Daily Health

Viagra Alternatives: Beyond the Little Blue Pill

Struggling with performance in the bedroom can do more than just impact your sex life. It can also harm confidence and emotional well-being. A healthy sex life is just as important as other aspects of your relationship. 

Erectile dysfunction (ED) is far more common than you might think, but stigma keeps many people quiet about their own struggles. In a 2020 study for the International Society for Sexual Medicine, it was found that upwards to 48% of individuals experience erectile dysfunction. That’s a lot and hopefully it gives you some comfort knowing you’re not alone. But it also means there are treatments for erectile dysfunction, including Viagra. 

While Viagra may be the most commonly known erectile dysfunction treatment, and the first erectile dysfunction prescription treatment to hit the markets, there are plenty of alternatives to give you a bit of a lift. 

Understanding what erectile dysfunction is, including possible causes, can help you make the best decision as to what dysfunction treatment will work for you. 

What is erectile dysfunction?

There are a lot of common misperceptions about erectile dysfunction and unfortunately, that keeps a lot of individuals quiet about their own struggles down south. Fewer than 25% of individuals choose to do anything about their erectile dysfunction struggles and hyper-masculine stereotypes can lead to stigma and silence. Oftentimes, people turn to the internet for information, which may not always be the best (or most reliable) info. 

Erectile dysfunction is a clinical condition that is defined as persistent, recurrent difficulty getting and/or staying hard. It’s common for many individuals to experience erectile dysfunction at some point in their lives, and for some, it can resolve. 

Even if you don’t suspect any underlying issue, it’s always best to contact your doctor if you’re experiencing difficulties getting or maintaining an erection. 

Possible causes of erectile dysfunction

Erectile dysfunction isn’t always caused by the same issue, and oftentimes, addressing the underlying cause can help with erection issues. Here are some possible causes of erectile dysfunction (this is not an exhaustive list and it’s always best to check with your doctor):

  • Inadequate blood flow: Without adequate blood flow, you’ll be left half-mast. Blood flow difficulties usually are a result of inadequate outflow of blood and can be impacted by other underlying conditions such as heart disease, hardened arteries, high blood pressure, and diabetes. 
  • Nerve signalling issues: The ability to get or maintain an erection comes from nerves in the lower spine, and if those nerves are damaged or injured, this can block signalling. 
  • Cancer: While this is more common in older men, prostate, colorectal, or bladder cancer can cause erectile dysfunction. Not only that, treatment for these cancers can also leave some people with ED challenges. This is something a urologist can help you with.
  • Illicit drugs and alcohol: Yep, sorry! Drugs and alcohol can have the unwelcome side effect of erectile dysfunction. This also includes cigarette smoking. 
  • Emotional and psychological factors: These can also contribute to erectile dysfunction. Conditions such as depression, anxiety, stress, relationship conflicts, and yes, worrying about bedroom performance can make it difficult to get it up. 

While the causes of ED are varied, it’s always best to contact your doctor as there are plenty of treatment options available, depending on what is causing your ED. 

7 Doctor-recommended Viagra alternatives

Viagra is the more commonly known trade name of the drug, sildenafil, and was the first prescription oral treatment for erectile dysfunction. It’s a PDE5 inhibitor, meaning that it affects the cascade of events that lead to smooth muscle relaxation, leading to an erection. It’s important to note that Viagra doesn’t increase sexual drive but simply helps you get hard with stimulation. 

There are side effects of Viagra, which may lead some individuals to choose not to take this as a form of ED treatment. These can include:

  • Dizziness
  • Headache
  • Flushing in the face
  • Upset stomach
  • Blurred vision
  • Changes in vision colour
  • Runny or stuffy nose or sore throat

Less common and serious side effects include:

  • Priapism — a prolonged erection that lasts more than four hours
  • Heart attack, stroke, cerebrovascular hemorrhage, palpitations, and arrhythmias
  • Vision loss
  • Hearing loss or ringing in the ears
  • Seizures
  • Swelling and pain in the arms and less

Serious side effects require immediate medication attention. If you’re concerned about any side effects, contact your doctor. 

For whatever reason you may be deciding not to use Viagra, there are plenty of doctor-recommended alternatives to Viagra. Here are seven of them. 

1. Levitra

Levitra is another prescription oral treatment that is similar to Viagra in that it is a PDE5 inhibitor. Levitra is the brand name for vardenafil. Despite the popular myth that oral medications can cause an erection without sexual stimulation, this isn’t true. Like Viagra, Levitra does require stimulation. 

Some side effects of Levitra are:

  • Nasal congestion
  • Indigestion
  • Dizziness
  • Headaches
  • Flushing, usually in the face

If you’re experiencing side effects, it’s always best to consult your doctor.

2. Staxyn

Like Levitra, Staxyn is another brand name for vardenafil and one of the alternatives to Viagra. It’s a PDE5 inhibitor, meaning it relaxes smooth muscles of the penis and allows for more blood flow resulting in an erection. Side effects are primarily the same as with Levitra, but as always, if you’re experiencing side effects or worsening side effects, consult your doctor.

  • Nasal congestion
  • Indigestion
  • Dizziness
  • Headaches
  • Flushing, usually in the face

3. Cialis

Cialis, another alternative to Viagra, is the brand name version of tadalafil and also belongs to the family of PDE5 inhibitors. Cialis requires a prescription. Cialis is also used to treat symptoms of benign prostatic hyperplasia (BPH) which is the same as an enlarged prostate. It works to help relieve frequent urination, painful urination, and the urge to pee. 

Common side effects of Cialis include:

  • Dizziness
  • Headache
  • Flushing in the face
  • Upset stomach
  • Blurred vision
  • Changes in vision colour
  • Runny or stuffy nose or sore throat
  • Muscle or back pain

Less common and serious side effects include:

  • Priapism — a prolonged erection that lasts more than four hours
  • Heart attack, stroke, cerebrovascular hemorrhage, palpitations, and arrhythmias
  • Vision loss
  • Hearing loss or ringing in the ears
  • Seizures
  • Swelling and pain in the arms and less

Serious side effects require immediate medication attention. If you’re concerned about any side effects, contact your doctor. 

4. Intracavernosal injection

Not everyone responds well to PDE5 inhibitors. An intracavernosal injection (ICI) is a self-injection therapy where you inject medications that help achieve erections directly into the penis. 

While the idea of a needle directly into your penis might be off-putting, ICI is an extremely effective treatment for ED, particularly for those who found PDE5 inhibitors ineffective. 

As with any medication, ICI is not right for everyone. If you have motor problems that affect your hands, ICI may not be the right choice for you. Uncontrolled high blood pressure is also a risk, and if you are taking MAO inhibitors, ICI is probably not the right choice. 

As always, check with your doctor. 

5. Penile implants

Generally reserved for individuals who haven’t had success with any other type of treatment, a penile implant is a surgical option that is used as a last resort. 

A penile implant can be a malleable or inflatable device that changes in size and involves manual activation (by a pump or a malleable rod). Implant devices don’t last forever though, with most lasting for around 10 years. 

6. Hormone therapy

Sex hormones play an integral role in erectile dysfunction. It can be both helpful and inhibiting, depending on the levels of the hormone. When you see your doctor, they will most likely run a blood test to determine if there are any endocrine (hormonal) issues. 

Because of the role of hormones in sexual function, having balanced endocrine levels is important. One of the challenges with hormone imbalances is ED, but this can also cause other sexual dysfunction issues. 

During your consultation with your doctor, they will go over all these aspects that could be contributing to your challenges and hormones will be one of those. 

7. Counselling

Yes, stress and anxiety can have a significant impact in the bedroom. Sometimes it can be a vicious cycle of performance anxiety causing more stress, which causes more performance challenges. Not fun. 

But this too can be addressed. Whether it’s performance anxiety, life stressors, or even past trauma, there are a myriad of psychological challenges that can lead to erectile dysfunction. Unfortunately, stigma keeps individuals from talking to their doctor about these challenges. 

8. Lifestyle changes

Lifestyle changes are usually doctor recommended along with other treatments, but can be recommended as the primary treatment of erectile dysfunction. 

Recommended lifestyle changes can include:

  • Quitting smoking
  • Reduce alcohol consumption
  • Quitting cannabis use
  • Quitting illicit drugs
  • Reducing life stressors
  • Addressing dietary changes
  • Exercise

Regardless of treatment, lifestyle changes are almost always beneficial. But it’s always best to talk to your doctor. 

Other Viagra alternatives

There are other alternatives to Viagra that are available without a prescription. Depending on the treatment, some of these may or may not be natural, per se, but they don’t involve surgery or pharmaceutical interventions. 

When it comes to other alternatives to treating erectile dysfunction, it’s always best to have a chat with your doctor about it as some methods (which we won’t list here) may actually be more harmful than good. Some may not have any empirical evidence that they do work, but they don’t do any harm. It really depends on what you and your doctor decide is best for you. 

Here are a few alternatives:

1. Acupuncture

Acupuncture is a form of traditional Chinese medicine that is used for a variety of ailments, erectile dysfunction being one of them, and use of it is on the rise. Acupuncture is performed by stimulating acupoints with fine needles, an electrical current, or local drug injections. It is performed by someone with training in acupuncture medicine. The exact mechanisms of how acupuncture works is not entirely clear, but research indicates that it stimulates nerves that help produce chemicals that help with sexual dysfunctions like ED. 

While there is no concrete evidence that acupuncture works, there are very few adverse side effects connected with acupuncture. These include: 

  • Indigestion 
  • Dizziness
  • Dry mouth
  • Facial redness
  • Localized pain and/or irritation

If you are considering acupuncture for erectile dysfunction, this is something you should speak with your doctor about. 

2. L-arginine

You might have heard of l-arginine around the gym water cooler as it is often found in different types of protein and dietary supplements. L-arginine is a type of amino acid, which are the building blocks of proteins. Your body  runs on proteins, and sexual function is no exception. 

There’s buzz that l-arginine is a treatment option for erectile dysfunction. Unfortunately, there is no concrete evidence that l-arginine on its own is an effective treatment for erectile dysfunction, but some studies have shown that when it is used in conjunction with PDE5 inhibitors (Viagra, Cialias, etc.), that patients report better outcomes than using PDE5s alone. 

L-arginine works as a vasodilator (opening blood vessels so more blood can flow). For some individuals, particularly those with cardiac issues, high blood pressure, or other vascular health concerns, l-arginine isn’t a great choice. As always, best to check with your doctor. 

3. Penis pumps

A penis pump (also known as a vacuum erection device or VED) is exactly what it sounds like: a device that is fitted over the penis and uses a vacuum to draw blood into the penis tissue, resulting in an erection. Pumps are often used in conjunction with a tension ring to prevent the blood leaving. 

While this method has been shown to be fairly effective, there is a high discontinuation rate given the adverse side effects. These include:

  • Bruising on the penis
  • Pivoting at the base of the penis
  • Coldness or numbness in the penis
  • Pain and discomfort
  • Decreased ability to ejaculate

If you’re considering using a pump, it’s best to get medical advice first and training can help avoid injury.

4. Tension rings

A tension ring (also known as a constriction band) is an elastic ring that is fitted at the base of the penis to help stop blood leaving, prolonging or assisting an erection. Like a pump, tension rings should be used with caution as they can cause several adverse side effects such as:

  • Discolouration of the penis
  • Bruising
  • Numbness

If you’re considering using a tension ring, seek medical advice first about risks and proper use. If used improperly, injury could occur. 

The takeaway

Erectile dysfunction can be distressing and contribute to poor confidence, anxiety, and increased stress. Historically, there’s been a lot of stigma about not being able to perform in the bedroom, but it shouldn’t be this way. 

If you’re experiencing difficulties showing up to the bedroom party, there’s help available

WRITTEN BY
Felix Team
Updated on:
September 23, 2021
Medically reviewed by
Dr. Sarah Peltz
Urologist, MD, FRCSC
Disclaimer

The views expressed here are those of the author and, as with the rest of the content on Active Ingredients, are not a substitute for professional medical advice, diagnosis, or treatment. If you have any medical questions or concerns, please talk to your healthcare provider.

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