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They work equally well if taken on an empty stomach or after a meal.

None produce spontaneous erections—no embarrassing bulges in the supermarket. They enhance firmness only in the context of erotic fondling.

And their side effects are very similar: headache (16 percent of users), stomach upset (7 percent), and nasal congestion (4 percent).

Important note: Never use erection medications if you’re taking nitroglycerin for angina.

But while Cialis clearly trumps Viagra and Levitra, the surprising little secret is how few older men use any of them. Sales are only about half of what pundits predicted when “vitamin V” was first approved.

Cornell researchers surveyed 6,291 older men on the subject. Almost half—48 percent—reported some erectile dysfunction.

One reason is that, compared with women, men are less willing to take medication.

But the main reason is that the drugs enhance intercourse, while older couples generally evolve away from the old in-out toward genital hand massage, oral sex, and vibrator play. Even with drugs, men’s erections may be iffy, and despite lubricant, vaginal dryness and/or atrophy cause many women pain during intercourse.

So older lovers who remain sexual generally switch from intercourse toward other pleasures.

And if you’re no longer having intercourse, erections aren’t necessary, so why take a drug?

In addition, men don’t need erections to have orgasms.

That’s right, with sufficient fondling, men can have marvelous orgasms with semi-firm or even flaccid penises. Among men who try erection medications, only half refill their prescriptions. The manufacturers claim the drugs are 70 to 85 percent effective, but the research shows effectiveness in the range of 50 to 60 percent, and possibly lower for men with diabetes, heart disease, or high cholesterol or blood pressure. In addition, in the studies, “effectiveness” does not mean rock-hard porn-star erections. It means any increase in firmness that enables intercourse. Drug-fueled erections can be on the soft side, so many men feel disappointed.

Medically, they’re minor, but headaches, stomach distress, and nasal congestion can be annoying enough to disrupt sex.

Bottom line: If you’re over 40 and have never tried an erection medication, you’re in the majority. But if you use one, you’ll probably be happiest with Cialis.

“Treatment Preferences in Men with Erectile Dysfunction: An Open Lavbel Study in Korean Men Switching from Sildenafil to Tadalafil,” Asian Journal of Andrology (2007) 9:760.

“Integrated Sildenafil and Cognitive-Behavior Sex Therapy for Psychgenic Erectile Dysfunction: A Pilot Study,” Journal of Sexual Medicine (2007) 4(4, Pt 2):1117.

“The Treatment of Erectile Dysfunction Study: Focus on Treatment Satisfaction of Patients and Partners,” BJU International (2007) 99:376. “Clinical Application of Prognostic Factors for Patients with Organic Causes of Erectile Dysfunction on 100 mg of Sildenafil Citrate,” International Journal of Urology (2004) 11:1104.

“Investigating Women’s Preference for Sildenafil or Tadalafil Use by their Partners with Erectile Dysfunction: The Partner’ Preference Study,” Journal of Sexual Medicine (2008) 5:1198. “Psychosocial Outcomes and Drug Attributes Affecting Treatment Choice in Men Receiving Sildenafil and Tadalafil sildenafil 100mg teva for Treatment of Erectile Dysfunction: Results of a Multicenter, Randomized, Open Label, Crossover Study,” Journal of Sexual Medicine (2006) 3:650. “Evaluation of Therapeutic Responses Of Patients with Erectile Dysfunction,” Medicinski Arhiv [Bosnian journal] (2009) 63:274. “Factors Associated with Preference for Sildenafil or Tadalafil for Treating Erectile Dysfunction in Men Naive to PDE-5 Inhibitor Therapy: Post Hoc Analysis of Data from a Multicenter, Randomized Open-Label, Crossover Study,” BJU Internationa l (2007) 100:122.

“An Open-Label, Multicenter, Randomized, Crossover Study Comparing Sildenafil and Tadalafil for Treating Erectile Dysfunction in Men Naive to PDE-5 Inhibitor Therapy,” BJU Internationa l (2005) 96:1323. “Impact of Diabetes Mellitus on the Severity of Erectile Dysfunction and Response to Treatment: Analysis of Data from Tardenafil Clinical Trials,” Diabetologia (2004) 47:1914.

“Tadalafil Versus Sildenafil in the Treatment of ED: Italian Patients’ Preferences and Explanatory Notes,” Urologia (2008) 75:24.

“ED Patients and their Female Partners Prefer Tadalafil,” Zhonghua, Nan Ke Xue [Chinese journal] (2011) 17:571. “Patterns of Switching PDE-5 Inhibitors in the Treatment of Erectile Dysfunction: Results from the Erectile Dysfunction Observational Study,” International Journal of Clinical Practice (2007) 61:1850. et al, “Physician-Rated Patient Preference and Patient- and Partner-Rated Preference for Tadalafil and Sildenafil: Results from the Canadian Treatment of Erectile Dysfunction Observational Study,” BJU International (2006) 98:623. “Psychogenic Erectile Dysfunction: Comparative Study of Three Therapeutic Approaches,” Journal of Sex and Marital Therapy (2005) 31:243.

“Patients’ Preference in the Treatment of Erectile Dysfunction: A Critical Review of the Literature,” International Journal of Impotence Research (2011) 23:1.

“Importance of and Satisfaction with Sex Among Men and Women Worldwide: Results of the Global Better Sex Survey,” Journal of Sexual Medicine (2008) 5:788. “A Multicenter, Randomized, Double-Blind, Crossover Study to Evaluate Patient Preference Between Tadalafil and Sildenafil,” European Urology (2004) 45:499. There are erection medications available, but you need an assessment to buy them. Still, they are much more reliable than erection pills that can be bought without an assessment. Medications

like

If you're having problems with erections, the first line of treatment are medications called PDE5-inhibitors. What they do is make it easier for you to get erections naturally, when you’re sexually aroused.

They require an assessment before you can buy them.

Below are the erection pills normally used to treat erectile dysfunction: Viagra. Viagra was the first PDE5-inhibitor erection pill to be invented.

Sildenafil is actually the same medicine as Viagra, but doesn’t have the brand name. One advantage of Sildenafil is that it is cheaper than Viagra, because other drugs manufacturers can produce it.

Viagra Connect is an over-the-counter version of Viagra.

Cialis lasts much longer than the other medicines in this list.

Cialis daily is a tablet that you take once every day instead of before sexual activity.

Cialis daily comes in a lower dosage than Cialis, so it’s taken more often.

Tadalafil (and Tadalafil daily) Tadalafil and Tadalafil daily are just like Cialis and Cialis Daily, but they’re the non-branded versions.

Like with Viagra and Sildenafil, this means they’re made and sold more cheaply.

But, some men find that Levitra starts working a little faster sildenafil 100mg teva sildenafil 100mg teva compared with Viagra and Sildenafil. Spedra is a lot newer than the other drugs in this list. It also works a lot faster, with some men finding that it only takes 15 to 30 minutes for the medicine to start working.

This may be a good option for you if you don’t want to plan sexual activity a long time in advance.

Please check your spelling or try another treatment name. Herbal erection pills aren’t proven to help with better erections. Although you can buy them without an assessment, you're not likely to get the results you want.

They also may not be safe, because they’re not regulated properly. Adds to the natural sex hormones made by the body Can cause acne. Increases blood flow to the penis May cause nausea, cramps, and diarrhoea Canit be taken with Viagra or Sildenafil.

Researchers are currently unsure of how it works May cause insomnia Little research sildenafil buy cheap on the effects of long term use.

Niacin (vitamin B3) Reduces cholesterol levels, which is thought to improve erection problems Do not take niacin if you suffer from type II diabetes May cause serious side effects including stomach ulcers and liver damage. The most convenient way to get erection pills is through an online doctor service .

At Zava, for example, you’ll complete a short assessment, with a few questions about you and your health. One of our doctors will then review your answers, and prescribe medication if there’s no medical reason not to.

You should only buy medications online from a source that you trust .

It can be tempting to buy from another source, especially if you already know which medicines work best for you. But if a seller isn’t regulated, there is no way of knowing that what you’re buying is safe, or that it’s going to work.

Your doctor or GP may give you a prescription, which you can take to any pharmacy. But, if you’re short of time or you’d rather avoid a face-to-face consultation, an online doctor service could work well for you.

Supplements that aren’t medication can be bought online or in specialist shops .

Again, you should make sure that these online sellers or shops are trustworthy and fully regulated. Different medications work best for different people.

It’s important to remember that everyone reacts to medicines differently. It can be really helpful to compare things like the time they take to work, and the potential side effects, to try and decide which might be best for you. Your online doctor or GP can also help by making a recommendation. Viagra, Sildenafil and Levitra all work in a similar way.

They’re normally taken 1 hour before sexual activity, and work for 4 to 6 hours.

Viagra and Sildenafil seems to be effective for the highest percentage of men, with up to 80% saying that it works for them in some studies . Cialis has the advantage that it works for a much longer time than the other medicines. Some people find that they still experience the effects a day and a half after taking it. This means Cialis can be a great option for people who don’t always want to plan sexual activity a long time in advance. Spedra is the newest medicine of the five that are commonly prescribed for erection problems.

It works much more quickly than the other medicines, with some people reporting that it takes just 15 minutes to work. This makes it another option for people who don’t want to plan sexual activity very far in advance.

Remember that medications for treating erectile dysfunction have been proven to work, and are safe if you've been assessed before buying them. Herbal pills have been researched, but that research hasn’t proved they work. The ingredients in herbal pills also may not be regulated, so you couldn’t be sure how strong they are, or what else they might have in them. There are some lifestyle changes that you can make, which have been proven to improve erections naturally. These include: quitting smoking not drinking alcohol, especially just before sexual activity eating a low-cholesterol diet exercising regularly.

The government recommends 30 minutes of moderate exercise, like jogging or cycling, 5 times a week.

When you first take a new erection pill, you may find that it doesn’t have the effect that you’re looking for. This is perfectly normal – there are a few simple things that you can do to make the most of erection pills: Make sure you get enough sexual stimulation as well as taking the pill . It’s common to get frustrated if you don’t get an erection straight away after taking an erection pill.

But, it’s important to remember that these pills work by enhancing your natural response to sexual stimulation and so will not give an erection without stimulation Don’t eat just before taking some medicines .

Viagra, Sildenafil, and Levitra work better if you eat two or three hours before taking them.

Cialis works just as well on an empty or full stomach Make sure you wait long enough before trying to get an erection .

Viagra, Sildenafil and Levitra need around 1 hour after being taken to work best.

Cialis may need as long as 3 hours Try a few times, even if it doesn’t work the first time . If you can, try out a new medicine at least six times before changing the dose or even switching to another medication.

Not getting results straight away can be discouraging, but often your body simply needs to get used to the medicine. Viagra Connect is the only prescription-free erection pill that works .

But you still need an assessment to get it, either online or in a pharmacy.

There are some dietary and herbal supplements which people use to try to improve their erections.

However, there isn’t a lot of research into how well they work, or even how safe they are to take. Only buy these medicines from a trusted source, and get a doctor’s advice before starting to use any of these supplements. Effective erection pills all work in a similar way.

PDE5-inhibitors relax your muscles and improve blood flow throughout the body.

In the penis, better blood flow means an improved erection. PDE5-inhibitors make it easier to get an erection for a certain period of time.

If they cause an erection that is painful or won't go away (priapism), this is a serious side effect and you should get medical help as soon as possible.

Erection pills can cause a drop in blood pressure, which isn’t an issue for most people.

But if you’re taking other prescription medicines which also lower your blood pressure (like beta blockers, ACE inhibitors, or nitrates), it may not be recommended for you to take erection pills too.

Your online doctor or GP will be able to give you advice on this.

Dr Kathryn Basford is a qualified GP who works as a GP in London, as well as with Zava. She graduated from the University of Manchester and completed her GP training through Whipps Cross Hospital in London. Zava offers a convenient and discreet service to help men improve their erectile dysfunction.

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