Learn what effect oral medications for erectile dysfunction have on male fertility, and why it's a bad idea to purchase them online.

Men who suffer from erectile dysfunction (ED) have difficulty maintaining an erection that is firm enough for sexual intercourse. Older men tend to be more affected by this problem, but younger men can also suffer from ED. This condition can pose an additional burden when those affected have an unfulfilled desire to have children.

Several oral medications are available that help to promote erections in men with ED. Below, we discuss everything from why purchasing these drugs without a doctor's prescription can be life-threatening, to how they affect sperm quality.

What are erectile dysfunction medications?

Also sometimes called sexual enhancers or potency enhancers, oral medications for erectile dysfunction help to promote an erection by increasing blood flow to the penis. They tend to be the first treatment option for men experiencing erectile dysfunction.

Probably the best-known sexual enhancer, Viagra was originally developed and tested by the pharmaceutical company Pfizer as a medication for high blood pressure. Many test subjects reported the positive side effect of increased erectile function. Since then, it has been prescribed to men with erection problems.

There are now several sexual enhancers from pharmaceutical companies, all of which fall into the category of phosphodiesterase-5 inhibitors or PDE-5 inhibitors. The best-known of these include:

  • Viagra (with active ingredient sildenafil)
  • Cialis (with the active ingredient tadalafil)
  • Levitra (with vardenafil as the active ingredient)
  • Stendra (with the active ingredient avanafil)

As the patents for Viagra have now expired, other pharmaceutical companies are now allowed to produce medications with sildenafil. Certain other of the brand names listed above are also available in generic forms. Generic medications contain the same active ingredients, but are typically offered at lower prices. Natural (mostly plant-based) medications for erectile dysfunction are also available, as we discuss below.

How do they work?

Erectile dysfunction medicines work in combination with sexual arousal. If a male is sexually aroused, an erection can occur and can be strengthened by the medication, but men do not get erections simply by taking the medication.

When sexual arousal is registered by the brain, a signal is sent to the penis via the spinal cord, and blood flow to the erectile tissue of the penis is increased through relaxation and dilation of blood vessels. This produces an erection.

ED medications help the arteries in the penis to relax and dilate. They also prevent the breakdown of the messenger substance, so that blood flows less quickly away from the penis. Provided that there is continual mental or physical sexual stimulation, this maintains the erection longer.

Medications for ED also have varying periods of effectiveness: some wear off after a few hours, while others can be effective for up to 36 hours. For more information on this, see our FAQ section below.

Priapism, a state in which an erection is involuntarily maintained for a long period, is an uncommon but serious side effect of ED medication. Men who experience this phenomenon should see a doctor after four hours at the latest, as prolonged erections can cause damage to the penis.

Other side effects occur more commonly with ED medications. These include headache, upset stomach, and dizziness.

Oral ED treatments and male fertility

Various studies have investigated erectile dysfunction medication in terms of its effect on sperm.

In 2004, a study of 57 males found that sildenafil, the active ingredient in Viagra, significantly increased the number and speed of sperm. However, the scientists also found that the medication negatively impacted the sperm’s ability to fertilise an egg. A subsequent study found no evidence of this effect with either sildenafil or tadalafil.

In a 2021 journal article, the European Society of Sexual Medicine advocated the prescription of ED medications for couples experiencing infertility for whom sexual activity is difficult due to problems with erectile function. According to the authors, where ED is a problem, ‘PDE-5 inhibitors should be suggested to ensure an effective and satisfying sexual relationship of the couple.’

Use caution when purchasing online

PDE-5 inhibitors are available as prescription medications for the protection of the patient. One reason for this is that erectile dysfunction can be an early signal of other men’s health problems, heart disease in particular. Thus, men who are experiencing ED should begin by consulting their doctor.

Dangerous interactions

Potentially life-threatening interactions can occur when an individual seeks out ED medication on their own. This especially applies to patients taking antihypertensive drugs with nitrates, such as nitroglycerin, to treat high blood pressure or kidney disease. When combined, nitrates and PDE-5 inhibitors can cause dangerously low blood pressure; this is because both ingredients encourage blood vessel dilation and work against hypertension (high blood pressure).

Questionable ingredients

ED pills are easy to find online. However, they are in many cases counterfeit. In Switzerland, online purchase of prescription drugs is only possible if: a) you have a prescription and b) the pharmacy has a licence to ship medicines. Purchases from abroad are illegal and may be prosecuted. According to Swissmedic, erection enhancers are still the most common medicines illegally imported into the country.

Anyone purchasing online should be particularly critical if the medication arrives without packaging and without a leaflet. In addition, be aware that ED drugs from internet suppliers often come in incorrect or inappropriately high dosages, and can contain toxic as well as addictive substances.

Natural sexual enhancers

Some men with erection problems prefer to take natural supplements, which are often available over the counter. If you search the internet for natural supplements, you will probably find ones with the following ingredients: Ashwagandha, Yohimbine, Maca, L-Arginine or Spanish Fly.

Ashwagandha, also known as Withania somnifera, Indian ginseng and sleeping berry, was found in a systematic review to have certain positive effects on sperm. There is no high-quality evidence that it reduces erectile dysfunction.

Yohimbine, or Pausinystalia johimbe, is extracted from the bark of the yohimbe tree in Central Africa. In folk medicine, yohimbine is used as a preparation for erectile dysfunction or an aphrodisiac (means to increase sexual desire). Yohimbine is an alpha-blocker, which promotes relaxation of blood vessels.  A meta-analysis from 1998 concluded that yohimbine can have a positive effect as a treatment for ED. In the past, however, there have also been cases of fatal overdose related to the drug.

Maca is a Peruvian plant, which is why it is sometimes called Peruvian ginseng. A study of 50 men suggested it to be effective in improving erectile function in men with mild erectile dysfunction.

L-arginine is an amino acid produced naturally in the body that is important for the formation of nitric oxide. Taking it leads to improved blood flow, which is why some men use it for erectile dysfunction, though there is insufficient evidence to support this use.

The Spanish fly, also called blister beetle, produces a substance called cantharidin. The use of this substance goes back a long way and is said to lead to an increase in libido in women and potency in men. From a scientific point of view, there is no basis for using cantharidin for the problems mentioned above. Instead, it is known that the substance can cause serious side effects. These include painful urination or blood in the urine, bloody vomiting, kidney failure, bleeding in the abdomen, strokes or coma.

If you are thinking about taking natural sexual enhancers, you should consult your healthcare provider first. He or she will determine whether there are any interactions with other medications, recommend the correct dosage and explain any possible side effects.

Lifestyle changes

It’s worth noting that men with erectile dysfunction are often recommended to make lifestyle changes, as these can have a significant positive impact on the condition, without the need for medication. They can also help to improve certain underlying causes of ED, such as low testosterone. These lifestyle modifications include things like weight loss, moderate exercise, and adopting a healthy diet.

Procedural therapies

Yet another category of treatment for ED consists of procedural therapies, including options such as alprostadil (which is either injected into the penis or inserted in pellet form into the urethra), vacuum devices, and surgical implants. For more information, check out our related article.

Frequently asked questions

Is ED medication dangerous?

In general, prescription medications for ED are safe when used after seeking advice from a doctor. It is important to follow advice regarding the correct dose and to be aware of possible side effects and interactions with other medications. When ED medication is purchased online and/or taken without first consulting a medical professional, it is more risky due to the unverified contents and strength of the medication, as well as the possibility of unaddressed health conditions that could be causing the ED.

What is the best oral medication for ED?

To find out which PDE-5 inhibitor is best for you, you should talk to a healthcare provider or specialist in urology. These medications come in different dosages, take different lengths of time to work and sometimes have to be taken on an empty stomach. Possible interactions with other medications you are currently taking should also be considered. In some cases, combinations of different PDE-5 inhibitors may be suggested.

How long does it take for sexual enhancers to start working and how long do they last?

Depending on the active ingredient and the dosage, ED medications work differently. The following information is therefore only a guide.

  • Sildenafil (e.g. Viagra): Takes effect within 30–60 minutes and lasts approx. 4 hours.
  • Tadalafil (e.g. Cialis): Works within 30–60 minutes and lasts up to 36 hours.
  • Vardenafil (e.g. Levitra): Works within 25–60 minutes and lasts up to 4 hours.
  • Avanafil (e.g. Stendra): Works within 15–30 minutes and lasts up to 6 hours.

Takeaway

Erectile dysfunction is a common problem affecting men’s sexual health and wellbeing. It’s important to investigate the causes of ED with a healthcare professional before beginning to treat it, so that that health conditions such as heart disease can first be ruled out.

There are many oral medications on the market for men with erection problems. Since the patent on many of them, including Viagra, has been lifted, there are also a number of generic products that are cheaper from a cost point of view. As far as fertility is concerned, there is no clear evidence that these medications are a hindrance to conception.

It is not recommended to try to purchase such medications on the internet, both because the advice of a health professional is important, and because online offerings can pose serious health risks.

Are you experiencing problems with erectile function? Cada's empathetic team of experts would be happy to offer you specialist advice. Reserve your spot for a free consultation now.