹16,500 per session.

For severe or treatment-resistant erectile dysfunction, penile implant surgery can cost approximately ₹2.5 lakh to ₹6 lakh, depending on the type of implant used.

Does Health Insurance Cover Erectile Dysfunction Treatment in India?

Most health insurance policies do not directly cover erectile dysfunction treatment in India. Erectile dysfunction is usually considered as lifestyle or cosmetic/non-hospitalization conditions rather than life-threatening medical emergencies.

Treatment of underlying chronic medical conditions such as diabetes, cardiovascular diseases, etc., which results in ED is generally covered by most mediclaim policies. It is advisable to contact your insurer directly to confirm the full extent of your coverage.

If health insurance is covered, coverage of at least ₹10 lakh to ₹15 lakh is recommended to help cover hospitalisation, surgery, treatment for underlying medical conditions, and related complications.

Disclaimer: Read the policy documents carefully and confirm coverage with your insurer, as benefits and exclusions vary by plan.

Frequently Asked Questions (FAQs)

Q1. How to improve erectile dysfunction naturally?

Ans: Doing regular exercise, staying at a healthy weight, eating a well-balanced diet, avoiding smoking, restricting alcohol intake, and managing stress could all help to improve erectile dysfunction.
Q2. How do you know if you suffer from erectile dysfunction?

Ans: You may have erectile dysfunction if you have difficulty getting or keeping an erection firm enough for sexual activity repeatedly. A doctor can help confirm the cause.
Q3. How do you fix erectile dysfunction?

Ans: The treatment for erectile dysfunction depends on the underlying cause. The options may include managing health conditions, counselling, oral medicines, vacuum erection devices, injections, or surgery.
Q4. What causes erectile dysfunction in men?

Ans: The primary cause of erectile dysfunction is problems with the blood vessels, such as those resulting from heart disease, high blood pressure, and diabetes.
Q5. Can erectile dysfunction be cured naturally?

Ans: Some people improve their condition by adopting healthy habits and coping with stress. Yet, since natural remedies do not cure erectile dysfunction that is due to an underlying medical condition, a medical evaluation might be needed.
Q6. At what age does erectile dysfunction become common?

Ans: Erectile dysfunction becomes more common with age, particularly in older men, but it is not considered an inevitable part of aging and can occur at any adult age.
Q7. What is the first stage of erectile dysfunction?

Ans: Erectile dysfunction does not have fixed stages. Early signs may include occasional difficulty getting or maintaining an erection, especially if the problem becomes frequent or persistent.
Q8. How can I test myself for erectile dysfunction?

Ans: You can find out whether erection problems occur repeatedly by using established self-assessment questionnaires, such as the International Index of Erectile Function (IIEF). However, a doctor should assess any persistent erectile dysfunction symptoms in order to determine the underlying cause.

References
- https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment
- https://europepmc.org/article/pmc/pmc4442997
- https://www.medicalnewstoday.com/articles/ayurvedic-medicine-for-ed
- https://medlineplus.gov/ency/patientinstructions/000396.htm?
- https://pmc.ncbi.nlm.nih.gov/articles/PMC13168926/