ED treatment: how it works and what to expect

An erection depends on healthy blood flow, nerves, hormones, and mood working together, so ED can have physical causes, psychological causes, or both. Common contributors include heart and blood-vessel conditions, diabetes, high blood pressure, certain medications, smoking, alcohol, stress, and anxiety. Because ED can be an early sign of a heart or circulation problem, it is worth discussing with a provider rather than treating in isolation. See MedlinePlus — Erectile Dysfunction for independent background.

The first-line treatments are PDE5 inhibitors. They relax the blood vessels that supply the penis, which increases blood flow during sexual arousal. An important detail: they do not create an erection on their own; they work alongside sexual stimulation. Different medications in the class differ mainly in how quickly they start working and how long they last, which is something to match to your needs with a provider. For medication-specific detail, see our guides to sildenafil and tadalafil.

These medications are taken before sexual activity, and the timing depends on which one you use. It can take a few tries to find the right medication and dose, so work with your provider rather than adjusting on your own. Results vary from person to person, and treatment is not a guaranteed outcome.

The most common side effects are headache, facial flushing, nasal congestion, indigestion, and back or muscle aches. They are usually mild and temporary. Less common effects include changes in vision or hearing. Tell your provider about any side effect that concerns you. This is not a complete list.

Some risks are serious and worth knowing before you start:

• Never combine with nitrates. Taking a PDE5 inhibitor with nitrate medications (often prescribed for chest pain or heart conditions) can cause a sudden, dangerous drop in blood pressure. Tell your provider about every medication you take.
• Priapism is an emergency. An erection lasting more than four hours can permanently damage tissue. Seek emergency care right away.
• Heart health matters. If you have certain heart conditions, or take alpha-blockers or some other blood-pressure medicines, your provider needs to know. Sexual activity itself is a demand on the heart.
• Sudden vision or hearing loss. Stop the medication and seek care if this occurs.

Eligibility is a medical decision made by a licensed provider, not by a questionnaire alone. The provider reviews your heart health, medications, and history before prescribing. ED treatment is not appropriate for everyone. The only way to know is a provider evaluation.

ED treatment on Panterra is priced per refill, all-in, with no membership required to be a patient. The price includes the medication, the provider, follow-ups, and shipping, and the provider consultation fee is part of that price, itemized before you pay. The treatment page lists its current "starting at" price.

See current pricing on the treatment page: Intimacy care (Kalos).

1. You complete a health intake online, including your heart history and medications.
2. A licensed U.S. provider reviews your information.
3. If ED treatment is appropriate for you, the provider issues a prescription.
4. Your medication ships to you, and follow-ups are included in the price.

If treatment is not appropriate, the provider will tell you and may suggest other options. A prescription is never guaranteed.

Prescription required. ED medications are available only with a prescription from a licensed provider after an evaluation.

Do not combine with nitrates. This combination can be life-threatening. Tell your provider about all medications and heart conditions.

Compounded medications are not FDA-approved. Some ED treatments offered through Panterra are compounded. The FDA does not review compounded medications for safety, effectiveness, or quality, and they are not tested in clinical trials the way FDA-approved medications are. See our guide to compounded medications.

This is education, not medical advice. It does not replace a conversation with your provider. Seek emergency care for an erection lasting more than four hours, or for chest pain or sudden vision or hearing changes. For a medical emergency, call 911.

Authoritative background: MedlinePlus — Erectile Dysfunction and FDA — Compounding and FDA: Questions and Answers.