It's hard to compete with a simple pill, but a variety of the alternatives for impotence (erectile dysfunction) are still good options for men who aren't helped by drugs like sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis).
Vacuum Devices
A vacuum pump that fits over the penis is used to draw blood into the penile shaft. Once the penis is erect, the user places a band or ring at the base of the shaft to maintain the erection.
Advantages: No medication side effects. May help some men who don't respond to other treatments.
Disadvantages: Cumbersome to use. A quality device may cost up to several hundred dollars.
Injections
After being injected into the base of the penis, alprostadil and certain other drugs can create an erection in 70 percent to 90 percent of cases. Although many men are understandably put off by the prospect of a shot, it's not as painful as it may sound. The injections are done with short, very thin needles similar to the type diabetics use to inject insulin.
Advantages: One of the most effective treatments. Works immediately.
Disadvantages: Needles scare many men. Rarely causes a prolonged, painful erection. May cause scarring when used over longer periods.
Suppositories
Tiny alprostadil pellets can be inserted into the urethra at the tip of the penis. However, only about half of the men who try this method find success with this technique. Still, for those who are averse to aiming a needle at such a delicate part of the anatomy, the suppository is worth a try. Researchers are currently working on other ways to deliver the same medication — via a gel cream, painless injections under pressure or even a nasal spray.
Advantages: No needles. Works quickly.
Disadvantages: Pellet needs to be inserted into the tip of the penis. Some men experience pain or a burning sensation.
Penile Implants
When all other options have been ruled out or have failed, a man may want to consider a surgical implant. The most common type uses inflatable cylinders that become filled with saline solution, driven by a small pump located under the skin in the scrotum.
Advantages: The only effective treatment for some men.
Disadvantages: Major surgery, with some risk of complications.
Blood Vessel Repair
When impotence has a vascular origin, surgery may correct the problem. If obstructions block the flow of blood into the penis, a surgeon may be able to repair the arteries. Surgery to the veins involves the opposite procedure: intentionally blocking the vessels to reduce the return flow of blood from the penis to the bloodstream.
Advantages: May cure impotence in some younger men.
Disadvantages: Few men are good candidates for this type of surgery. Not always effective.
