Erectile dysfunction treatments start with lifestyle changes and oral PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil), then injections, urethral medicine, vacuum devices, and penile implants, according to NIDDK and Mayo Clinic. Shockwave therapy and PRP (the P-Shot) are newer options whose evidence is still low certainty.
Written by Jen Adams, BSN, RN
Medically reviewed by Dr. Josh Allen, D.O., Medical Director on November 5, 2026
Medical disclaimer: This article is for educational purposes only and does not constitute medical advice. Erectile dysfunction can be a sign of heart disease or other health problems. See a licensed healthcare provider before starting any ED treatment.
Most men start with lifestyle changes and an oral PDE5 inhibitor. If pills don’t work or can’t be used, the next options are injections into the penis, medicine placed in the urethra, a vacuum device, or a penile implant, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and Mayo Clinic.
| Option | How it works | Evidence level | FDA status |
|---|---|---|---|
| Oral PDE5 inhibitors | Increase blood flow to the penis with sexual stimulation | Established first-line treatment | FDA-approved for ED |
| Alprostadil injection | Injected into the side of the penis to increase blood flow | Established second-line treatment | FDA-approved for ED |
| Alprostadil urethral medicine | A small pellet placed in the urethra | Established second-line treatment | FDA-approved for ED |
| Vacuum erection device | A pump draws blood into the penis, held by a ring | Established option (NIDDK, Mayo) | A device, not a drug |
| Penile implant | Surgery places an inflatable or bendable device in the penis | Established option for men who don’t respond to other treatments | A device, not a drug |
| Shockwave therapy | Low-intensity sound waves aimed at the penis | Low-certainty evidence | Not an FDA-approved treatment for ED |
| PRP (P-Shot) | Platelet-rich plasma from your own blood, injected into the penis | Mixed, low to moderate certainty | Not an FDA-approved treatment for ED |
ED is common. In the Massachusetts Male Aging Study, 52% of men aged 40 to 70 reported some degree of erectile dysfunction. It isn’t only an older man’s issue, either. In a 2013 study by Capogrosso and colleagues, 1 in 4 men seeking first medical help for new ED at one clinic was 40 or younger.
ED often shares causes with heart disease, diabetes, and high blood pressure, and it can be the first symptom of heart disease, according to Cleveland Clinic. A provider can look for underlying causes before recommending a treatment.
The four oral PDE5 inhibitors are sildenafil, tadalafil, vardenafil, and avanafil. All four are FDA-approved prescription medicines for ED; the sildenafil and tadalafil prescribing information are two examples.
They work by increasing blood flow to the penis, and they need sexual stimulation to work; they don’t cause an erection on their own. Mayo Clinic notes that common side effects can include headache, flushing, stuffy nose, backache, upset stomach, and vision changes.
Never take a PDE5 inhibitor with nitrates. The sildenafil and tadalafil labels list nitrate use, such as nitroglycerin for chest pain, as a reason not to take these medicines, because the combination can cause a dangerous drop in blood pressure. Tell your provider about every medicine you take.
The FDA-approved drug treatments for ED are the oral PDE5 inhibitors (sildenafil, tadalafil, vardenafil, and avanafil) and alprostadil, given as an injection into the penis or as medicine placed in the urethra. Vacuum erection devices and penile implants are established treatments named by NIDDK and Mayo Clinic.
Shockwave therapy and PRP are not FDA-approved treatments for ED.
With alprostadil injection therapy, a fine needle delivers the medicine into the base or side of the penis, according to Mayo Clinic. A member of your healthcare team shows you how to do it.
Alprostadil can also be placed inside the tip of the penis with a special applicator, according to Mayo Clinic. NIDDK describes it as a suppository, a solid piece of medicine, and it’s an option for men who’d rather not use a needle.
A vacuum device is a plastic tube with a pump that pulls blood into the penis, according to NIDDK. An elastic ring placed at the base of the penis helps hold the erection.
A penile implant is a device placed in the penis during surgery, according to Mayo Clinic. Some can be inflated; others are semirigid rods you can bend. Implants are usually suggested only after other treatments have been tried.
Low-intensity shockwave therapy uses sound waves aimed at the penis, with the goal of improving blood flow. The research is still building.
A 2025 Cochrane review pooled 21 randomized trials with 1,357 men. It found that shockwave therapy may have a small effect on erectile function in the short term that men may not notice, and may improve erectile function in the long term. All of the evidence was rated low certainty, and several trials were funded by device makers.
A 2025 meta-analysis of 12 randomized trials with 882 men with vasculogenic ED, the type caused by blood flow problems, found improvement compared with sham treatment. A Mayo Clinic urologist describes shockwave therapy as experimental.
Our ED shockwave therapy is priced at your consultation.
Newer approaches keep emerging, and the latest research is collected in our look at new ED treatments.
Our nurse-led team reviews your history and talks through whether shockwave fits your situation.
Priced at your consultation
The P-Shot uses platelet-rich plasma (PRP) made from your own blood. Platelets carry growth factors, and PRP is injected into the penis with the goal of improving erectile function.
The research is mixed:
A Mayo Clinic urologist describes PRP for ED as experimental. If you’re weighing it, does the P-Shot work depends partly on the cause of your ED. At InjectCo, the P-Shot is $1,799 per session.
Venous leak, also called veno-occlusive dysfunction, happens when the veins in the penis don’t close properly during an erection, so blood drains out and the erection fades. Men with venous leak may get an erection but have trouble keeping it.
A urologist can check blood flow with a penile Doppler ultrasound, sometimes done after a shot of medicine that triggers an erection, according to Mayo Clinic. Treatment options depend on the findings. A 2021 review of venous ED describes options that include risk factor changes, medicines, surgery, and embolization, a procedure that blocks the leaking veins.
There’s no definite evidence that any herbal product is effective or safe for ED, according to the National Center for Complementary and Integrative Health (NCCIH). Some can be dangerous.
The FDA has warned about many sexual enhancement products that contain hidden drug ingredients, including sildenafil-like compounds that aren’t listed on the label. These can interact with nitrates and other medicines. NIDDK also advises against ordering an ED medicine online before talking with a health care professional.
NIDDK lists lifestyle changes that can help ED, either on their own or alongside other treatment:
Counseling can help when ED has a psychological cause, and it can be combined with medical treatment.
| Your situation | Usual first step | If that doesn’t work |
|---|---|---|
| New ED, otherwise healthy | Provider check, lifestyle changes, oral PDE5 inhibitor | Alprostadil injection or urethral medicine |
| You take nitrates | Talk with your provider; PDE5 inhibitors aren’t an option | Injections, urethral medicine, or a vacuum device |
| Pills haven’t worked | Injections, urethral medicine, or a vacuum device | Penile implant, with a urologist |
| Erections fade quickly | Urologist evaluation for venous leak, including Doppler ultrasound | Options based on the findings |
| You’re curious about newer options | Discuss shockwave or PRP with your provider, knowing the evidence is low certainty | Established treatments above |
In this men’s health series: Previous, Does the P-Shot Work? For the P-Shot itself, see our P-Shot page.
A private consultation with a nurse injector, under the medical direction of Dr. Josh Allen, D.O., Medical Director.
P-Shot $1,799 per session; other treatments priced at your consultation
Dr. Allen earned his Doctor of Osteopathic Medicine at Lake Erie College of Osteopathic Medicine and completed his emergency medicine residency with Texas A&M. As Medical Director, he reviews InjectCo’s treatments, protocols, and patient education content for accuracy and safety across all nine Texas locations.
No single treatment works for everyone. Oral PDE5 inhibitors work for many men, according to Mayo Clinic, and other options like injections, vacuum devices, and implants help men who don’t respond to pills.
Seeing a provider is the fastest first step, because they can check for underlying causes and prescribe an oral PDE5 inhibitor if it’s right for you. Pills are usually the first treatment tried.
The FDA-approved drug treatments for ED are the oral PDE5 inhibitors (sildenafil, tadalafil, vardenafil, and avanafil) and alprostadil, given as an injection or as urethral medicine.
No. Shockwave therapy is not an FDA-approved treatment for ED. A 2025 Cochrane review rated the evidence for it as low certainty.
The evidence is mixed. A 2024 meta-analysis found better erectile function scores with PRP than with controls, but a 2026 analysis of placebo-controlled trials found no difference from placebo. A Mayo Clinic urologist describes it as experimental.
A urologist can confirm venous leak with a penile Doppler ultrasound. Options can include risk factor changes, medicines, surgery, and embolization, depending on the findings.
Not always. NCCIH says there’s no definite evidence that herbal products are effective or safe for ED, and the FDA has found hidden drug ingredients, including sildenafil-like compounds, in many sexual enhancement products. Talk with a provider before taking any.
