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GoodRx Guide

Erectile Dysfunction: Your GoodRx Guide

Comprehensive information for you or a loved one — including treatment options and discounts on popular medications.
Sophie Vergnaud, MDMandy Armitage, MD
Written by Sophie Vergnaud, MD | Reviewed by Mandy Armitage, MD
Updated on December 1, 2022

Definition

Erectile dysfunction (ED) is when you regularly have difficulty getting an erection or keeping enough of an erection to have satisfying intercourse. All people with penises will have this on occasion — but when it happens more often than not, this is a symptom of ED, or impotence. 

You might have heard of it, but you may not realize how common it is: Some degree of ED is reported by 18% of men over age 20. For men between ages 20 and 39, that number is 5%. But it increases with age. Reports of ED increase to 44% between the ages of 60 and 69 and 70% over age 70.  

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Thankfully, treatments are available for ED. They are generally safe and effective in about 70% of cases. There are also other types of problems with sex. And some people have these along with ED: 

  • Low libido: when you have little or no interest in sex 

  • Premature ejaculation: ejaculating too soon after sex begins 

  • Anejaculation: being unable to ejaculate at all (even though you can get and keep an erection)  

Treatments for ED will not help with low libido, premature ejaculation, or other ejaculation problems.

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Causes

ED can happen to anyone at any age. That said, you are more likely to get ED as you get older

You are also more likely to get ED if you:

Other causes of ED include: 

  • Hormonal disorders

  • Nerve disorders

  • Pelvic trauma or surgery

  • Some medications, including those for high blood pressure, depression, and anxiety

Symptoms

The symptoms of ED are straightforward, but ED isn’t an all-or-nothing experience. It exists on a spectrum from mild to complete. Here are some common ways in which people experience ED: 

  • Regular inability to get or keep an erection when they want to have sex

  • Regular inability to get or keep an erection firm enough and long enough for satisfying sex

  • Complete inability to get an erection at any time

  • Sometimes, they may also have a low libido, or reduced interest in sex  

Diagnosis

The most effective treatments for ED require a diagnosis and a prescription. But for many men, visiting a provider and talking about ED can be embarrassing or uncomfortable. It may help to know that providers are used to it (they’ve definitely heard it all). And if you really don’t want to do a face-to-face visit, there are several services that can provide a diagnosis and prescription online

If you have had symptoms for more than 6 months, and you are wondering whether you could have ED, start with an online test. This test is often used by healthcare providers to see how severe your ED is, and how it improves with treatment.   

Most of the time, ED is not serious beyond its impact on people’s personal lives and relationships. But, in about 20% of cases, ED can be a sign of an underlying health problem, such as: 

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When you see a healthcare provider about ED, they will ask some questions and run some simple tests to see whether you have an undiagnosed health condition that could be causing your condition. Getting treatment for that could also improve your ED symptoms without medication — so it might be a win–win. Other causes of ED may be reversible too, such as: 

  • Having overweight

  • Smoking cigarettes

  • Drinking too much alcohol

  • Certain medications

  • Stress

  • Relationship difficulties

  • Hormonal disorders    

If ED is a problem for you, don’t let awkwardness stop you from seeking help. It could help much more than your sex life. 

Medications

The most common medications for ED are sildenafil (Viagra), tadalafil (Cialis), vardenafil (Staxyn), and avanafil (Stendra). These all belong to a class of drugs known as PDE₅ inhibitors. They are safe and effective, and there is very little difference between them in terms of how well they work.

The American College of Physicians recommends that the choice of medication is up to you: It will depend on cost, your lifestyle, and your relationship status.

It’s worth bearing in mind that Viagra is by far the cheapest drug and the one with the longest safety record. 

Viagra (sildenafil)

Viagra is cheap and good for occasional use, but you’ll need to wait 1 to 2 hours after a meal before taking it. It works in as little as 11 minutes and takes 1 hour to reach its maximum effect, and the effects typically last 3 to 5 hours. 

Staxyn (vardenafil)

This is an expensive ED medication without many additional benefits over Viagra. It starts to work in as fast as 14 minutes and takes 45 minutes to reach its maximum effect, and it can last 4 to 5 hours. Vardenafil can’t be taken with a meal, but it may be an option if sildenafil hasn’t worked for you.

Cialis (tadalafil)

This expensive medication for ED has much longer-lasting effects than do other ED medications and can be taken with a meal. Another plus for tadalafil is that it can be taken as a daily dose for those who have a frequent need for it. 

Stendra (avanafil)

Avanafil is the newest ED medication. It works in a similar way to other ED medications. A main advantage is that, at higher doses, it has the fastest onset — 15 minutes or less. It also isn’t affected by food, so you can take it at any time. Stendra is currently only available as a brand medication, meaning you can’t buy a generic version yet.

Possible side effects are similar for all PDE₅ inhibitors:

  • Headache

  • Flushing

  • Nasal congestion

  • Indigestion

  • Abnormal vision

  • Muscle pain

Common concerns

How do erections work anyway?

Erections are the result of a complicated sequence of biological steps involving: 

  • Emotions

  • Nerves

  • Hormones

  • Muscles

Stimulation (emotional, physical, or both) sends a message to the muscles and tissues of the penis. Blood fills the spongy tissues of the penis and makes it rigid enough for intercourse. When the erection ends, blood leaves the tissues, and the penis becomes flaccid again.

There are many steps required to get an erection, and maintaining one requires a careful balance of nerves and hormones. It’s not surprising that, along the way, things can become out of whack.  

How do ED drugs work?

The key player in getting an erection is a substance called nitric oxide (NO). You can think of NO as the “on switch”: It sends a message to the tissues and blood vessels of the penis to open up, which allows blood to fill and harden the penis. The “off switch” for the erection is an enzyme called PDE5 (phosphodiesterase-5).  

To get and maintain a satisfying erection, the on and off switches must be in balance. 

Viagra, vardenafil, and tadalafil are all inhibitors of PDE5: They slow the off switch. You still need to be stimulated in the first place to get an erection (the drugs do not help with that part). Read more.

Is ED serious?

ED is frustrating, but it usually isn’t serious. In 20% of cases, though, ED can be a warning sign that you might have an undiagnosed health condition, such as heart disease or diabetes. Your provider will run some simple tests to see whether this is the case. 

What can I expect when taking an ED medication?

PDE5-inhibitors, such as Viagra, vardenafil, and tadalafil, will help you get and maintain a more satisfying erection in 70% to 80% of cases if you take it correctly. This means taking it with enough time for it to work, following recommendations about food, and making sure you are sufficiently aroused. Your erection won’t be immediate, shouldn't be painful, and won’t last forever. Many men report better self-esteem, confidence, and improved relationships with the help of these medications. Read more.

How do I talk about ED with my partner?

Talking about ED with an existing or new partner can be difficult. You may be worried about how they will react and what questions they might have. A good place to start could be to reassure them that ED is not related to how attracted you are to them. Reading this page together might also be a good way to get a conversation going. 

View All References (9)

Hatzimouratidis, K., et al. (2005). A comparative review of the options for treatment of erectile dysfunction. Drugs.

Mehrotra, N., et al. (2007). The role of pharmacokinetics and pharmacodynamics in phosphodiesterase-5 inhibitor therapy. International Journal of Impotence Research.

Nehra, A., et al. (2012). The Princeton III consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clinic. 

Porst H., et al. (2003). Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after dosing: A randomized controlled trial. Urology. 

Qaseem, A., et al. (2009). Hormonal testing and pharmacologic treatment of erectile dysfunction: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 

Rosen, R. C., et al. (1999). Development and evaluation of an abridged, 5-item version of the International Index of Erectile Dysfunction (IIEF-5) as a diagnostic tool for erectile dysfunction. International Journal of Impotence Research.

Tsertsvadze A., et al. (2009). Oral phosphodiesterase-5 inhibitors and hormonal treatments for erectile dysfunction: a systematic review and meta-analysis. Annals of Internal Medicine. 

Vlachopoulos, C. (2005). Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study. European Urology. 

Yuan, J., et al.  (2013). Comparative effectiveness and safety of oral phosphodiesterase type 5 inhibitors for erectile dysfunction: A systematic review and network meta-analysis. European Urology.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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