Erectile dysfunction (ED) can happen occasionally, but when erection problems become persistent or start affecting your confidence, relationship or quality of life, it may be time to consider treatment.
Thank you for reading this post, don't forget to subscribe!For many men, tablets are one of the main medical treatment options for erectile dysfunction. Medicines such as sildenafil, tadalafil, vardenafil and avanafil belong to a group called PDE5 inhibitors and work by supporting the natural blood-flow process involved in an erection.
However, an ED tablet is not automatically the right answer for every man.
The important question is not simply “Which ED tablet should I take?” but rather:
“Why am I experiencing erection problems, and is medication appropriate and safe for me?”
The NHS explains that persistent erection problems can sometimes be associated with conditions such as high blood pressure, high cholesterol, diabetes, anxiety, depression, hormone problems or medicine side effects. Treatment can usually help, but identifying the underlying cause is an important part of care.
This guide explains when you might consider ED tablets, what should be checked before treatment, how common medicines differ, and when you should speak with a healthcare professional instead of simply trying a tablet yourself.
What Are ED Tablets?
ED tablets are oral medicines used to help men who have difficulty achieving or maintaining an erection.
The main oral ED medicines belong to the PDE5 inhibitor group:
- Sildenafil
- Tadalafil
- Vardenafil
- Avanafil
These medicines enhance the body’s natural response to sexual stimulation by supporting the chemical pathways that increase blood flow into the penis.
They do not normally create an automatic erection. Sexual stimulation is still required.
Mayo Clinic describes PDE5 inhibitors as commonly used oral treatments for ED and explains that they enhance the effects of nitric oxide, helping increase blood flow to the penis during sexual activity.
For a broader explanation, see our guide to how erectile dysfunction treatments work.
When Should You Consider ED Tablets?
There is no single age or number of unsuccessful sexual encounters that determines when medication is necessary.
ED tablets may be worth discussing with a healthcare professional when:
- You regularly struggle to get an erection
- You repeatedly lose an erection during sex
- Your erections have become noticeably less firm
- The problem has continued for several weeks or longer
- Erection difficulties are affecting your confidence
- ED is affecting your relationship
- Lifestyle changes alone have not resolved the problem
- A healthcare professional has identified ED and considers medication appropriate
The NHS recommends speaking with a GP when erection problems keep happening.
The important distinction is between occasional erection difficulty and persistent erectile dysfunction.
Occasional Erection Problems Do Not Always Mean ED
Almost any man can experience an unsuccessful sexual encounter.
Tiredness, stress, anxiety, excessive alcohol consumption or relationship tension can temporarily affect sexual performance.
For example, if you have been under significant pressure at work and have difficulty maintaining an erection one evening, that does not necessarily mean you have erectile dysfunction.
Likewise, becoming worried after one unsuccessful experience can create a cycle of performance anxiety.
Before immediately considering medication, think about whether the problem is:
Occasional → situational → associated with stress or alcohol
or:
Persistent → recurring → occurring in different circumstances → affecting sexual confidence or relationships
Persistent symptoms are more deserving of medical assessment.
When ED Tablets May Be Appropriate
For a man with confirmed or persistent ED who has no contraindication to treatment, a PDE5 inhibitor may be an appropriate option.
The NHS lists sildenafil, tadalafil, vardenafil and avanafil among the main medicines used for erectile dysfunction.
These medicines can be particularly useful when the primary difficulty is achieving or maintaining an erection despite having sexual desire and stimulation.
However, the appropriate medicine, dose and treatment schedule depend on individual circumstances.
Your medical history matters.
Your other medicines matter.
Your cardiovascular health matters.
And the cause of your ED matters.
Should You See a Doctor Before Taking ED Tablets?
Ideally, yes.
A healthcare professional can determine whether the symptoms are consistent with ED and whether an oral medicine is safe.
An assessment may include questions about:
- How long the problem has existed
- How often it happens
- Whether you can achieve erections during masturbation
- Whether you still experience spontaneous or morning erections
- Your level of sexual desire
- Current medicines
- Alcohol and smoking
- Existing medical conditions
- Blood pressure
- Cardiovascular health
- Psychological or relationship factors
The NHS notes that assessment of ED can include lifestyle and relationship questions, blood-pressure checks and physical examination where appropriate.
NIDDK also explains that ED assessment may involve medical, sexual and mental-health history, physical examination and laboratory or other tests when appropriate.
Why the Cause of ED Matters
ED is a symptom rather than one single disease.
There can be many different causes.
Physical causes can include:
- Diabetes
- High blood pressure
- High cholesterol
- Cardiovascular disease
- Obesity
- Hormonal problems
- Neurological conditions
- Certain medicines
- Pelvic surgery or injury
Psychological contributors can include:
- Anxiety
- Depression
- Stress
- Relationship difficulties
- Performance anxiety
- Low self-confidence
Lifestyle factors such as smoking, excessive alcohol consumption and lack of physical activity can also contribute.
NIDDK recommends addressing lifestyle factors such as smoking, alcohol consumption, physical activity and weight as part of ED management.
Our detailed guide to causes of erectile dysfunction covers these factors in greater depth.
ED Can Sometimes Be a Sign of a Wider Health Problem
One reason not to self-diagnose ED is that persistent erectile problems can sometimes be associated with cardiovascular or metabolic health.
The blood vessels involved in erections are sensitive to changes in vascular health.
Mayo Clinic notes that ED without an obvious cause can sometimes warrant assessment for cardiovascular disease.
This does not mean that every man with ED has heart disease.
It means persistent or unexplained ED can be a reason to look more carefully at overall health.
This is particularly relevant if erection problems occur together with:
- High blood pressure
- Diabetes
- High cholesterol
- Obesity
- Smoking
- Chest discomfort
- Reduced exercise tolerance
A strong family history of cardiovascular disease
The Main ED Tablets
The four commonly used PDE5 inhibitors are:
| Medicine | Main use | General characteristic |
| Sildenafil | ED | Common on-demand option |
| Tadalafil | ED | Longer duration of action |
| Vardenafil | ED | On-demand PDE5 inhibitor |
| Avanafil | ED | Faster onset for some patients |
The medicines work through a similar general mechanism but are not identical.
Mayo Clinic notes that the medicines differ in how quickly they take effect, how long their effects last, how food affects absorption and which side effects may occur.
The best option therefore depends on individual preference, health conditions, other medicines and treatment response.
Sildenafil
Sildenafil is one of the best-known medicines used for ED.
It supports blood flow to the penis when sexual stimulation occurs.
NHS information states that sildenafil is mainly used to treat erection problems and is available in the UK through prescription and, in certain circumstances, pharmacy supply after an appropriate consultation.
It is generally taken before anticipated sexual activity rather than automatically every day.
Food can affect how quickly sildenafil works, particularly a large meal. NHS guidance also advises avoiding excessive alcohol because it can make obtaining an erection more difficult.
For more information, see our sildenafil for erectile dysfunction guide.
Tadalafil
Tadalafil is another PDE5 inhibitor used to treat erectile dysfunction.
One of its distinguishing characteristics is its longer duration of action compared with sildenafil.
The NHS states that tadalafil’s effects can last up to 36 hours, although this does not mean that a man has a continuous erection. Sexual stimulation is still required.
Tadalafil can be taken as an on-demand treatment or, for some patients, as a lower daily dose prescribed for ongoing ED management.
For more information, read our guide to tadalafil for erectile dysfunction.
Sildenafil vs Tadalafil
There is no universal winner between sildenafil and tadalafil.
The choice can depend on:
- How frequently you have sex
- Whether you prefer planned or more spontaneous activity
- How long you want the treatment effect to remain available
- How your body responds
- Side effects
- Other medicines
- Existing medical conditions
Mayo Clinic explains that the choice between oral ED medicines can depend on factors such as how long the medicine works, cost, convenience, side effects and other health conditions.
Our sildenafil vs tadalafil guide provides a more detailed comparison.
Daily vs On-Demand ED Tablets
Some ED medicines are used when sexual activity is anticipated.
Others, particularly tadalafil at a suitable low dose, may be prescribed for daily use.
On-demand treatment
An on-demand tablet is taken before anticipated sexual activity according to the medicine’s instructions.
This approach can suit men who have sex less frequently or prefer not to take an ED medicine every day.
Daily treatment
A low daily dose of tadalafil may be appropriate for some men who want greater spontaneity or have more frequent sexual activity.
However, daily treatment is not automatically better.
The choice should be made with a healthcare professional based on medical suitability and personal preference.
When ED Tablets May Not Be Safe
PDE5 inhibitors are effective for many men, but they are not suitable for everyone.
One of the most important safety issues involves nitrate medicines.
Nitrates are commonly used for chest pain and certain heart conditions.
Combining nitrates with PDE5 inhibitors can cause a potentially dangerous fall in blood pressure.
Mayo Clinic specifically warns that oral ED medicines may be dangerous when taken with nitrate medicines such as nitroglycerin, isosorbide mononitrate or isosorbide dinitrate.
If you take nitrates, do not start an ED tablet without medical advice.
Other Medicines That Need Checking
ED tablets can interact with other medicines.
Depending on the medicine, particular attention may be needed with:
- Nitrates
- Alpha-blockers
- Certain blood-pressure medicines
- Some antifungal medicines
- Certain antibiotics
- HIV medicines
- Other PDE5 inhibitors
- Certain recreational substances
NHS guidance for sildenafil and tadalafil advises patients to tell a doctor or pharmacist about other medicines, supplements and herbal remedies before treatment.
Never assume that a medicine is safe simply because it is commonly used by other men.
When Heart Health Needs to Be Considered
Sexual activity itself places some physical demand on the cardiovascular system.
If a man has significant cardiovascular disease or has been advised to avoid sexual activity, ED medication should not simply be started without professional assessment.
Mayo Clinic notes that people with certain recent heart or blood-vessel problems, very low blood pressure or other cardiovascular issues may need a different approach.
A medical professional can assess whether sexual activity and ED treatment are appropriate.
What About Low Blood Pressure?
PDE5 inhibitors can lower blood pressure to some degree.
Men who already have very low blood pressure may therefore need specific medical advice before treatment.
Mayo Clinic lists very low blood pressure among circumstances in which oral ED medicines may not be safe or effective.
This is another reason not to treat ED tablets as ordinary supplements.
Common Side Effects of ED Tablets
Most side effects associated with PDE5 inhibitors are relatively mild, although individual experiences vary.
Possible side effects include:
- Headache
- Flushing
- Indigestion
- Stuffy or runny nose
- Dizziness
- Back pain with some medicines
- Visual changes
Mayo Clinic lists these among possible side effects of oral ED medicines.
If side effects are persistent, severe or concerning, speak with a healthcare professional.
Serious Symptoms That Need Urgent Attention
Certain symptoms require urgent medical assessment.
These include:
- An erection lasting more than four hours
- Sudden loss of vision
- Sudden loss of hearing
- Severe allergic symptoms
- Serious cardiovascular symptoms
NIDDK advises seeking medical attention for an erection lasting longer than four hours or vision or hearing loss after ED medication.
A prolonged erection can damage erectile tissue and should never be ignored.
What If ED Tablets Do Not Work?
Not every man responds to the first treatment he tries.
There can be several reasons.
The medicine may not have been used correctly, the underlying cause may be more complicated, the dose may need review, or another treatment may be more suitable.
Mayo Clinic notes that ED medicines do not work for everyone and that treatment depends on the cause, severity and underlying health conditions.
If a prescribed treatment is not helping, do not simply increase the dose yourself.
Instead, speak with the prescribing doctor or pharmacist.
Our guide to what to do when ED treatment is not working can provide further educational information.
Can Lifestyle Changes Reduce the Need for ED Tablets?
Sometimes lifestyle changes can improve erectile function, particularly when cardiovascular or metabolic risk factors contribute to ED.
Useful measures can include:
Stop smoking
Smoking damages blood vessels and increases cardiovascular risk.
Exercise regularly
Physical activity supports cardiovascular health and can contribute to healthier weight and metabolic function.
Reduce excessive alcohol
Heavy alcohol consumption can interfere with sexual function and general health.
Maintain a healthy weight
Weight management can improve several health factors associated with ED.
Manage stress
Reducing chronic stress and addressing anxiety can be important when psychological factors contribute to erection problems.
Improve sleep
Adequate sleep supports general physical and psychological wellbeing.
NIDDK recommends lifestyle changes such as quitting smoking, limiting alcohol, increasing physical activity, maintaining a healthy body weight and following a healthy eating plan as part of ED management.
See our guide to lifestyle changes that support erectile function for more information.
Do You Need ED Tablets If You Can Still Get Erections?
Not necessarily.
If you can reliably achieve and maintain satisfactory erections, an ED tablet is generally not intended simply to make a normal erection “stronger.”
Mayo Clinic specifically notes that men who can get and maintain erections without assistance do not need ED medicines, and these medicines are not intended to improve sexual performance in men without ED.
This is an important distinction because ED medicines are treatments for a medical problem, not general performance enhancers.
Should Younger Men Take ED Tablets?
Age alone does not determine whether ED treatment is appropriate.
A man in his 20s or 30s can experience genuine ED and may benefit from treatment.
However, younger men with persistent erection problems should also consider possible underlying factors such as:
- Anxiety
- Depression
- Performance pressure
- Relationship problems
- Smoking
- Alcohol
- Medication effects
- Diabetes
- Cardiovascular risk
- Hormonal problems
Treating the underlying cause may be as important as improving the erection itself.
What If the Problem Is Mostly Psychological?
Medication is not necessarily the only option.
If anxiety, depression, relationship difficulties or performance concerns are major contributors, psychological support may be useful.
Counselling or psychosexual therapy can help some men understand and manage the factors contributing to ED.
NIDDK notes that counselling can be useful when mental-health or emotional factors are affecting ED and can help reduce anxiety and stress related to sex.
Some men benefit from a combination of psychological support and medical treatment.
How to Choose an ED Tablet Safely
If medication is appropriate, the choice should be based on your individual circumstances rather than online claims about which tablet is “strongest.”
Discuss:
- Your medical history
- Your current medicines
- Your cardiovascular health
- How frequently you have sex
- Whether you prefer daily or on-demand treatment
- Previous experiences with ED medicines
- Any side effects you have experienced
A healthcare professional can help determine which option is most appropriate.
Buying ED Tablets Online in the UK
Online access to ED treatment can be convenient, but medicine safety is important.
The NHS warns that medicines bought from unregulated websites may be fake, contain different ingredients or be unsuitable for the person taking them. It recommends checking that online pharmacies and healthcare providers are appropriately registered.
If using an online service, check:
- Who is prescribing the medicine
- Whether the pharmacy is properly registered
- Whether a health assessment is performed
- Whether you receive appropriate medicine information
- Whether you can contact a qualified healthcare professional
- Whether the supplied medicine is clearly labelled
Mayo Clinic similarly warns that illegal online sellers may supply counterfeit medicines or incorrect doses.
When Should You See a GP Instead of Simply Trying ED Tablets?
You should consider medical assessment if:
- ED keeps happening
- Symptoms appeared suddenly
- You have diabetes
- You have high blood pressure
- You have high cholesterol
- You have cardiovascular disease
- You take several medicines
- You have symptoms suggesting low testosterone
- You have penile pain or curvature
- You have other unexplained symptoms
- You have concerns about your general health
You should also seek medical advice if ED treatment does not work or causes troublesome side effects.
Persistent ED is worth investigating rather than repeatedly treating the symptom without understanding why it is happening.
Frequently Asked Questions
When should I consider ED tablets?
You may consider discussing ED tablets with a healthcare professional when erection difficulties are persistent, recurrent or affecting your sexual wellbeing. Occasional problems caused by stress, tiredness or alcohol do not necessarily require medication.
What are the main ED tablets available?
The main PDE5 inhibitors used for ED include sildenafil, tadalafil, vardenafil and avanafil. They have similar overall mechanisms but differ in onset, duration, food effects and side-effect profiles.
Is sildenafil or tadalafil better?
Neither is universally better. The choice depends on factors such as how often you have sex, how long you want the effect to last, side effects, other medicines and your health.
Can I take ED tablets every day?
Some treatments, particularly low-dose tadalafil, may be prescribed for daily use in suitable patients. Other medicines are generally used on demand. Follow the specific instructions for the medicine prescribed to you.
Can I take ED tablets with heart medicines?
It depends on the medicine. Nitrates are particularly important because they should not be combined with PDE5 inhibitors. Always tell your doctor or pharmacist about every medicine you take.
Do ED tablets increase sexual desire?
No. PDE5 inhibitors primarily support the physical erectile response. They do not directly increase libido.
Can I take an ED tablet if I do not have ED?
ED medicines are intended to treat erectile dysfunction rather than enhance normal erections. Mayo Clinic states that men who can get and maintain erections without assistance do not need ED medicines.
What should I do if an ED tablet does not work?
Do not automatically take a higher dose. Speak with the prescribing healthcare professional. The cause, timing, treatment choice, dose and underlying health conditions may need to be reviewed.
Can lifestyle changes help ED?
Yes. Stopping smoking, reducing excessive alcohol, increasing physical activity, maintaining a healthy weight and addressing other health conditions can help some men.
Is ED a normal part of ageing?
Erectile difficulties can become more common with age, but persistent ED should not simply be dismissed as an inevitable part of ageing. It can be associated with treatable physical or psychological factors.
Final Thoughts
ED tablets can be an effective treatment for many men with erectile dysfunction, but deciding whether to use one should involve more than choosing a product from a list.
Persistent erection problems can sometimes point to cardiovascular, metabolic, hormonal, medication-related or psychological factors that deserve attention.
If ED happens repeatedly, the sensible first step is to understand what may be causing it and establish whether an ED tablet is safe for you.
For suitable men, PDE5 inhibitors such as sildenafil and tadalafil can support the natural erectile response. But they are not appropriate for everyone, particularly people taking nitrate medicines or those with certain cardiovascular and other health conditions.
A healthcare professional can help identify the cause, assess safety and choose an appropriate treatment approach.
Medical Disclaimer
This article is intended for general educational purposes and does not replace personalised medical advice, diagnosis or treatment.
Erectile dysfunction can have many causes, and the information provided here cannot determine whether a particular medicine is appropriate for an individual. Speak with a qualified doctor or pharmacist before starting, stopping or changing medication.
If you experience chest pain, sudden loss of vision or hearing, a severe allergic reaction or an erection lasting more than four hours after taking an ED medicine, seek urgent medical attention.
