Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual function. Causes include vascular disease, hormonal imbalance, neurological conditions, or psychological factors. Treatment aims to restore sexual function and improve quality of life.
First-line oral medications are phosphodiesterase-5 (PDE-5) inhibitors: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra). These improve blood flow to the penis and are effective in 60–80% of men; they require sexual stimulation to work. Tadalafil's longer half-life (36 hours) suits daily dosing or on-demand use. Testosterone replacement improves ED if hypogonadism is the underlying cause; therapy includes gels, injections, or patches. For men not responding to PDE-5 inhibitors, alprostadil (prostaglandin analogue) can be self-injected or delivered as a urethral suppository; efficacy is good but side effects (pain, systemic effects) limit use. Penile vacuum devices (penis rings) are mechanical, non-invasive, and effective when used correctly. Psychosexual counselling addresses performance anxiety and relationship factors. Vascular surgery is rare but considered in select young men with arterial insufficiency.
Herbal supplements (ginseng, fenugreek, L-arginine) are popular; evidence is modest and mixed. Acupuncture is used in traditional medicine with limited clinical support. Shockwave therapy (low-intensity extracorporeal shock-wave therapy, LiESWT) has emerging evidence for improving vascular function and is used off-label; several trials are ongoing. Topical anaesthetics or desensitising products reduce sensation and may help with premature ejaculation. Pelvic-floor muscle training (Kegel exercises) improves erectile function and ejaculatory control when performed consistently.
Regenerative approaches, particularly stem-cell and platelet-rich plasma (PRP) therapies, are being investigated for ED. Intracavernosal injection of bone-marrow or adipose-derived mesenchymal stem cells may restore vascular and neurological function, reducing fibrosis and enhancing blood flow. PRP injections into the corpus cavernosum are emerging and aim to stimulate tissue repair. These therapies remain investigational, with limited large-scale trials. Candidates are typically men with vascular ED who have not responded adequately to PDE-5 inhibitors. Learn more at regenerative ED options and evaluation criteria.
| Option | Type | Evidence | Indicative cost | Invasiveness | Recovery |
|---|---|---|---|---|---|
| Sildenafil (Viagra) or tadalafil (Cialis) | Standard | Strong | €3–8 per dose | Low | None; effects 30m–36h |
| Testosterone replacement | Standard | Moderate | €50–150/month | Low | Ongoing; effects 4–12 weeks |
| Alprostadil (injection or suppository) | Standard | Strong | €10–20 per dose | Medium | None; effects 30m–60m |
| Penile vacuum device | Standard | Strong | €150–400 one-time | Low | None; reusable |
| Psychosexual counselling | Standard | Moderate | €80–150 per session | Low | Ongoing; 8–12 weeks benefit |
| Low-intensity shock-wave therapy (LiESWT) | Alternative | Moderate | €300–800 per course | Low | None; multiple sessions |
| Herbal supplements (ginseng, L-arginine) | Alternative | Limited | €20–50/month | Low | Ongoing; 4–8 weeks trial |
| Stem-cell or PRP intracavernosal therapy | Regenerative | Investigational | €3,000–12,000 | Medium | Few days; clinical trials ongoing |
PDE-5 inhibitors relax smooth muscle in penile blood vessels, enhancing blood flow. They work only during sexual stimulation—they do not cause spontaneous erections. Effectiveness depends on the underlying cause; they work best if ED is vascular or mixed, less well if purely psychological or neurological.
No. Testosterone therapy helps only if your blood testosterone is genuinely low (hypogonadism). If levels are normal, supplementation adds no benefit and carries risks (prostate effects, cardiovascular changes). A testosterone test is essential before starting therapy.
Common mild side effects include headache, flushing, indigestion, and nasal congestion. Visual changes (blue tint) are rare. Serious contraindications include concurrent nitrate use (severe blood-pressure drop) and uncontrolled cardiovascular disease. Discuss contraindications and side effects with your doctor.
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Educational overview of treatment options; not medical advice. Standard treatments reflect mainstream guidance; regenerative/stem-cell uses are largely investigational. Reviewed by the StemCellAtlas editorial team.
GMP-zertifizierte regenerative Medizin mitten in der EU — ab 3.000–8.000 €, ein Bruchteil der US- oder Deutschland-Preise. Individuelle Protokolle für internationale Patienten aus über 50 Ländern.
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