Most tablets work by increasing the blood flow to your penis. They do this by affecting cGMP, the chemical involved in dilating (widening) the blood vessels when you are sexually aroused. One drug, apomorphine works by increasing the level of certain chemicals in the brain which are involved in sending messages down nerves to the penis when you are sexually aroused.
You can place a small pellet into the end of the urethra (the tube which passes urine and opens at the end of the penis). The pellet contains a similar medicine to that used for the injection treatment. The medicine is quickly absorbed into the penis to cause an erection, usually within 10-15 minutes.
This was the most common treatment before tablets became available. It usually works very well. You are taught how to inject a medicine into the base of the penis. This causes increased blood flow, and an erection usually develops within 15 minutes.
Pelvic floor muscle exercises
A common treatment for incontinence in women is to strengthen the pelvic floor through exercise. Some studies suggest that strengthening the pelvic floor muscles in men can cure ED in some cases.
The pelvic floor muscles are a group of muscles that wrap around the underside of the bladder and rectum. One of these muscles (the bulbocavernosus muscle) also partly wraps around the base of the penis. This is involved with preventing blood escaping during an erection, (as well as being active during ejaculation, and when emptying the urethra of urine when finishing at the toilet).
To identify your pelvic floor muscles: firstly, contract the muscles that you would use to stop passing wind from your anus; secondly contract the muscles that you would use to stop the flow of urine. These are the muscles that can be trained and strengthened. Ideally you should see a physiotherapist for advice on exactly how to do the correct exercises.
These work by putting your penis into a plastic container and a pump then sucks out the air from the container to create a vacuum. This causes blood to be drawn into the penis and cause an erection. When erect, a rubber band is placed at the base of the penis to maintain the erection. The plastic container is then taken off the penis and the penis remains erect until the rubber band is removed (which must be removed within 30 minutes).
A surgeon can insert a rod permanently into the penis. The most sophisticated type can be inflated with an inbuilt pump to cause an erection. The more basic type keeps the penis rigid all the time.
Treating an underlying cause
For example, treating depression, anxiety, changing medication, cutting back on drinking lots of alcohol, or treating certain hormonal conditions may cure the associated ED.
Lifestyle and other advice
ED is often a marker that heart disease or other cardiovascular diseases may soon develop. Review your lifestyle to see if any changes can be made to minimise the risk of developing these problems, such as stopping smoking, taking regular exercise or eating a healthy diet.
Couple counselling or sex therapy can be useful. These are most useful if certain psychological problems are the cause of, or the result of, ED.