Erectile dysfunction (ED), formerly called “impotence,” means that a man often can't have an erection firm enough for intercourse. Men with diabetes get ED three times as often as other men.

If you think you may have ED, see your health care provider. Most cases can be treated or even cured. For example, a medical problem (such as high blood pressure) may be the cause and can be treated. Sometimes, drugs cause ED. In that case, you may be able to switch to some other drug.

Pills are the most common treatment for ED. Sildenafil (Viagra), vardenafil(Levitra), and tadalafil (Cialis) work by making muscles in the penis relax. Then more blood flows in.

ED pills do not cause erections by themselves. A man must also be sexually excited. The erection-helping effects of ED pills last about 4 hours with sildenafil and vardenafil and 36 hours with tadalafil.

You should not borrow these drugs from friends or buy them online. They should only be taken with your health care provider's knowledge and oversight.

Some men should never take ED pills. These include men who should not have sex for medical reasons and men who take certain drugs or have certain medical problems.

ED pills can also cause side effects. The most common are headache,flushing, upset stomach, vision changes, and erections that last longer than 4 hours.

Alprostadil is an ED drug that comes in two forms. One form (Caverject,Caverject Impulse, or Edex) is injected into the side of the penis to increase blood flow and cause an erection within 5 to 20 minutes. Its effects last 1 hour or less. The most common side effect is pain. Other side effects include bruising, redness, numbness, bleeding, and irritation.

Alprostadil also comes as a pellet that is placed within the penis. An erection then starts within 8 to 10 minutes. It lasts 30 to 60 minutes. Side effects can include pain, aching, burning, minor bleeding, and redness.

When a man has low levels of male hormones, a doctor may prescribe testosterone patches. These are worn every day. Too few studies have been done to know whether these patches work for ED. Injections of testosterone are also given for ED. The need for these can be determined with a blood test.

Counseling. Stress, relationship problems, and other mental factors can cause ED. Also, a man with ED may become anxious about sex, making ED worse. So counseling may help even when ED has a physical cause.

Vacuum device. This device is placed over the penis. Then air in the device is pumped out. Blood flows into the penis and causes an erection. An elastic ring then slides onto the penis to keep the erection going after the device is removed.

Surgery. Blood vessel surgery helps some men, such as those with penis injuries. This surgery cannot help most men with diabetes.

In another type of surgery, implants are placed in the penis. Some implants are rods that make the penis always stiff. Other implants can be inflated to cause an erection when desired.

In the past, many men just lived with ED. Today's treatments mean that most men with ED can get their sex lives back. The most important step is the first one: seek help by talking to your health care provider.