The number of erectile dysfunction (ED) treatments and medications approved for use in the UK has increased significantly in the years since Sildenafil (the active ingredient in Viagra) was first tested[1] in Pfizer’s UK laboratories back in 1989.
Today, the prevalence of a wide range of ED medications is why questions regarding which erectile dysfunction treatment is best to relieve the associated symptoms are common.
Therefore, our experts have prepared this comprehensive guide to erectile dysfunction treatments based on the latest available medical research to assist with deciding on which ED treatment may be best for you.
Continue reading to learn how ED treatments work, the primary differences between them, and more.
How do ED treatments work?
ED treatments that are classified as PDE-5 inhibitors work by preventing an enzyme called phosphodiesterase type 5 (PDE-5) from stimulating the smooth muscle to constrict blood vessels in the penis.[2] This extends the duration of blood flow to the genital area following arousal, resulting in an erection that can be sustained for longer.[3]
It is important to note that ED treatments only work properly if the individual taking them is sexually stimulated or aroused.
Recommended reading: Erectile Dysfunction - Everything You Need To Know
Comparing different erectile dysfunction treatments
Oral ED medication
Sildenafil (Generic Viagra)
Sildenafil is the active ingredient in Viagra and Viagra Connect. It works by inhibiting the PDE-5 enzyme which is responsible for breaking down cyclic guanosine monophosphate (cGMP), a substance that plays a crucial role in achieving an erection.[4]
The scientific mechanism behind how Sildenafil works can be explained in four steps:
- Arousal - When a man becomes sexually aroused, nitric oxide (NO) is released in the spongy tissue within the penis.
- Guanylate activation - The release of NO activates the guanylate cyclase enzyme, resulting in increased levels of cGMP.
- Increased blood flow - cGMP relaxes smooth muscle cells, increasing blood flow to the penis and leading to an erection.
- PDE-5 inhibition - Normally, PDE-5 is released in the body once arousal subsides to break down cGMP and relax the muscles, ending the erection. Sildenafil inhibits PDE-5, preventing the mechanism mentioned earlier and prolonging the erection.
Tadalafil (Generic Cialis)
Tadalafil is the active ingredient in Cialis and Cialis Together. The scientific mechanism behind how Tadalafil works is identical to that of Sildenafil, however, the duration of action differs with each of these ED medicines.
The main difference between Tadalafil and Sildenafil is how long it takes for effects to be produced in the body. Tadalafil can remain effective for up to 36 hours because it has a half-life of 17.5 hours.[5] In other words, it takes 17.5 hours for the levels of Tadalafil in the body to halve in volume. In comparison, Sildenafil has a half-life of 4 hours.
Viagra
Viagra is the branded version of Sildenafil. It works in the same way as Sildenafil but is generally priced higher as it is a branded ED pill.
Viagra Connect
Viagra Connect contains 50 mg of Sildenafil per tablet. The scientific mechanism behind how Viagra Connect works is identical to Cialis and Tadalafil, however, Viagra Connect does not require a prescription.
The decision to allow the sale of Viagra Connect without a prescription in the UK was based on several factors, including the safety profile of the drug at that dosage, the risk of potential side effects, and the need to complete a medical assessment to determine whether the medication is suitable.
Cialis
Cialis is the branded version of Tadalafil. It works in the same way as Tadalafil but is generally priced higher as it is a branded ED medication.
Cialis Together
Cialis Together contains 10 mg of Tadalafil, which is why the scientific mechanism regarding how it works is identical to that of Tadalafil. The main difference between these ED treatments is that Cialis Together can be obtained without a prescription, while Tadalafil is a prescription ED medication.
Vardenafil (Generic Levitra)
Vardenafil is a PDE-5 inhibitor and works in the same way as other PDE-5 inhibitors such as Sildenafil and Tadalafil. Vardenafil is the generic version of Levitra and is recommended for diabetics because it has a slightly different molecular structure compared to Sildenafil (Viagra) and Tadalafil (Cialis), which can mean that for some men with diabetes, it may work better or have fewer side effects.
Like other PDE-5 inhibitors, Vardenafil does not cause sexual arousal. It simply facilitates the physiological processes that allow an erection to occur and be maintained following sexual stimulation.
Spedra (Avanafil)
Spedra is another type of PDE-5 inhibitor similar to Sildenafil, Tadalafil, and Vardenafil. According to research,[6] Spedra produces a quicker onset of action (approximately 15 to 30 minutes) because it is formulated to be absorbed by the body quicker than other PDE-5 inhibitors. In comparison to Spedra, Sildenafil, Vardenafil, and Tadalafil all take at least 30 minutes to produce effects.
Non-oral ED treatments
VaxAid Deluxe
VaxAid Deluxe is a non-invasive, vacuum pump treatment for erectile dysfunction. It creates a seal on the pelvic seat to improve blood flow along the full length of the penis and prevents excessive negative pressure due to the elastic recoil strength of its pump. The pump also features a cycling action that allows the user to achieve an erection gradually.
Other non-oral ED treatments
Numerous additional non-oral ED treatments such as erectile dysfunction creams and injections are touted to be effective. There is no scientific evidence to prove that these treatments work or help with managing any of the physical causes of erectile dysfunction.
Please consult a pharmacist or GP before using any ED treatment and do not use any treatment that has not been approved by the Medicines and Healthcare products Regulatory Agency.
What are the most popular ED treatments?
The most popular ED treatments are Viagra and Cialis as they have been on the market for longer than other ED treatments. This is confirmed through Google Trends data,[7] which indicates that the most popular ED treatment is Sildenafil (Viagra) followed by Tadalafil (Cialis) as per the average number of searches for various ED treatments in 2023 up until November 2023.
Viagra Connect and Cialis Together have comparatively lower demand, although Cialis Together is growing increasingly popular as of November 2023.
Things to consider when choosing erectile dysfunction treatments
Dosage strength
Dosage strength is an important consideration when choosing erectile dysfunction treatments because too high a dosage may result in side effects, while too low a dose may not give the desired results.
It is recommended to take medium-strength ED treatments before trying maximum-strength variants after consulting a pharmacist or GP.
Duration of the onset of effects
Knowing how long it takes for ED treatments to produce effects and how long they can remain effective in the body allows for better planning of sexual activity. It is recommended to speak with a pharmacist or GP about the exact duration of the onset of effects before taking any ED medication as it can vary depending on factors like the physiological makeup of the individual taking it.
Side effects
The potential side effects of the ED treatments discussed in this article are similar because all of the treatments are PDE-5 inhibitors. However, individual reactions can vary, so it is important to consult a pharmacist or GP and carefully read the Patient Information Leaflet that comes with each ED treatment before taking it.
How long ED treatments remain active in the body
Individual responses to the duration of ED treatments can differ based on the specific treatment used and the unique physiological characteristics of the person taking it. The average duration for the active ingredients in the ED treatments mentioned in this article are:
| Treatment |
How long the active ingredient remains in the body |
| Sildenafil |
4-6 hours |
| Tadalafil |
Up to 36 hours |
| Vardenafil |
4-6 hours |
| Spedra (Avanafil) |
4-6 hours |
| Viagra Connect |
4-6 hours |
| Cialis Together |
Up to 36 hours |
Branded vs. generic ED medication
Branded and generic versions of the same ED treatment contain the same active ingredient. For example, Viagra (a branded ED treatment) and Sildenafil (generic Viagra) both contain the same active ingredient - Sildenafil. Therefore, generic ED medications are medically identical to branded variants and equally effective.
Individuals who require help deciding between generic ED medications may wish to consider using an ED trial pack after speaking with a pharmacist or GP.
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