WebMD Medical Reference

Reviewed by Michael W. Smith, MD, November 2005

If you have diabetes and it has caused erectile dysfunction (ED), you still have every reason to be optimistic about the future and a healthy sex life. There are many proven treatments you can try.

A doctor's first choice for treating erectile dysfunction is usually one of the pills called PDE5 inhibitors. First there was Viagra. Now there's also Levitra and Cialis. All three drugs work in similar ways. They don't increase sexual desire. They make it physically possible to get an erection when you are aroused.

No one of them has been proven to work better than the others. But the time they take to start working and the duration of their effects vary. That's something you may want to consider based on your sexual habits. For example, does spontaneity matter to you, or do you usually plan sex ahead of time?

Viagra starts working in about 15 to 30 minutes and its effects last about four hours. Levitra starts working in about 30 to 60 minutes and lasts four to five hours. Cialis starts working in about 30 to 60 minutes and lasts as long as 36 hours.

These drugs are not good for every man. Men who take nitrate drugs for chest pain or alpha blockers for high blood pressure or prostate problems shouldn't take Cialis, Levitra or Viagra. Other reasons why you may not be able to take these drugs include:

• High blood pressure that isn't under control
• Very low blood pressure
• A heart attack or stroke in the past six months
• Kidney or liver disease
• Retinitis pigmentosa (an eye disease)

Other Treatments for Erectile Dysfunction

If erectile dysfunction pills are out of the question, or if they haven't worked for you, don't worry. There are other good options.

Alprostadil is another drug for erectile dysfunction. However, it's not a pill. One brand, called MUSE, is an alprostadil pellet that you insert into the tip of your penis with an applicator. It widens blood vessels and relaxes smooth muscle tissue in the penis, allowing blood to fill the spongy tissue that makes the penis erect.

Injections directly into the penis are another way to deliver alprostadil. Phentolamine and papaverine are additional drugs that are injected into the penis to treat erection problems. When injecting these drugs there is some risk that your erection may last too long, a condition that can require medical treatment.

Next, you may want to try a vacuum device, or "penis pump." This is typically a clear plastic cylinder with a bulb or plunger and a constriction band.

You put your penis in the cylinder and start pumping. The suction creates a vacuum, so blood rushes in to fill the spaces in the spongy tissue of the penis, creating an erection. The erection lasts only as long as the blood stays in, so you slide the band down around the base of your penis, trapping the blood. It's safe to keep the band on for up to 30 minutes.

These devices are available without a prescription, but it's important to buy them from a reputable manufacturer. The device must include a safety control so you can't harm your penis with too much suction.

Surgery for Erectile Dysfunction

Most men would prefer to avoid surgery, but for some men, penis implants are the best bet for regaining sexual function.

There are two kinds of penis implants. One kind is a rigid but flexible rod implanted in the penis. You bend it up for sex or down for daily living. The other kind is an inflatable implant. The device stores fluid in a reservoir under the skin of your abdomen or scrotum. You press on the reservoir to pump fluid into cylinders in the penis. That creates an erection. A valve drains the fluid out of the penis when you're done.

There are drawbacks to implants. An erection you get with an implant may be slightly shorter than a natural erection. The device itself may malfunction, in which case it would require another surgery to remove or replace it.

Choosing to have a penis implant is a big decision. Once you have it, you may not be able to try other treatments. That's because the implant replaces the chambers in the penis that fill with blood for a natural erection.

Alternative Treatments for Erectile Dysfunction

Before Viagra hit the market in 1998, there was no proven treatment for erectile dysfunction that men could take in pill form. Doctors were interested in yohimbe, an herb that increases heart rate and blood pressure. Some doctors prescribed it to their patients in combination with other treatments for erection problems. Even then it was not a recommended treatment and is still not today. Studies have not proven that it works.

Currently, no herb or supplements have been proven to help with erectile dysfunction. Herbs and supplements that some people believe are helpful include:

• Ginseng
• Horny goat weed
• Ginkgo biloba
• Muira puama
• Pycnogenol
• L-arginine
• Damiana

Before trying any alternative treatment, be sure to ask your doctor about it first. Herbs and supplements, whether they help with erectile dysfunction or not, have real effects on the body. They could cause dangerous reactions with other medicines you might be taking.

SOURCES: American Urological Association, "Management of Erectile Dysfunction," 2005. The American Urological Association Erectile Dysfunction Clinical Guidelines Panel, Report on the Treatment of Organic Erectile Dysfunction, 1996. The American Urological Association Erectile Dysfunction Clinical Guidelines Panel, The Treatment of Organic Erectile Dysfunction: A Patient's Guide, 1996. Gaines, K., "Tadalafil (Cialis) and Vardenafil (Levitra) Recently Approved Drugs for Erectile Dysfunction," Urologic Nursing, 24(1):46-48, 2004. Lamm, Steven, The Hardness Factor, HarperCollins. May 2005. Medscape Drug Reference, "Alprostadil Urethral." Medscape Drug Reference, "Sildenafil Oral." Muserx.net, Vivus, Inc., "Administering MUSE." WebMD Live Events Transcript, "Natural Alternatives to Viagra with Ellen Kamhi," May 26, 2000.