Available and future treatments for erectile dysfunction.

There is now a range of treatments for patients with erectile dysfunction (ED) beyond the psychosexual counselling and surgical implants that were the only available management options for many years. Oral treatments, which are minimally invasive, are the favoured first-line option for treatments and include the phosphodiesterase-5 (PDE5) inhibitors, and dopamine agonists such as apomorphine. Psychosexual counselling may still be an appropriate treatment, on its own or in combination, in a minority of patients who do not respond to oral treatment, or where an origin for the ED is likely from the history. The PDE5 inhibitors, sildenafil, tadalafil, and vardenafil, have proven to be effective and well tolerated and facilitate erectile function. Apomorphine is also effective, but causes nausea in a minority of men. The alpha-receptor antagonist yohimbine has been found to be effective in some placebo-controlled trials, but its effectiveness is probably inadequate for treatment of most ED. Intracavernosal injection of drugs such as prostaglandin E1, papaverine, and phentolamine (sometimes in combination) is an effective but invasive treatment. Other treatments include testosterone, vacuum-pump treatment, surgery, and surgical implants, and tend to be used where patients do not respond to oral treatment and counselling.