Treatment for erectile dysfunction depends on the cause. Testosterone supplements may be used for cases due to hormonal deficiency. However, the cause is more usually lack of adequate penile blood supply as a result of damage to inner walls of blood vessels. This damage is more frequent in older men, and often associated with disease, in particular diabetes.

Most treatments work on a temporary basis: they enable an erection to be attained and maintained long enough for intercourse, but do not permanently improve the underlying condition. There are different treatments available:

Oral treatment
These work when there is sexual stimulation. Depending on the treatment, it will need to be taken 20 minutes to 1 hour before sex and the period of time over which it works can vary between 3 hours and up to 36 hours.

Alprostadil
This can be injected into the penis or inserted using a special applicator - usually just before sexual intercourse.

Vacuum pumps
These work by drawing blood into the penis and are also used just before sexual intercourse.

Hormone treatment
It is rare, but some men receive hormones for their erection problem. This does depend on the cause of the problem as well as other factors.

Surgery
Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.

Counselling
Counselling is often a consideration, both where a psychological cause is suspected or must be ruled out, or to assist in management of any distress.
ED can in many cases be treated by drugs taken orally, injected, or as penile suppositories. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate cock ring fitted to the penis to maintain it.

More drastically, inflatable or rigid penile implants may be fitted surgically. Implants are irreversible and costly.

All these mechanical methods are based on simple principles of hydraulics and mechanics and are quite reliable, but have their disadvantages.

In a few cases there is a vascular problem which can be treated surgically.

You take your new girlfriend out to a hot new restaurant for dinner, then to the bar for a couple cocktails. Conversation and libations are flowing – until you get home and into the bedroom. Suddenly, when it comes to doing the deed, Man’s Best Friend just won’t cooperate. Damn that last martini, you think to yourself; I should’ve had something much, um, stiffer.

Don’t panic! Erectile difficulty, the catch-all name for troubles with getting it up, happens at some point to almost every human being who owns a penis. If you’re one of those human beings – that is, a man – read on to find out why it’s so not the end of the world – or even the end of night.
The Lowdown

First things first: you get an erection when blood flows into your penis, making it thick and stiff. Now, erectile difficulty can be caused by physiological issues or psychological issues, or a combination of the two. Psychologist and sex therapist Dr. Lori Buckley, of Pasadena, California, says that ED can be the result of being a smoker, being overweight, having prostate problems or diabetes, or of other cardiovascular problems that limit blood flow in general. And yes, it can be caused by too much booze; while alcohol’s supposed to relax you, it sure can backfire! If you have consistent erectile difficulty, visit your doctor for a check-up to make sure that you’re healthy and that you’re eating a balanced diet.
Doing It

Of course, ED can be caused by nerves and performance anxiety, too. And if you let that anxiety affect your self-esteem, one limp situation, so to speak, can snowball into permanent insecurity. “Men have an emotional connection to their penises,” says Dr. Buckley. “They think women feel the same way, and fear rejection.” A fear of rejection is natural, but you’ll fear no more if you think of pleasure, not performance or penetration, as your goal. That’s the sure-fire way for both partners to end the night smiling. Here’s how:

Relax. As lots of women will tell you, “sex” does not necessarily mean “intercourse.” Focus on each moment of pleasure instead of thinking ahead to the end result. That way, when you do get hard, sex will be even better.

Remember, it’s okay if you lose your erection! “It’s not gone forever,” Dr. Buckley assures. “But what you do when you lose it makes a big difference. Instead of stressing out, focus on other things: spend some time arousing your partner; curl up for some cuddling or kissing; or just go watch a movie and try again later.
What about the magic pill?

Erection-sustaining prescription drugs, such as Viagra, Levitra, or Cialis, which are taken thirty minutes before intercourse and can last up to a couple of days, can be a good option, in Dr. Buckley’s opinion. “They can act as an insurance policy,” she points out. “They take the pressure off, because you know they’re there if you need them.” But she suggests trying drug-free solutions first, since relying on a pill unnecessarily won’t do your self-esteem any good. If you’re considering taking erection-sustaining medication, talk to your doctor about which drug is right for you.

Check out these resources for more information on ED:

The New Male Sexuality by Bernie Zilbergeld (New York: Bantam, 1999)
http://www.sexualhealth.com
http://www.webmd.com