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In addition to Viagra and Stendra, the two other ED drugs available in the United States are tadalafil (Cialis) and vardenafil (Levitra). These all improve blood supply to the penis. In combination with sexual stimulation, the drugs can produce an erection sufficient to initiate and complete intercourse. There is also a fast-dissolving form of Levitra, called Staxyn, that you put under your tongue.

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We have used epidural SCS for pain control during the past 65 years. An analysis of our records revealed 67 consecutive patients diagnosed as having RSD before undergoing SCS. Eight of the 67 patients had undergone previous ablative sympathectomy. All 67 patients experienced relief of pain after trial stimulation and had their systems permanently implanted.

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The most common side effects of ED drugs, in order of most to least common are headache , flushing, upset stomach, nasal congestion, urinary tract infections, vision problems, diarrhea, dizziness, and rash. A man who has an erection that lasts four hours or more needs to get to a hospital or risk permanent damage.

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Eight patients reported excellent pain relief, and four patients described good results. SCS is an effective treatment for the pain of RSD, including recurrent pain after ablative sympathectomy. The low morbidity of this procedure and its efficacy in patients with refractory pain related to RSD suggest that SCS is superior to ablative sympathectomy in the management of RSD.

The ED drugs break down at different rates in the body. The durations of action range from four hours to more than a day (for Cialis in the higher doses). Each dose should be sufficient to provide a full cycle of intercourse, from erection to climax.

"Will it last through another cycle? It's not guaranteed," Dr. Liou says. To have sex more than once a day, Cialis is your best bet.

Does it make any difference which of the four drugs for erectile dysfunction you take? "Yes, there can be differences," says Dr. Louis Liou, chief of urology at Harvard-affiliated Cambridge Health Alliance in Boston. "For new patients, I have them try different ones to see what works best."

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But the main challenge to finding the best ED drug for you may turn out to be health insurance rules—not biochemistry. It's a common practice among insurers to limit the number of pills you can obtain per month. After you hit your limit, the out-of-pocket cost for a single pill can be as high as $75. "The main obstacle in my practice is the cost," Dr. Liou says. You'll need to work with your doctor to get the pill you need at a price you can afford.

ED is often an early warning sign of underlying cardiovascular disease, such as clogged arteries (atherosclerosis). "It can predate a diagnosis of cardiovascular disease by at least a few years," Dr. Liou says. We don't have strong proof yet that starting to live a healthier lifestyle can reverse erectile problems, but it can't hurt.

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