Lifestyle Changes and ED Medication

Some allow you to make specific requests to delete your data; others don’t. Talkspace stands alone among these companies for two reasons. First, it allows you to manually delete messaging information between you and your doctor if you switch doctors and want a clean slate. Having all your old messages accessible to your new doctor may introduce certain prejudices in treatment, or you simply may want to start from scratch for your own sake. Whatever the case, we appreciate this option from Talkspace. Second, Talkspace states it will retain your data only as long as your account is active. That means it’s gone once you fully delete your account. Other companies will retain the same data for up to ten years. The companies in this part of our guide are all benefactors of a combined tech and telehealth boom in the late 2010s and early 2020s.

What Medications Can Treat ED?

Shockwave treatment and vacuum erection assistance are very much medical treatments, whereas penis rings have roots in the fetish community and have been adopted as a practical solution for men with ED. We often steer men toward shockwave treatment because research suggests it could have lasting positive effects on erectile health.18 The only downside is that you have to see a urologist to have the treatments performed on you. At-home devices exist, but blue tablets they’re typically unregulated, potentially dangerous, and universally very loud. Having the treatments in a clinical setting provides you with the peace of mind that they’re being performed correctly with the best possible equipment, but they can be very expensive over the course of treatment. By comparison, penis rings offer a degree of efficacy for a very low price.

Medication May Not Be the Solution

But it’s important to remember that you can use penis rings even if you’re also undergoing shockwave treatment (though, ideally, not at the exact same time). So, the rings can help you immediately, provided your ED is mild enough, even as you work toward more lasting erectile health through other treatments. Can be uncomfortable or awkward to use Men with very large or small penises may have a hard time Difficult to differentiate among brands and models Penis rings, known colloquially as cock rings, look a lot like rubber gaskets that you’d see in the plumbing aisle of a home improvement store. They’re thin, round, and flexible O shapes that you fit around the base of your penis to constrict blood flow. Because they’re bigger than your penis is thick when it’s flaccid, they won’t stop blood from flowing in, but if you can get the blood in there and the penis thickens, they can stop that blood from flowing out.

Sildenafil (Viagra)

For some men, the use of rings also provides an additional physical or psychological stimulus, increasing the odds of a successful erection. The best part about rings is that you can use them in conjunction with just about any other ED treatment on the market, from PDE5 inhibitors and supplements to shockwave devices and penis pumps. However, penis rings come with a unique set of risks, most notably the danger of completely cutting off blood flow to the penis and the possibility of something called penile entrapment. Cases of entrapment, which are more commonly seen with metal penis rings, occur when you can get the ring on, but you can’t get it off.34 This can result in numerous complications, but it’s fairly easy to manage with the help of a medical professional, who will likely need to remove the ring by force (e.g., with bolt cutters or a saw). In our estimation, the rings offered by Hims are among the best out there. As such, they all offer sleek, responsive interfaces with good apps and reliable communications. Cerebral has an edge here, thanks to the positive experiences we had in extensive testing. None of these companies ever let us down through our sessions, but Cerebral’s platform felt simultaneously more accessible and more discreet than others. Cerebral also had our preferred therapist selection tool. Again, this win was marginal, with BetterHelp and Talkspace offering platforms that others may very well prefer. Any man who has lost or failed to achieve an erection would tell you there are undeniable emotional and psychological effects from the experience. Fear, anger, stress, and disappointment are just some of the most common responses to such an event.29 There are myriad physiological reasons a man can have a one-time erectile hiccup that isn’t ED, but the anxiety surrounding that experience can fuel future failures. And that only covers psychogenic ED that starts from one or two minor physiological issues that are easily corrected, like fatigue or overconsumption of alcohol. There are also countless cases of psychogenic ED that arise from other psychological concerns that have physiological effects on the body.30 For example, chronically elevated cortisol levels in patients with anxiety can lead to episodes of ED.

So, too, can depression have significant effects on libido.31 Treating these issues directly, through talk therapy, psychiatric medication, or a combination of the two, should have similar effects as treating high blood pressure in men whose hypertension is causing erectile issues. By treating the root cause of the ED, you can, in theory, eliminate the ED.

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

They come in two sizes that should serve the vast majority of men, and they’re flexible enough to come off safely when it’s time to remove them. Ideal for men who have postsurgical ED (e.g., after prostatectomy) Water-based pumps demand use in the shower Penis pumps are essentially little vacuum chambers out of which you pump the air after inserting your penis. Some do this with manual pumps, while others work electronically. As the air is sucked out of the chamber, the vacuum force in its place applies suction to your penis, causing it to fill with blood.35 Penis pumps occupy a specific section of ED research that focuses on treatment for men who've undergone radical prostatectomies or similar surgeries that have caused their ED.36 In some cases, another side effect of such surgeries is a phenomenon in which the penis retreats somewhat into the body. They’ve been shown to work for other types of ED, as well, but the majority of the research seems to focus on postoperative ED.

Testosterone Replacement Therapy

Some research has also highlighted the potential for pumps to help with Peyronie’s disease, a painful curvature of the penis that involves calcium deposits around the shaft.37 As with other device-based therapies, you might want to use penis pumps as one part of a multipronged treatment approach. They pair well with rings to ensure that the blood you’ve drawn into your penis doesn’t escape. The biggest fault of penis pumps is that they can be a pain to use, both literally and figuratively (he vacuum pressure can be uncomfortable). Some brands, like Bathmate, are designed to be used with water in the chamber, which softens the experience. But these necessitate a shower or a bath that can get in the way of foreplay and slow down a passionate moment. There are inherent risks with any kind of healthcare, including both psychiatry and talk therapy. While the latter certainly seems safe, there’s always a risk of exposing underlying trauma or deepening symptoms of anxiety or depression along your journey.32 For some patients, these twists and turns are inevitable parts of the healing process. Psychiatry presents more obvious risks, as psychiatric medications each come with their specific sets of potential side effects and contraindications.33 You and your consulting health professional — typically a psychiatric mental health nurse practitioner in the telehealth space — will have to review these potential risks to determine which medication would best suit your needs. Sildenafil and tadalafil — the active ingredients in Viagra and Cialis, respectively — remain the most reliable treatments for erectile dysfunction, but some men may prefer to avoid medications of any kind. Others, of course, discover through consultation that they aren’t viable candidates for prescription ED treatments.

• Duration Comparison: Sildenafil/Vardenafil/Avanafil (4-6 hrs), Tadalafil (up to 36 hrs), Injections (1-2 hrs).
• Side Effect Management: Headache, flushing, nasal congestion common; usually mild and temporary.
• Food Interactions: High-fat meals delay sildenafil and vardenafil absorption; less impact on tadalafil.
• Alcohol Limitation: Heavy drinking worsens ED; moderate consumption may be okay with some pills.
• Vision Changes (rare): Non-arteritic anterior ischemic optic neuropathy (NAION) reported with PDE5 inhibitors.

Still others may want to throw everything but the kitchen sink at the problem and use a multipronged treatment approach that includes prescription ED medication and devices.

• Always consult a healthcare professional before starting ED medication.
• Check for interactions with other medications or health conditions.
• Be aware of possible side effects: headaches, flushing, nasal congestion.
• ED pills do not increase sexual desire, only help with erection during arousal.
• Use as prescribed; overdose can cause serious health issues.
• Some ED medications are not suitable for heart patients.
• Alcohol can interact negatively with ED pills, reducing effectiveness.
• Maintain a healthy lifestyle for better results: exercise, diet, adequate sleep.
• Remember that psychological factors also influence erectile function.
• ED medications may lose effectiveness over time; consult doctor if needed.
• Cost varies; generic options are often more affordable than brand-name drugs.
• Ensure purchase from reputable sources to avoid counterfeit medications.

For all of these groups, there are physical treatment devices that can help. There are essentially three main types of physical devices you can use to combat ED, one of which is intended to treat the condition itself, while the other two are intended to help with immediate erectile performance: Shockwave devices rely on low-intensity shockwave therapy (LI-SWT) to apply acute pressure with acoustic shock waves that stimulate blood flow and repair penile tissue toward healthier erections.18 Penis rings apply physical pressure at the base of the penis to restrict blood flow out of the penis after an erection is achieved.

The bottom line

Fear, anger, stress, and disappointment are just some of the most common responses to such an event.29 There are myriad physiological reasons a man can have a one-time erectile hiccup that isn’t ED, but the anxiety surrounding that experience can fuel future failures. And that only covers psychogenic ED that starts from one or two minor physiological issues that are easily corrected, like fatigue or overconsumption of alcohol. There are also countless cases of psychogenic ED that arise from other psychological concerns that have physiological effects on the body.30 For example, chronically elevated cortisol levels in patients with anxiety can lead to episodes of ED. So, too, can depression have significant effects on libido.31 Treating these issues directly, through talk therapy, psychiatric medication, or a combination of the two, should have similar effects as treating high blood pressure in men whose hypertension is causing erectile issues. By treating the root cause of the ED, you can, in theory, eliminate the ED.

Vacuum Devices

There are inherent risks with any kind of healthcare, including both psychiatry and talk therapy. While the latter certainly seems safe, there’s always a risk of exposing underlying trauma or deepening symptoms of anxiety or depression along your journey.32 For some patients, these twists and turns are inevitable parts of the healing process. Psychiatry presents more obvious risks, as psychiatric medications each come with their specific sets of potential side effects and contraindications.33 You and your consulting health professional — typically a psychiatric mental health nurse practitioner in the telehealth space — will have to review these potential risks to determine which medication would best suit your needs. Sildenafil and tadalafil — the active ingredients in Viagra and Cialis, respectively — remain the most reliable treatments for erectile dysfunction, but some men may prefer to avoid medications of any kind. Others, of course, discover through consultation that they aren’t viable candidates for prescription ED treatments.

FYI on ED

Still others may want to throw everything but the kitchen sink at the problem and use a multipronged treatment approach that includes prescription ED medication and devices. For all of these groups, there are physical treatment devices that can help. There are essentially three main types of physical devices you can use to combat ED, one of which is intended to treat the condition itself, while the other two are intended to help with immediate erectile performance: Shockwave devices rely on low-intensity shockwave therapy (LI-SWT) to apply acute pressure with acoustic shock waves that stimulate blood flow and repair penile tissue toward healthier erections.18 Penis rings apply physical pressure at the base of the penis to restrict blood flow out of the penis after an erection is achieved. They may also aid in physical and psychological arousal. Penis pumps apply vacuum pressure to the penis to draw blood into it and create an erection. They may also aid in physical and psychological arousal.

• Cialis for Daily Use: 2.5mg or 5mg taken daily, maintains steady medication levels in the bloodstream.
• Levitra 20mg: Higher strength for patients needing a more potent vardenafil effect.
• Kamagra (Unofficial Sildenafil): Not FDA-approved, often sold online, carries significant safety risks.
• Heart Health Assessment: Essential first step, ED can be an early sign of cardiovascular disease.
• Drug Interaction Review: Crucial before starting any ED pill, especially with nitrates or alpha-blockers.

Penis pumps apply vacuum pressure to the penis to draw blood into it and create an erection.

Do erection pills have side effects?

Research is still less thorough for supplement ingredients, which makes it harder to assess reliability and safety for everyone. They also typically come in only one dose, so the efficacy can be wildly different in men with disparate BMIs and metabolisms. And from a cost standpoint, supplements are often much more expensive than prescriptions, especially considering generic options. Shockwave treatment and vacuum erection assistance are very much medical treatments, whereas penis rings have roots in the fetish community and have been adopted as a practical solution for men with ED.

Surgery for ED

Prescription ED medications are safe and effective ways for most men to treat ED. However, not all men want to take prescription medication, and some men cannot take PDE5 medicine safely. Based on our research, we believe you may find an effective treatment for very mild cases of ED using a nutritional supplement. As with any medication or supplement, it’s important to discuss this with your primary care provider to make sure there’s nothing in your medical history that might make these alternative treatments unsafe for you. Nutritional supplements don’t work as strongly as prescription ED medications, based on clinical research. We often steer men toward shockwave treatment because research suggests it could have lasting positive effects on erectile health.18 The only downside is that you have to see a urologist to have the treatments performed on you. At-home devices exist, but blue tablets they’re typically unregulated, potentially dangerous, and universally very loud. Having the treatments in a clinical setting provides you with the peace of mind that they’re being performed correctly with the best possible equipment, but they can be very expensive over the course of treatment. By comparison, penis rings offer a degree of efficacy for a very low price. But it’s important to remember that you can use penis rings even if you’re also undergoing shockwave treatment (though, ideally, not at the exact same time).

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

Some allow you to make specific requests to delete your data; others don’t. Talkspace stands alone among these companies for two reasons. First, it allows you to manually delete messaging information between you and your doctor if you switch doctors and want a clean slate. Having all your old messages accessible to your new doctor may introduce certain prejudices in treatment, or you simply may want to start from scratch for your own sake. Whatever the case, we appreciate this option from Talkspace.

PDE5 Inhibitors

Second, Talkspace states it will retain your data only as long as your account is active. That means it’s gone once you fully delete your account. Other companies will retain the same data for up to ten years. The companies in this part of our guide are all benefactors of a combined tech and telehealth boom in the late 2010s and early 2020s. As such, they all offer sleek, responsive interfaces with good apps and reliable communications.

Language matters

Cerebral has an edge here, thanks to the positive experiences we had in extensive testing. None of these companies ever let us down through our sessions, but Cerebral’s platform felt simultaneously more accessible and more discreet than others. Cerebral also had our preferred therapist selection tool. Again, this win was marginal, with BetterHelp and Talkspace offering platforms that others may very well prefer. Any man who has lost or failed to achieve an erection would tell you there are undeniable emotional and psychological effects from the experience. So, the rings can help you immediately, provided your ED is mild enough, even as you work toward more lasting erectile health through other treatments. Can be uncomfortable or awkward to use Men with very large or small penises may have a hard time Difficult to differentiate among brands and models Penis rings, known colloquially as cock rings, look a lot like rubber gaskets that you’d see in the plumbing aisle of a home improvement store. They’re thin, round, and flexible O shapes that you fit around the base of your penis to constrict blood flow. Because they’re bigger than your penis is thick when it’s flaccid, they won’t stop blood from flowing in, but if you can get the blood in there and the penis thickens, they can stop that blood from flowing out. For some men, the use of rings also provides an additional physical or psychological stimulus, increasing the odds of a successful erection. The best part about rings is that you can use them in conjunction with just about any other ED treatment on the market, from PDE5 inhibitors and supplements to shockwave devices and penis pumps. However, penis rings come with a unique set of risks, most notably the danger of completely cutting off blood flow to the penis and the possibility of something called penile entrapment. Cases of entrapment, which are more commonly seen with metal penis rings, occur when you can get the ring on, but you can’t get it off.34 This can result in numerous complications, but it’s fairly easy to manage with the help of a medical professional, who will likely need to remove the ring by force (e.g., with bolt cutters or a saw). In our estimation, the rings offered by Hims are among the best out there. They come in two sizes that should serve the vast majority of men, and they’re flexible enough to come off safely when it’s time to remove them. Ideal for men who have postsurgical ED (e.g., after prostatectomy) Water-based pumps demand use in the shower Penis pumps are essentially little vacuum chambers out of which you pump the air after inserting your penis. Some do this with manual pumps, while others work electronically. As the air is sucked out of the chamber, the vacuum force in its place applies suction to your penis, causing it to fill with blood.35 Penis pumps occupy a specific section of ED research that focuses on treatment for men who've undergone radical prostatectomies or similar surgeries that have caused their ED.36 In some cases, another side effect of such surgeries is a phenomenon in which the penis retreats somewhat into the body. They’ve been shown to work for other types of ED, as well, but the majority of the research seems to focus on postoperative ED. Some research has also highlighted the potential for pumps to help with Peyronie’s disease, a painful curvature of the penis that involves calcium deposits around the shaft.37 As with other device-based therapies, you might want to use penis pumps as one part of a multipronged treatment approach. They pair well with rings to ensure that the blood you’ve drawn into your penis doesn’t escape. The biggest fault of penis pumps is that they can be a pain to use, both literally and figuratively (he vacuum pressure can be uncomfortable). Some brands, like Bathmate, are designed to be used with water in the chamber, which softens the experience. But these necessitate a shower or a bath that can get in the way of foreplay and slow down a passionate moment. Prescription ED medications are safe and effective ways for most men to treat ED.

• ED medications are not an instant cure; they assist during sexual activity.
• Always follow dosage instructions provided by your doctor.
• Avoid mixing ED pills with recreational drugs or nitrates.
• Monitoring side effects can help determine the right medication.
• Some men may need multiple tries to find optimal treatment.
• Communicate openly with your partner about ED treatment options.
• Remember that age and health status influence medication choice.
• In some cases, underlying health issues need addressing first.
• Explore alternative therapies if medications are ineffective or unsuitable.
• Use medications as part of a broader approach to sexual health.
• Consider psychological factors that may contribute to ED.
• Keep regular medical appointments for ongoing evaluation.

However, not all men want to take prescription medication, and some men cannot take PDE5 medicine safely. Based on our research, we believe you may find an effective treatment for very mild cases of ED using a nutritional supplement. As with any medication or supplement, it’s important to discuss this with your primary care provider to make sure there’s nothing in your medical history that might make these alternative treatments unsafe for you. Nutritional supplements don’t work as strongly as prescription ED medications, based on clinical research. Research is still less thorough for supplement ingredients, which makes it harder to assess reliability and safety for everyone. They also typically come in only one dose, so the efficacy can be wildly different in men with disparate BMIs and metabolisms. And from a cost standpoint, supplements are often much more expensive than prescriptions, especially considering generic options.