What Are the Potential Side Effects of Erectile Dysfunction Medications, and Are There Alternative Treatments?

What Are the Potential Side Effects of Erectile Dysfunction Medications, and Are There Alternative Treatments?

Erectile dysfunction (ED), or the inability to get and maintain an erection long enough for satisfactory sexual activity, is a common condition that affects men around the world. This condition can contribute to personal distress, relationship issues, and/or mental health problems for those who struggle with it.

Fortunately, there are effective oral medications available to treat ED, such as Viagra (sildenafil), Cialis (tadalafil), Levitra and Staxyn (vardenafil), and Stendra (avanafil). These medications are known as phosphodiesterase 5 (PDE5) inhibitors, and they can provide significant relief to individuals who take them.

Nevertheless, PDE5 inhibitors may also come with potential side effects. The following are some possible side effects of oral ED medications:

  • Headaches: One of the most common side effects of PDE5 inhibitors is headaches. These can range from mild to severe and may occur shortly after taking the medication.
  • Flushing of the skin: Some people experience facial flushing or redness in the face and neck, often described as a warm sensation. This is due to the medication’s effect of dilating blood vessels throughout the body.
  • Digestive issues: Oral ED medications can lead to mild digestive problems, including indigestion, stomach discomfort, and diarrhea.
  • Nasal congestion: A stuffy or runny nose can also occur as a result of taking these medications. It is usually a minor inconvenience.
  • Muscle aches: Some types of PDE5 inhibitors can cause muscle aches or soreness.
  • Vision changes: In rare cases, ED medications have been linked to vision changes, such as blurred vision, sensitivity to light, or a temporary bluish tint. While seeing a temporary bluish tint is not a medical emergency, if any of the other symptoms occur, seek immediate medical attention.
  • Priapism: Also rare, priapism, a painful and prolonged erection lasting more than four hours, is a serious side effect that requires immediate medical attention. Failure to treat priapism promptly can lead to permanent damage to the penis.
  • Interactions with other medications: If you are planning to take oral ED medications, it is crucial to inform your health care provider of all medications you are taking. PDE5 inhibitors can interact poorly with certain drugs, particularly those containing nitrates.

If you and your health care provider determine that oral ED medications may not be right for you, (particularly if they interact with other medications), there are alternative treatments for ED available.

Firstly, lifestyle changes, such as regular exercise, a balanced diet, maintaining a healthy weight, quitting smoking, and reducing stress can support healthy erectile functioning. This is because these changes promote good overall cardiovascular health, which is closely linked to erectile function.

For some men, ED has psychological causes. Counseling or psychotherapy, such as cognitive-behavioral therapy (CBT), can help address performance anxiety or relationship issues contributing to ED.

Alternatively, vacuum erection devices are external devices that create a vacuum around the penis, drawing blood into it and facilitating an erection. Then, a constriction band can be used to keep the blood in the penis and maintain the erection. These devices are a safe and effective alternative to oral ED medications for some men.

Intracavernosal injections involve directly injecting a medication into the penis that relaxes the blood vessels and increases blood flow to induce an erection. Additionally, intraurethral suppositories and topical agents such as the FDA-approved Eroxon can be used to create erections.

Low-intensity shockwave therapy is a relatively new and potentially promising treatment for ED. It works by using low-energy shockwaves to improve blood flow and stimulate the growth of new blood vessels in the penis, but there is still debate within the sexual medicine community around its effectiveness.  

Lastly, surgically implanted inflatable penile prostheses (IPPs) or malleable prostheses can provide a lasting solution to ED. IPPs are discreet and can be inflated to create an erection when desired, while malleable devices can be maneuvered into position away from the body to create an erection.

For more information on this topic, please read these publications from the ISSM Journals: The Journal of Sexual Medicine, Sexual Medicine Reviews, and Sexual Medicine Open Access:

Cardiovascular Outcome Risks in Patients With Erectile Dysfunction Co-Prescribed a Phosphodiesterase Type 5 Inhibitor (PDE5i) and a Nitrate: A Retrospective Observational Study Using Electronic Health Record Data in the United States

Update on the Safety of Phosphodiesterase Type 5 Inhibitors for the Treatment of Erectile Dysfunction


Lue, T.F. (2000). Erectile dysfunction. New England journal of medicine342(24), 1802-1813. DOI: 10.1056/NEJM200006153422407

Mayo Clinic. (2023, June 24). Erectile dysfunction: Viagra and other oral medications. https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/in-depth/erectile-dysfunction/art-20047821

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