Education and Communication and other Non-surgical Treatments for Erectile Dysfunction (ED)?

Education and communication

Education about sex, sexual behaviors, and sexual responses may help a man overcome his anxieties about sexual dysfunction.

Talking honestly with your partner about your needs and concerns may also help to overcome many barriers to a healthy sex life.


Medications such as

    • sildenafil (Viagra®),
    • vardenafil (Levitra®),
    • or tadalafil (Cialis®)

may help improve sexual function in men by increasing blood flow to the penis. Men who are on medicines that contain nitrates such as nitroglycerine should not take oral ED medications. The combination of nitrates and these specific medications can cause low blood pressure (hypotension).

The most common side effects of these medications are indigestion, nasal congestion, flushing, headaches and a temporary visual disturbance.

Mechanical aids

Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men.

A vacuum constriction device (above) is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off of the base of the cylinder and onto the base of the penis. The band can stay in place for up to 30 minutes. The vacuum device can be safely used to treat most causes of erectile failure. Lack of spontaneity, discomfort, and cumbersomeness of the device seem to be the biggest concerns of patients.

Figure 3. Choosing an injection site

Penile injection therapy (intracavernosal injection therapy)

Men are taught how to inject medications directly into the erection chambers of the penis to create an erection. Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve and psychological conditions.

The tissue that causes you to get an erection (erectile tissue) is a muscle. Going long periods of time without an erection is unhealthy for erectile tissue and may damage it.

We believe that having erections keeps erectile tissue healthy. A penile injection helps you have an erection. It works best if it’s given about 5 to 15 minutes before you want an erection.

Using a tiny needle and syringe, the man injects a small amount of medicine into the side of his penis. The medicine relaxes the blood vessels, allowing blood to flow into the penis. This treatment has been widely used and accepted since the early 1980s. The three most common medicines are prostaglandin E1 (alprostadil), papaverine (Papacon®), and phentolamine (Regitine®).

The most common side effects are pain and penile scarring (fibrosis). In extremely rare cases, patients with cerebral and vascular disease or severe cardiovascular diseases might not be able to tolerate the dizziness and high blood pressure occasionally caused by injection therapy.

A painful erection that lasts longer than two to three hours is called priapism and may occur with injection therapy. This can be lessened with proper dosing and by following the treatment guidelines.

The 3 most commonly used medications for injection therapy are Trimix, Bimix, and Papaverine. Most men begin injection therapy with Trimix, which is a mixture of 3 ingredients: alprostadil, phentolamine, and papaverine. These ingredients work by relaxing the smooth muscle and opening the blood vessels in your penis, causing an erection. Your APP will decide whether Trimix or a different medication is best for you.


Psychology and sex therapies

Psychological causes may contribute to erectile failure even when there is a clear organic cause.

Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual dysfunction.

Sex therapy can be beneficial to most men when counseling is provided by a skilled sex therapist. Sex therapy also helps a man’s partner accept and cope with the problems.

A patient whose ED has a clear psychological cause should receive sex therapy counseling before any invasive treatments are pursued.

When you seek out sex therapy, you need to look for a relationship or marriage counsellor, psychotherapist or psychologist who uses specialised clinical skills and theoretical knowledge about human sexuality. In addition to having post-graduate training in couples and marriage counselling, we get specific sex therapy training to help you deal with your sexual difficulties or concerns.

Sex therapists are qualified counsellors or healthcare professionals who have had extensive training in human sexuality, in addition to being well-trained couples and marriage counsellors and therapists.

Sexual issues can often cause distress and conflict in relationships and sex therapists can assist you with these difficulties.

Some sexual concerns include:

      • Lack of sexual knowledge or education
      • Believing wrong/harmful information about sex from the media or religious institutions
      • Struggle to understand sex, desire, eroticism, privacy versus secrecy
      • Erectile and/or ejaculation difficulties
      • Performance anxiety and lack of confidence
      • Problems reaching orgasm
      • Low sexual desire concerns for both men and women
      • Intimacy problems
      • Relationship and marriage difficulties
      • Painful sex or intercourse
      • Sexual problems or changes due to illness, ageing, surgery or stress
      • Compulsive sexual behaviours, or out of control sexual behaviours (wrongly called sexual addiction)
      • Sexual trauma
      • Questioning your sexual identity, orientation or preferences
      • LGBTQI issues
      • Gender identity issues
      • Interest in kink
      • Cross dressing or other fetishes


Low hormone levels may play a role in ED. Hormone replacement in the form of topical gels, creams, patches, injections and pellets are only used after physician evaluation.

Can Viagra Cause Hours-long Erections ?

The facts: While this may sound intriguing theoretically, this condition (known as priapism) can be harmful.

Fortunately, it doesn’t really happen if you’re only taking Viagra.



“To my knowledge, Viagra has never caused a prolonged erection by itself,” Dr. Montague says. “But, it can happen if you’re also getting penile injection therapy.”

Combining the treatments has a cumulative effect — penile injection therapy makes your erections hard, and adding Viagra makes them harder and even more long-lasting. So, stay on the safe side and don’t pair them, he says.

How do you use Viagra?

Always take Viagra exactly as prescribed to you by your doctor. Viagra is an oral medication taken in pill form as and when the patient wishes to use it. This is typically between 30 minutes to 1 hour before engaging in sexual activity, although it’s possible to take the drug up to four hours in advance.

It’s usual to start taking Viagra with one 50mg tablet. A doctor may prescribe a lower dose for men over 65.

If you find your prescribed dosage isn´t working for you speak to your doctor. Don´t just increase the amount you take on your own as this could cause side effects.

Also, if the tablet you have taken doesn´t seem to be working at all do not take another. This could be dangerous and cause a painful erection that lasts several hours and damages the penis tissue. Speak to your doctor before commencing with further doses.

Your diet and your overall health will affect how Viagra works for you, including how long its effects last. The average length of time it lasts is between 2 and 3 hours. You may achieve more than one erection after taking one Viagra tablet but you will not have a continuous erection. After ejaculation you may or may not get another erection, depending on your metabolism. And you will only achieve more erections with further sexual stimulation.

You can take Viagra with or without food. If you take it after food or a heavy meal it may take longer to work.

There are many common misconceptions about Viagra, or Viagra more generally. In order for the drug to be effective, you will have to engage in normal sexual stimulation, it will not work on its own or sporadically. If you feel relaxed and comfortable the medication is likely to be more effective and act sooner.

If you do not experience erectile dysfunction then it is not advisable to take Viagra. It will not have any effect, it does not increase libido, penis size, or act as an aphrodisiac. This is a common myth. Viagra also won’t cause an erection without stimulation or for prolonged periods of time. It should be used as an aid for treating erectile dysfunction only.

Why do I need to answer questions to get Viagra Connect?

When trying any new medication it is important that this has been deemed suitable for you to protect your health and well-being. As Viagra Connect is available without a prescription you will no longer need to see a GP, however you will need to complete a discreet and easy questionnaire when you purchase Viagra Connect.

Or if you’d prefer you can chat in-store to a pharmacist, they will be able to answer any additional questions you may have whilst checking your suitability for this treatment. Your pharmacist may ask to review your Summary Care Record or Patient Medication Record to check whether you have any conditions or are on any medication that could react with Viagra Connect.

How can I complete a consultation?

1. Online

If you choose to purchase Viagra Connect online, you’ll be prompted to complete a quick online consultation. The majority of the questions you will be asked simply require a yes or no answer, although you will need to fill in a small part about any medication that you are currently taking.

Once you have completed your answers they’ll be sent to our team to review. They’ll check that you are suitable for Viagra Connect.

You then have the option to get Viagra Connect discreetly delivered to your home for free or next day, or alternatively to click and collect to pick it up in your local LloydsPharmacy or Sainsbury’s store at a time that is convenient for you.

There is a very small chance that you won’t be suitable for Viagra Connect. In this instance Online Doctor offers a wide range of erectile dysfunction treatments, with a variety of strengths and ingredients, so with the help of a GP you’ll find one that is just right for you.

2. In-store

You can speak to an expert pharmacist in complete confidence within your local LloydsPharmacy store at a time that suits you. You don’t need to book an appointment to speak to a pharmacist about purchasing Viagra Connect and whether this medication is right for you.

You’ll have the option to either chat to the pharmacist on the shop floor or go into a discreet consultation room. Your pharmacist will run through a set of pharmacy questions to determine whether Viagra Connect is the right treatment for you. They can also answer any additional questions or concerns you may have whilst offering any extra advice to put your mind at ease.

What questions will I be asked?

If you order Viagra Connect via Online Doctor you will be asked to complete a confidential questionnaire consultation containing straightforward questions. The majority of these require a simple yes or no answer, or multiple choice.

These questions will focus on your overall fitness for sex, to find out if you get out of breath quickly or experience any chest pain when undertaking physical activity.

You’ll also be asked about the health of your heart, any underlying medical conditions, whether you are allergic to any of the ingredients in Viagra Connect and what other medication you are currently taking. It’s important that our doctors understand any medical issues that you may have or any medication that you may be taking.

After you have completed the consultation your answers will be reviewed by a member of our clinical team to determine if you are suitable for Viagra Connect. If you have decided to talk to a Pharmacist in store rather than order online you will be asked a similar set of confidential questions, and the Pharmacist will also be able to answer any questions that you may have.

Viagra Connect and Sildenafil – what’s the difference?

We’ve created a helpful table to compare generic Sildenafil with branded Viagra. If you’re looking to compare our variety of ED treatments and their active ingredients, explore your options at LloydsPharmacy Online Doctor.

  Sildenafil (generic) Viagra (branded)
Active ingredient  Sildenal citrate Sildenafil citrate
Available dosage (mg) 25, 50, 100 25, 50, 100
Pack size 4, 8, 16 4, 8, 16
When to take Effective within one hour, up to four hours Effective within one hour, up to four hours
How to take On an empty stomach On an empty stomach
Prices on Online Doctor from £3.25/pill £5.31/pill


What are the possible side effects of Viagra Connect?

As with any medication there are always possible side effects, the most commonly reported ones include:

  • Headache
  • Facial flushing
  • Nausea
  • Nasal congestion
  • Dizziness
  • Blurred or blue-tinted vision
  • Indigestion and heartburn

Can I use Viagra Connect if I have a medical condition?

Whether you can use Viagra Connect to treat your erectile dysfunction depends upon the nature of your medical condition and the medication you’re taking. Your Pharmacist will decide if Viagra Connect is suitable for you during your confidential consultation, or a doctor will review your suitability using the answers you provided in your online questionnaire.

How do I take Viagra Connect?

The recommended dose of Viagra Connect is one 50mg tablet to be taken an hour before sexual activity. Viagra Connect usually works within 60 minutes and the effects can be seen up to four hours after the initial dose. You cannot take more than one 50mg tablet a day.

Prices correct April 2020


Image for illustrative purposes only. Posed by models.

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