Erectile dysfunction and Viagra: a practical guide

Plenty of men put off asking about erectile dysfunction for months, and fill the gap with search results, forum threads and adverts for "natural" boosters. This collection is meant to replace some of that guesswork with straight answers. It is built around Viagra, the medicine most people have heard of, and the questions that tend to follow once the name comes up.

Some of those questions are about biology. Sildenafil does not create arousal; it protects a chemical signal, nitric oxide and then cGMP, that the body already sends when you are aroused, which is why it needs stimulation to work and why it cannot make an erection firmer than nature allows. Others are about risk: a fake tablet bought from an unknown website, a dose taken by someone on nitrates, or a heart patient wondering whether it is safe after a bypass.

Then there are the alternatives. Aspirin, pine bark extract, gas-station enhancement capsules and Stendra all get compared with Viagra online, with very different levels of evidence behind them. We look at each on its merits.

One thing runs through every page: a persistent problem with erections deserves a proper assessment. It can be linked to blood pressure, diabetes, hormones, medication or anxiety, and a GP or urologist is the person who sorts out which, then decides whether a prescription makes sense.

A good first read

Begin with the nitric oxide explanation of how Viagra works. Once the mechanism is clear, the pages on side effects, interactions and supplements are much easier to follow.

What Viagra is and what it does

The brand name, the chemistry, and the conditions sildenafil treats apart from ED.

• Nitric oxide, cGMP and the PDE5 enzyme
• Where the name Viagra comes from
• Sildenafil for lung and other conditions
• Other approved uses of the drug
• Do these pills increase firmness?

Risks, side effects and people who should steer clear

Old packs, fake tablets, heart conditions and blood-pressure medicines.

• Is an out-of-date pack still usable?
• What fake sildenafil can contain
• When Viagra is ruled out
• How quickly flushing and headaches fade
• Combining it with alpha-blockers
• After heart surgery or ablation

Supplements, shelf products and rival drugs

How non-prescription options and another PDE5 inhibitor measure up against sildenafil.

• Is anything like Viagra sold without a prescription?
• What enhancement capsules really offer
• Aspirin as a substitute: the evidence
• Pine bark extract and its studied doses
• Avanafil (Stendra) compared with sildenafil

Getting a prescription and everyday questions

Raising the subject with your doctor, filling the prescription, and two common worries.

• Filling a sildenafil prescription at a big-box pharmacy
• How to bring up ED with your doctor
• Stimulant pre-workout and erections
• Is sildenafil inflammatory?

At a glance

What's on your mind	Page to open
The science behind the pill	Nitric oxide, cGMP and the PDE5 enzyme
Whether my health rules it out	When Viagra is ruled out
Whether a supplement could do the job	Is anything like Viagra sold without a prescription?
Getting a genuine supply	Filling a sildenafil prescription

Frequently asked questions

Will ED go away on its own?

Sometimes, if it was triggered by stress or a short-term factor. When it lingers, finding the cause and treating it is what usually helps.

Why is Viagra prescription-only?

Because it is unsafe for some people, notably anyone taking nitrates. A prescription means somebody has checked, and tablets from unchecked online sellers are often counterfeit.

Is ED ever a sign of something else?

It can be. Narrowed blood vessels, diabetes and low testosterone may first show up this way, which is a good reason to mention it at your next check-up.