Reviewed by Kristin Hall, FNP
Written by Our Editorial Team
If you’re reading this, you likely know that we specialize in helping men take the guesswork out of their bedroom performance.
Erectile dysfunction, or ED, is a common problem that can affect men of all ages. In fact, ED is estimated to affect approximately 30 million men in the United States alone.
These days, a range of different medications are available to treat erectile dysfunction. There’s sildenafil (generic Viagra®), a PDE5 inhibitor that works by increasing blood flow to your penis, as well as options such as tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Stendra®).
These medications are usually sold as tablets or gel capsules, allowing for use 30 to 60 minutes before you have sex.
Recently, we’ve been hearing more and more about erectile dysfunction creams -- medications that are applied topically to your penis to treat ED. Since we’re interested in all things to do with male sexual health, we figured it was time to do a little more research.
The idea behind cream for erectile dysfunction is simple -- instead of taking a pill shortly before sex, you can apply an ED medication directly to your penis to get similar benefits from a topical cream.
In this guide, we’ll take a look at the ED creams that are available on the market, as well as the science behind how they work. We’ll also see what the best ED cream is (as far as we know at the moment) and take a look at other topical ED drugs currently undergoing scientific testing.
Finally, we’ll cover the more old-fashioned medications that are available for treating ED, as well as how they compare to topical treatments.
If you have ED, you may find it difficult to get or maintain an erection that’s firm enough to have penetrative sex. Most of the time, a healthcare provider will diagnose you with ED if you:
Can’t get an erection at all, even when you feel sexually aroused
Can get an erection, but not every time you want to engage in sexual activity
Can get an erection, but can’t always sustain it for longer enough to have sex
For some guys, ED is an occasional problem that occurs every now and then. For others, it’s a chronic issue that makes having satisfying, fulfilling sex difficult and even impossible.
Although ED is typically something that we associate with older men, the reality is that it affects guys of all ages. In fact, according to research, some men first begin to develop ED in their 20s, 30s or 40s.
A range of factors can cause, contribute to or increase your risk of developing ED. Some of the most common causes include physical health conditions and diseases that affect blood flow or nerve function, such as:
High blood pressure
Heart and blood vessel disease
Type 2 diabetes
Chronic kidney disease
Injuries to the penis, spinal cord or other tissue
Some of these conditions can make it more difficult for blood to flow to your penis, affecting your ability to get and stay hard.
Sometimes, ED is psychological. Mental health issues such as anxiety and depression, as well as factors such as severe stress, low self-esteem and concerns about your sexual performance may all have an impact on your ability to get an erection.
Even your use of medication and habits can cause or contribute to ED. You may be more likely to develop ED if you use certain types of cardiovascular or hormonal medication, or if you drink alcohol frequently, smoke tobacco, use illicit drugs or have a sedentary lifestyle.
You can learn more about erectile dysfunction and the factors that may contribute to it in our full guide to the causes of ED.
For the most part, ED is treated with medications called PDE5 inhibitors, which work by making it easier for blood to flow into your penis.
More recently, a variety of ED creams have popped up around the world, either as the subjects of ongoing research or as medications available to consumers.
Because topical creams are a relatively new form of treatment for ED, there isn’t as much data on their effectiveness as there is for oral PDE5 inhibitors. However, in the last few years, a few studies have been published suggesting that some ED creams may be effective.
A review, which was published in the journal Research and Reports in Urology in 2016, looked at the effects of a topical cream containing the ingredient alprostadil.
Alprostadil, or Prostaglandin E1, is a type of prostaglandin -- a substance that’s produced by the body at sites of tissue damage to control blood flow and inflammation. It’s used as an ingredient in certain injectable ED medications.
The review authors looked at several clinical trials of alprostadil dating back to the 1990s, noting that most research shows that alprostadil produces real, measurable improvements in the men’s ability to get an erection firm enough for penetrative sex.
The authors concluded that alprostadil is proven to be an “effective and well-tolerated” option for treating erectile dysfunction, and that it can be safely used by men who also take nitrates, alpha blockers and other drugs that are unsafe to use with medications like sildenafil (Viagra).
Another review noted that an alprostadil cream sold as Vitaros® performed well in clinical trials, with up to 83 percent of men with severe ED experiencing improvements, and that it caused no safety issues for the men’s female partners.
The author of this review made note of the fast onset of action of alprostadil, as well as its lack of interactions with other medications, suggesting that it could be an option for people who like the idea of a cream more than a tablet for treating ED.
In short, there’s real evidence that topical creams for ED can and often do work, at least when they contain alprostadil.
However, it’s worth noting that scientific research into the effects of ED creams isn’t anywhere near as advanced or large in scale as the research into existing treatments, such as sildenafil, tadalafil and similar oral medications.
It’s also worth noting that none of the ED creams that are being studied currently are approved by the FDA. This means that they haven’t been through the usual long, large-scale process of clinical studies to assess their safety and efficacy.
As such, it’s best to think of ED creams as a potential future option for the treatment of erectile dysfunction, not necessarily as a more effective choice than what’s available right now.
Over the last few years, a range of different topical creams have emerged as potential future treatments for ED. We’ve listed four common types of erectile dysfunction cream below, with additional information on the science behind each type of treatment.
Vitaros is a prescription ED cream that’s available in the United Kingdom. It first appeared on the market in 2014 as an alternative to oral drugs for patients with erectile dysfunction.
Vitaros is a type of topical alprostadil cream. As we mentioned above, alprostadil is a natural prostaglandin that’s used to dilate blood vessels and improve blood flow. When it’s applied to the penis, alprostadil makes it easier to develop and maintain an erection.
From a medical perspective, Vitaros cream is similar to early erectile dysfunction drugs like Caverject and Edex, which use an injectable form of alprostadil to increase blood flow to the tissue of the penis.
Understandably, injectable erectile dysfunction medications aren’t popular today in the age of more convenient options.
Vitaros has undergone phase II and III medical trials, but it hasn’t received approval from the FDA. Because of this, it isn’t yet available in the United States. However, it is available in the United Kingdom and certain other countries.
SST-6006 is a topical erectile dysfunction cream that contains sildenafil -- the exact same active ingredient that’s used in Viagra.
As of June 2015, SST-6006 was still under development by Strategic Science and Technologies LLC (SST) and about to enter into phase II medical trials.
The idea behind SST-6006 is interesting. Instead of using a new medication to treat ED, it takes an older, well-known active ingredient and attempts to deliver it through the skin directly into the penis rather than throughout the body as an oral medication.
Strategic Science and Technologies, the company behind SST-6006, claims that the medication uses technology called KNOSIS to penetrate the skin’s protective barrier and supply sildenafil to the tissue of the penis.
Like Vitaros, SST-6006 hasn’t been approved by the FDA, meaning it isn’t yet available in the United States.
Finally, there are various “male enhancement” creams containing substances like L-arginine that promise improved erections and sexual performance.
Many of these products are sold over the counter in supplement stores or online marketplaces like Amazon.
Although L-arginine is linked to nitric oxide production and blood flow, these products are not a type of medication, and there’s no scientific evidence to show that they have any positive effect on erectile function of sexual health.
As such, they’re generally best avoided. In fact, we generally recommend avoiding all products marketed as ED treatments that are sold over the counter.
This is because many of these products use unreliable, unproven ingredients that may not treat ED effectively. Worse yet, some have been found to contain unlabeled, potentially unsafe active ingredients that may have a negative impact on your health.
Like the L-arginine creams mentioned above, some over-the-counter creams for ED are made using natural ingredients such as ginkgo biloba leaf, cuscuta seed and various forms of exotic tree bark.
Manufacturers of these products often claim that they have medicinal properties and the ability to penetrate deep into the tissue of the penis for better erections.
For example, a product called VigRX Oil is promoted as using various leaves, barks and berry extracts to stimulate blood flow to the penis.
As dietary supplements, these products aren’t subject to the same efficacy testing that normal medications are put through before receiving FDA approval. For the most part, there’s no real evidence that they have any effects on your erections, “male vitality” or sexual function.
Currently, no ED creams have received approval from the FDA, meaning we don’t have reliable data on their side effects or interactions just yet.
However, the evidence that’s available right now suggests that ED creams containing alprostadil are generally safe, at least for most men.
In a review article published in Urologia Journal, researchers noted that the medication Vitaros -- an alprostadil product that comes in cream form -- appears to be safe, with just three percent of men reporting systemic side effects in clinical trials.
Other research on the safety of alprostadil topical creams has also been largely positive, with a review published in Research and Reports in Urology noting the following side effects in a small number of men:
Erythema (skin redness caused by inflammation)
A mild burning sensation at the application site
A very small percentage of users also noted more severe side effects, such as moderate sinus bradycardia (slow heartbeat), moderate dizziness and hypotension (low blood pressure).
Additionally, some of the men’s sexual partners experienced mild side effects, mostly related to vaginal burning and discomfort. These side effects occurred in between two and six percent of cases, suggesting that they’re not very common.
Researchers noted that using a condom may help to prevent alprostadil from spreading into the vagina and causing these side effects.
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Although topical ED creams show lots of promise as a form of treatment for erectile dysfunction, none have been approved by the FDA just yet.
This means that if you have ED, you’ll need to stick to the treatment options that are available at the moment. We’ve listed these below and explained how you can use each type of treatment to prevent erectile dysfunction and improve your sexual performance.
Currently, the most reliable way to treat ED is through the use of oral medications, referred to as PDE5 inhibitors. These medications work by dilating the blood vessels that supply blood to your penile tissue, allowing for better blood flow and firmer, more reliable erections.
The following oral medications are currently available to treat ED:
Sildenafil. The active ingredient in Viagra, sildenafil provides relief from ED for around four hours per dose.
Tadalafil. The active ingredient in Cialis, tadalafil is a long-lasting medication that isn’t affected by food and can last for up to 36 hours per dose.
Vardenafil. The active ingredient in Levitra, vardenafil provides relief from ED for about four to five hours per dose.
Avanafil. Sold as Stendra, avanafil is a newer, fast-acting ED medication that works in as little as 15 minutes and has a reduced risk of causing some side effects.
Unlike ED gels/ creams, which aren’t legally available in the United States, all of these medications are approved by the FDA for treating erectile dysfunction and available with a prescription.
Using oral ED medications is simple. Most can be taken between one hour and 30 minutes in advance of sex. Some, such as tadalafil, can be taken on a daily basis for round-the-clock ED prevention.
We offer several medications for ED online, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.
Sometimes, the most effective way to treat erectile dysfunction is by making a positive change to your habits and health.
This could mean losing weight, eating a more balanced diet, exercising more often to improve your cardiovascular health, or taking action to treat anxiety, depression or other mental health issues that could cause psychological ED.
Our guide to natural ways to protect your erection shares lifestyle changes and habits that you can use to improve your erectile function and sexual health.
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Vitaros cream is the only topical ED treatment available. However, until SST-6006 goes through its clinical testing and gains FDA certification, or until Vitaros becomes legal in the United States, the best options for men affected by ED are the traditional oral medications we already know about.
If you suspect you have erectile dysfunction, consider going through an ED consultation and talking to a healthcare provider about your treatment options.
You can also find out more about successfully treating ED in our guide to what causes erectile dysfunction and what you can do about it.