Alternatives to Viagra?

From MNT

Alternatives to Viagra: Pills, Herbal Remedies, and Other Treatments

Last reviewed: Mon 28 November 2016

Viagra is a well-known drug for the treatment of erectile dysfunction, a distressing and common condition.

There are many alternatives to Viagra, which can improve or reverse the symptoms of erectile dysfunction. These options include drugs, medical treatments, lifestyle changes, and alternative remedies.

What is Viagra?

[man looking worried]
Erectile dysfunction can be distressing, but there are solutions.

Viagra was developed in the United Kingdom. In 1998, the American pharmaceutical company, Pfizer Inc., put it on the market.

The generic name for Viagra is sildenafil. The trade name is Viagra, and the drug also goes by the name of Revatio. Viagra works by slowing down the action of PDE5, an enzyme that works in the tissues of the penis.

The PDE5 enzyme breaks down a substance that is responsible for blood flow in the penis. Inhibiting PDE5 increases blood flow to the penis. This helps men to achieve and maintain an erection.

However, sildenafil can only assist in maintaining an erection if the penis is physically stimulated. Without a physical stimulus, sildenafil cannot cause an erection.

Common side effects of Viagra, or sildenafil, include headache, facial flushing, indigestion, nasal congestion, and a blue tint to the vision.

What is erectile dysfunction?

If a man is unable to get or keep an erection that is firm enough to engage in sex, does not achieve an erection at all, or loses an erection during sex, this can signal erectile dysfunction.

Erection problems are common, and they affect almost all adult men at some time. However, an ongoing issue that frequently affects erectile function may be classed as erectile dysfunction.

Figures indicate that erectile dysfunction affects over 600,000 men in the United States each year. Although the frequency of this problem increases with age, it is not confined to older adults.

Causes of erectile dysfunction

Erectile dysfunction can result from factors that are medical, psychological, emotional, or a combination of these.

Medical conditions that are linked with erectile dysfunction include:

Psychological issues that contribute to erectile dysfunction include anxiety, depression, guilt, stress, and low self-esteem.

Lifestyle choices that have been linked to erectile dysfunction include:

  • Alcohol or drug use
  • Excess weight
  • Lack of exercise
  • Smoking.

When to see a doctor

As erectile dysfunction is a medical problem, cases that persist for several weeks or more should be seen by a doctor. This is particularly important for those who suspect their erectile dysfunction may be related to another cause, such as heart disease or diabetes.

Some prescription medications are linked to erectile dysfunction. Those taking certain prescribed drugs may wish to discuss possible side effects and alternatives to these medications with their doctor.

Drug alternatives to Viagra

There are several alternatives to Viagra available to men with erectile dysfunction.

Oral medications

Oral drugs, including Viagra, are frequently the first course of treatment offered to men with erectile dysfunction.

Alternative PDE5 inhibitors to Viagra, only available by prescription, are:

  • Vardenafil: Sold under the brand names Levitra and Staxyn, this drug is available in tablet and disintegrating tablet form. To be effective, it should be taken an hour before sex. It can be effective for up to 7 hours.
  • Tadalafil: Sold under the brand names Adcirca and Cialis, tadalafil can be taken 1 to 2 hours before sex. These tablets are effective for 36 hours.
  • Avanafil: Marketed in the U.S. as Stendra, avanafil tablets can be taken 15 to 30 minutes before sex and last up to 6 hours.

Non-oral drugs

Alternatives to oral medications include:

  • Penile self-injections: Medications such as alprostadil, papaverine, and phentolamine can be injected directly into the side or base of the penis. These can help achieve or maintain an erection for up to 40 minutes.
  • Urethral suppository: Very small alprostadil suppositories can be placed in the penile urethra using a special applicator. This stimulates an erection to begin within 10 minutes, which can last for up to 60 minutes.
  • Testosterone replacement: This treatment may be suggested for those whose erectile dysfunction is linked to low levels of testosterone. The testosterone hormone can be delivered by a variety of methods including injection, patch, or oral medication.

Other medical treatments

There may be some men for whom medication is unsuitable, either because of other medical conditions or another reason. In these situations, other medical treatments may be suggested.

Vacuum erection devices are hollow tubes, also known as penis pumps. They are attached to a hand- or battery-operated pump and work by drawing blood into the penis. They help to achieve an erection that can be maintained using a tension ring.

Implants are inflatable or bendable rods that are surgically implanted into the erection chambers of the penis. This type of treatment is usually only recommended after trying other options first.

All of these treatments must be delivered by a qualified healthcare professional.

Dietary supplements and herbal remedies

Several dietary supplements, herbal preparations, and food products are sold as remedies for erectile dysfunction.

[ginseng root]
Ginseng may help in cases of erectile dysfunction.

Some of the better-known alternative treatments, which have shown positive results in small studies and are generally considered safe, include:

  • DHEA
  • Ginseng
  • L-arginine
  • Propionyl-L-carnitine.

However, consumers should be careful when purchasing or consuming any alternative products, including those that claim to be herbal versions of Viagra.

The U.S. Food and Drug Administration (FDA) have issued several statements warning consumers about the safety of such goods. They say these products may contain hidden synthetic chemicals or other ingredients which could be harmful. There has not been enough research to support the usage of these supplements fully.

According to the FDA, lab tests show that nearly 300 of the supplements or foods marketed to enhance sexual function contain undisclosed drug ingredients. Anyone who is using a supplement must let their doctor know.

Lifestyle changes for erectile dysfunction

Certain lifestyle choices can contribute to erectile dysfunction in some men. Research indicates the condition may be successfully reversed in some situations by focusing on lifestyle factors.

The following changes may be helpful for those with erectile dysfunction:

  • Eating a balanced diet: Some research suggests that eating flavonoid-rich foods, such as blueberries, strawberries, blackberries, and citrus fruits, can reduce erectile dysfunction in both young and middle-aged men.
  • Maintaining a healthy body weight: Being overweight or obese can cause or worsen erectile dysfunction.
  • Engaging in regular exercise: Physical activity can benefit those with erectile dysfunction in several ways. It improves circulation, reduces stress, and it contributes to a healthy body weight.
  • Quitting smoking: Research indicates a strong link between the intensity of cigarette smoking and the degree of erectile dysfunction. Stopping smoking can improve erectile dysfunction in many smokers.
  • Avoiding too much alcohol and illicit drug use: Drinking too much, or taking illegal drugs, can affect sexual function in men. Smoking marijuana can cause erectile dysfunction.
  • Seeking help for psychological or emotional issues: Addressing stress, anxiety, depression, and other types of emotional distress can improve or resolve symptoms.

A medical professional can give the best advice for men who are experiencing erectile dysfunction.

Sex helps pass kidney stones?

Want to improve your sex life? Get a kidney stone!

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Urology – January 30, 2016 – Vol. 33 – No. 9

Sexual intercourse 3 to 4 times per week may increase the probability of spontaneous stone passage for distal ureteral stones <6 mm in size.

Article Reviewed: Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study. Doluoglu OG, Demirbas A, et al: Urology; 2015;86 (July): 19-24.

Objective: To investigate the role of sexual intercourse on passage of distal ureteral stones.

Design: Prospective, randomized controlled study.

Participants: 90 male patients with distal ureteral stones <6 mm in size undergoing a trial of spontaneous passage.

Methods: Group 1 was randomized to sexual intercourse 3 to 4 times a week, group 2 received tamsulosin 0.4 mg/day for medical expulsive therapy, and group 3 served as a control. Expulsion rate was compared at 2 and 4 weeks.

Results: Mean stone size was similar between all groups at just under 5 mm (group 1, 4.7 mm; group 2, 5.0 mm; group 3, 4.9 mm). At 2 weeks, 83.9% (26/31) patients in the sexual intercourse group had passed stones. In comparison, 47.6% (10/21) in the tamsulosin group and 34.8% (8/23) in the control group had passed stones (P =0.001). At 4 weeks, the differences lost significance, but still showed benefit for the sexual intercourse group with 93.5% passage compared to 81.0% passage in the tamsulosin group and 78.3% passage in the control. The mean expulsion time was 10.0 days in the sexual intercourse group, 16.6 days in the tamsulosin group, and 18.0 days in the control group.

Conclusions: Sexual intercourse 3 to 4 times per week may increase the probability of spontaneous stone passage for distal ureteral stones <6 mm in size.

Reviewer’s Comments: This study led to lots of conversation given the unique and unusual approach proposed to improve spontaneous ureteral stone passage. The authors hypothesized that sexual intercourse may improve spontaneous stone passage by nitric oxide release leading to relaxation of ureteral muscles. They found that the sexual intercourse group passed their stones much faster than either the tamsulosin or control group. While intriguing, several problems exist with the study, which makes me somewhat surprised that it was published. The study is extremely underpowered based on overestimations in initial statistical planning. No compliance measures with sexual activity and/or lack of sexual activity or with taking tamsulosin as prescribed were performed. Only 6% of patients were lost to follow-up in the sexual activity group compared to 23% in the tamsulosin and control arms. If those patients were lost to follow-up because they passed their stones, then the study would have no significance. Last, sexual activity would be a very brief exposure of nitric oxide to the ureter (if the theory is correct). Younger patients should still get nocturnal erections, which would also release nitric oxide for brief periods. It seems that a more consistent delivery of nitric oxide such as with PDE5 inhibitors may be more successful, and PDE5 inhibitors have shown some promise in early studies. Overall, the study makes a good headline and interesting discussion, but much better studies are needed to find a relevant method to facilitate stone passage.(Reviewer–David A. Duchene, MD).

ED Treatment Options? We Offer Them All!



Treatment options for

The successful treatment of ED is best achieved by a step by step process in which the all of the options are delineated and then starting with one that is most cost effective, safest, easy to administer and one that works satisfactorily with out side effects. It is a process and it is not advisable to skip steps and jump immediately to a surgical solution.

The surgical solution, a penile implant, is a good solution but should be the last resort after having tried all of the non-surgical options. 

The website  is an excellent resource in all things ED and worth visiting before an office visit for this problem.

Northeast Georgia Urological Associates’ Page on ED.

Northeast Georgia Urological Associates’ Page on Penile Implants