DEAR MAYO CLINIC: Are herbal products for erectile dysfunction safe? Do they work? What about over-the-counter creams? Are there any other nonprescription medications that can safely and effectively eliminate this problem?
ANSWER: Products available without a prescription that claim to treat erectile dysfunction are frequently cited by the Food and Drug Administration (FDA) as containing hidden ingredients that can be harmful. Do not use any of these products. Instead, talk with your health care provider about treatment for erectile dysfunction. In some cases, an underlying medical condition could be causing erectile dysfunction, and treatment for that disorder may resolve the problem. If not, there are a number of prescription medications that are approved as safe and effective to treat erectile dysfunction.
Erectile dysfunction — the inability to get and keep an erection firm enough for sex — is a complex problem. A host of factors can contribute to the development of erectile dysfunction. They include a variety of physical causes, such as a health condition like heart disease or diabetes; lifestyle choices like tobacco and alcohol use; and medical treatment like radiation therapy or surgery. Psychological issues, such as stress, depression, anxiety or relationship problems, can play a role, too.
Age is another factor that can contribute to erectile dysfunction. As you get older, it's common for erections to take longer to develop or to not be as firm. This can happen at any age, but it's still important to talk with your health care provider to determine a cause. The younger you are, the more likely that erectile dysfunction signals a risk of heart disease. Research suggests that men with erectile dysfunction who have no obvious cause, such as trauma, and who have no symptoms of heart problems should be screened for heart disease before starting any treatment. Men younger than 50 are at especially high risk. In men older than 70, erectile dysfunction is much less likely to be a sign of heart disease.
Due to the complicated nature of erectile dysfunction — and the fact that it may be a symptom of another health problem that requires attention — it's important to be evaluated by a medical professional who can thoroughly and accurately assess erectile dysfunction, and help you decide on treatment.
Because erectile dysfunction can be an uncomfortable topic to talk about, many men opt to avoid a medical appointment and instead turn to the type of nonprescription remedies that you mention. That's not a good idea.
The Food and Drug Administration has discovered that dozens of these products — often marketed as dietary supplements — contain varying amounts of prescription drug ingredients, untested and unapproved active ingredients, and controlled substances. Typically, none of these ingredients are disclosed on the label or packaging.
These hidden ingredients pose significant health risks. Some may interact with other medications an individual takes and trigger dangerous side effects. Active ingredients that are not FDA-approved may lead to serious health problems, particularly in men who have medical conditions such as diabetes, high blood pressure and high cholesterol.
In addition, the active ingredients of the prescription medications routinely used to treat erectile dysfunction — a category of drugs knows as phosphodiesterase 5, or PDE5, inhibitors — often are found in the nonprescription products. But in those products, the medications are not tested or regulated, so they may be tainted with contaminants.
The bottom line is that there is no way for a consumer to reliably know what nonprescription erectile dysfunction products contain. They are not safe.
The good news is that if you require medication to treat erectile dysfunction, generic versions of two medications often prescribed for the disorder ― sildenafil and tadalafil ― now are available in the U.S. That has helped decrease the cost of treatment, as has the option to compare the prices of generic medications using new tools such as online apps. To find out whether prescription medication is right for you, though, you first need your health care provider to evaluate your condition. After that, you can decide on the appropriate treatment that is effective and safe for your situation. — Dr. Gregory Broderick, Urology, Mayo Clinic, Jacksonville, Florida