Erectile Dysfunction (ED) can take a significant toll on your confidence, relationships, and overall quality of life. As a vascular surgeon who treats patients with ED every day, I want to help you better understand the medications that are often the first line of treatment: phosphodiesterase type 5 inhibitors, or PDE5 inhibitors.
These medications have changed the way we approach ED, offering a non-invasive way to improve blood flow and restore sexual function. In this guide, I’ll walk you through how these medications work, when they’re effective, and what to do if they’re not delivering results.
What Are PDE5 Inhibitors?
PDE5 inhibitors are oral medications that enhance blood flow to the penis, allowing men to achieve and maintain erections during sexual stimulation. These are the most commonly prescribed ED medications, and include:
- Sildenafil (Viagra): One of the earliest and most widely used. It begins working in 30 to 60 minutes and lasts about 4–5 hours.
- Tadalafil (Cialis): Known for its long-lasting effect—up to 36 hours—which allows for more flexibility.
- Vardenafil (Levitra): Similar to sildenafil in onset and duration, but may work better for some men.
- Avanafil (Stendra): A newer option with the fastest onset—sometimes in as little as 15 minutes.
How Do These Medications Work?
During sexual arousal, your body releases nitric oxide, a molecule that relaxes the smooth muscle in your blood vessels. This relaxation allows increased blood flow to the penis. PDE5 inhibitors enhance and prolong this effect by preventing the breakdown of a molecule called cGMP, which is crucial for maintaining an erection.
In short: PDE5 inhibitors help your blood vessels stay open longer, improving the quality and duration of your erections.
Who Can Benefit from PDE5 Inhibitors?
These medications are effective for many men, including those with:
- Diabetes
- High blood pressure
- Mild to moderate heart disease
They’re easy to take, non-invasive, and often provide fast results.
Who Should Avoid Them?
Not everyone is a candidate for PDE5 inhibitors. You should avoid them if you:
- Take nitrates for chest pain
- Have severe heart or liver disease
- Have been advised against sexual activity by your doctor
Always speak with a qualified physician before starting any ED treatment.
Possible Side Effects
While generally safe, PDE5 inhibitors can cause side effects such as:
- Headache
- Flushing
- Nasal congestion
- Dizziness
- Indigestion
- Visual changes
More serious side effects, like priapism (an erection lasting more than 4 hours) or sudden vision/hearing loss, are rare but require immediate medical attention.
What If They Don’t Work?
In my practice, I see many men who have tried these medications without success. This is often due to underlying vascular issues, such as:
- Penile arterial disease: Blocked or narrowed arteries limit blood flow.
- Venous leak: Blood escapes too quickly from the penis, preventing a sustained erection.
If pills haven’t worked for you, you’re not alone—and you may have a treatable vascular cause. Advanced testing and minimally invasive procedures are available to address the root of the problem.
Next Steps
If you’re struggling with ED and looking for real solutions, I encourage you to take the first step. At the Vascular Institute for Erectile Dysfunction, we offer advanced diagnostics and cutting-edge treatments that go beyond the pill.
Schedule a consultation today to see if you’re a candidate for a personalized treatment plan.
You don’t have to live with ED. Let’s work together to restore your confidence and quality of life.
— Dr. Khalil Masabni
