The first-line therapy for ED is the use of a phosphodiesterase-5 inhibitor (PDE5I), of which sildenafil (Viagra), tadalafil, vardenafil, and avanafil are the most commonly prescribed. PDE5I in combination with prescription testosterone therapy has also been effective in improving ED symptoms.[1]
Other treatments for ED include the application of vasodilators like alprostadil (topical, intraurethral, or intracavernosal), low-intensity extracorporeal shockwave therapy (Li-ESWT), vacuum erection devices, testosterone therapy (intramuscular or transdermal), psychosexual counseling,cognitive behavioral therapy (CBT), vascular surgery, and the use of penile prostheses (inflatable or semirigid devices). Among these, the strongest evidence supports CBT (often in combination with PDE5Is), intracavernous alprostadil injections, and penile prosthesis implantation.[2]