Sexual Dysfunction Treatment Options, Compared
Treatments for erections, desire, menopausal discomfort, and hormone deficiency answer different medical questions. Here is what each option treats and how well it is supported.
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Sexual concerns fall into different categories: erection problems, low desire, pain or dryness after menopause, and symptoms tied to a confirmed hormone deficiency. Start by naming the problem. Then compare treatments studied for that problem and population. Strong evidence for one use does not transfer to another.
Three questions before comparing treatments
What has changed
Identify the main concern: erections, desire, comfort after menopause, or symptoms that may come from a hormone deficiency.
Which options address it
Erection treatments, menopause treatments, desire medications, and hormone therapy serve different purposes.
What evidence applies to you
The evidence is specific to who was studied and what the treatment was meant to change.
Sexual function can change for many reasons. Treatments exist for erection problems, menopausal discomfort, low desire, and diagnosed hormone deficiencies. Comparing them by the problem they treat makes the choices easier to understand.
Why people look for sexual dysfunction treatment options
People usually seek treatment because erections become unreliable, desire fades, sex becomes painful after menopause, or testing confirms a hormone deficiency. Each concern points to a different assessment and set of options.
Erectile dysfunction can be treated with oral drugs, vacuum devices, or implants; shockwave therapy remains debated. Medications for low desire have different indications. Local menopause treatments address dryness, irritation, and painful sex. The useful comparison starts with the symptom or diagnosis.
What each treatment option is
These treatments work in different ways. Some improve blood flow or provide mechanical support for erections. Local therapies treat menopausal tissue changes. Hormone therapy addresses a diagnosed deficiency or menopause symptoms. Other medications are approved for low desire, and exercise may also improve erectile function.
Two medications approved by the U.S. Food and Drug Administration (FDA) treat HSDD in women, with different eligible populations. Bremelanotide is indicated for premenopausal women with acquired, generalized HSDD. Its label specifies that it is not intended to enhance sexual performance 1.
Kisspeptin remains experimental. A one-center study randomized 37 men and used brain imaging as its primary endpoint. Erectile response and self-reported desire were secondary measures 2. Peptides for sexual wellness explains the research in more detail.
Diagnosing testosterone deficiency in men requires compatible symptoms plus two early-morning total testosterone tests on separate days 6. A blood panel a clinician orders and reads explains how clinicians interpret the results. Menopausal hormone therapy is guided by symptoms and clinical assessment, not a deficiency blood test 5.
Sexual wellness treatments side by side
The table compares what each option treats and how well that specific use is supported. Evidence strength applies to the population and outcome studied.
- Treatment
- Common oral ED medications, including Viagra and Cialis (PDE5 inhibitors)
- What it treats
- Erectile dysfunction
- Evidence strength
- Established
- What the evidence covers
- Guidelines recommend discussing an approved medication in this class unless it is contraindicated. The recommendation is strong and based on Grade B evidence, below the guideline's top grade [3].
- Treatment
- Low-dose vaginal estrogen
- What it treats
- Genitourinary syndrome of menopause (GSM): dryness, irritation, painful sex
- Evidence strength
- Established
- What the evidence covers
- Two guideline bodies support local low-dose vaginal estrogen for GSM [5]. A 2025 multi-society guideline strongly recommends offering it for dryness, irritation, and painful sex, despite Grade C evidence [4].
- Treatment
- Vacuum erection devices and penile implants
- What it treats
- Erectile dysfunction when oral medication is not the preferred option
- Evidence strength
- Established
- What the evidence covers
- Guidelines say men should be informed about both options. The supporting evidence is a lower grade than the evidence for oral ED medications such as Viagra and Cialis [3].
- Treatment
- Systemic menopausal hormone therapy
- What it treats
- Hot flashes, night sweats, and genitourinary syndrome of menopause (GSM)
- Evidence strength
- Established
- What the evidence covers
- Systemic hormone therapy is the most effective treatment for vasomotor symptoms and can also improve GSM. When GSM is the only indication, low-dose vaginal estrogen is preferred. Systemic therapy also prevents bone loss and fracture. Benefits and risks depend on age and time since menopause. It generally does not improve desire independently of its effect on GSM [5].
- Treatment
- Testosterone therapy for men
- What it treats
- Low sex drive in men with diagnosed testosterone deficiency; support for separate erectile-dysfunction treatment
- Evidence strength
- Established (for diagnosed testosterone deficiency)
- What the evidence covers
- Testosterone may improve low sex drive when deficiency is confirmed [6]. Testosterone alone is not an effective erectile-dysfunction treatment; clinicians may combine it with one of these ED medications when deficiency is present [3]. Evidence is inconclusive for cognition, diabetes measures, energy, and fatigue [6].
- Treatment
- Desire medications and research peptides
- What it treats
- Acquired, generalized low desire that causes marked distress and is not better explained by health, relationship, medication, or substance factors (HSDD)
- Evidence strength
- Established (for the approved indications) / Early-stage (research peptides)
- What the evidence covers
- Flibanserin is approved for women under 65 following a December 2025 label revision [7]. Kisspeptin has only small-trial evidence [2].
- Treatment
- Lifestyle and exercise
- What it treats
- Erectile function, alongside cardiovascular and metabolic health
- Evidence strength
- Established (general health) / Emerging (erectile-function improvement)
- What the evidence covers
- Guidelines recommend lifestyle changes for overall health and say they may improve erectile function [3]. Across 7 trials with 478 participants, pooled results showed improvement in erectile-function scores. The authors rated the risk of bias moderate to high [8].
- Treatment
- Shockwave therapy (low-intensity extracorporeal shock wave therapy)
- What it treats
- Erectile dysfunction
- Evidence strength
- Early-stage / debated
- What the evidence covers
- The American Urological Association classifies it as investigational [3]. The European Association of Urology gives a weak recommendation for selected men with mild vasculogenic erectile dysfunction or poor response to oral ED medication [12].
- Treatment
- Herbal supplements
- What it treats
- Erectile function
- Evidence strength
- Debated
- What the evidence covers
- A 14-trial meta-analysis found short-term benefit for some botanicals and insufficient evidence for others. Follow-up lasted 1 to 6 months, and the pooled erectile-function result had high heterogeneity [9].
| Treatment | What it treats | Evidence strength | What the evidence covers |
|---|---|---|---|
| Common oral ED medications, including Viagra and Cialis (PDE5 inhibitors) | Erectile dysfunction | Established | Guidelines recommend discussing an approved medication in this class unless it is contraindicated. The recommendation is strong and based on Grade B evidence, below the guideline's top grade [3]. |
| Low-dose vaginal estrogen | Genitourinary syndrome of menopause (GSM): dryness, irritation, painful sex | Established | Two guideline bodies support local low-dose vaginal estrogen for GSM [5]. A 2025 multi-society guideline strongly recommends offering it for dryness, irritation, and painful sex, despite Grade C evidence [4]. |
| Vacuum erection devices and penile implants | Erectile dysfunction when oral medication is not the preferred option | Established | Guidelines say men should be informed about both options. The supporting evidence is a lower grade than the evidence for oral ED medications such as Viagra and Cialis [3]. |
| Systemic menopausal hormone therapy | Hot flashes, night sweats, and genitourinary syndrome of menopause (GSM) | Established | Systemic hormone therapy is the most effective treatment for vasomotor symptoms and can also improve GSM. When GSM is the only indication, low-dose vaginal estrogen is preferred. Systemic therapy also prevents bone loss and fracture. Benefits and risks depend on age and time since menopause. It generally does not improve desire independently of its effect on GSM [5]. |
| Testosterone therapy for men | Low sex drive in men with diagnosed testosterone deficiency; support for separate erectile-dysfunction treatment | Established (for diagnosed testosterone deficiency) | Testosterone may improve low sex drive when deficiency is confirmed [6]. Testosterone alone is not an effective erectile-dysfunction treatment; clinicians may combine it with one of these ED medications when deficiency is present [3]. Evidence is inconclusive for cognition, diabetes measures, energy, and fatigue [6]. |
| Desire medications and research peptides | Acquired, generalized low desire that causes marked distress and is not better explained by health, relationship, medication, or substance factors (HSDD) | Established (for the approved indications) / Early-stage (research peptides) | Flibanserin is approved for women under 65 following a December 2025 label revision [7]. Kisspeptin has only small-trial evidence [2]. |
| Lifestyle and exercise | Erectile function, alongside cardiovascular and metabolic health | Established (general health) / Emerging (erectile-function improvement) | Guidelines recommend lifestyle changes for overall health and say they may improve erectile function [3]. Across 7 trials with 478 participants, pooled results showed improvement in erectile-function scores. The authors rated the risk of bias moderate to high [8]. |
| Shockwave therapy (low-intensity extracorporeal shock wave therapy) | Erectile dysfunction | Early-stage / debated | The American Urological Association classifies it as investigational [3]. The European Association of Urology gives a weak recommendation for selected men with mild vasculogenic erectile dysfunction or poor response to oral ED medication [12]. |
| Herbal supplements | Erectile function | Debated | A 14-trial meta-analysis found short-term benefit for some botanicals and insufficient evidence for others. Follow-up lasted 1 to 6 months, and the pooled erectile-function result had high heterogeneity [9]. |
What treatment can realistically change
Treatment can improve erections or relieve menopausal pain and dryness. Certain medications address low desire in approved populations. Testosterone may improve sexual function in men with diagnosed deficiency. The sexual-function evidence cited here does not establish that relieving a sexual symptom prolongs life. Exercise and menopausal hormone therapy have separate health evidence that belongs in their dedicated guides.
Approval does not guarantee a large benefit. In the integrated bremelanotide trials, between-group effect sizes were 0.39 for desire and 0.27 for distress 10.
How strong the evidence is for each treatment
Evidence strength varies widely. Several treatments are supported by clinical guidelines, while shockwave therapy remains investigational under one major guideline. The supplement evidence comes from a small, short-term literature.
Low-intensity shockwave therapy is the clearest area of disagreement. The American Urological Association classifies it as investigational, based on a conditional recommendation and Grade C evidence 3. The European Association of Urology gives a weak recommendation for selected men with mild vasculogenic erectile dysfunction or poor response to oral ED medication 12. Its status remains Early-stage / debated.
Herbal supplements have a positive pooled finding, with results that differ by ingredient. Across 14 trials involving 1,227 men, saffron and ginseng showed benefit. Evidence for Tribulus terrestris and maca remains insufficient 9. The erectile-function analysis had high heterogeneity, study quality varied, and follow-up lasted 1 to 6 months.
For men with diagnosed testosterone deficiency, testosterone therapy may improve low sex drive 6. Testosterone alone is not an effective treatment for erectile dysfunction; clinicians may combine it with an oral ED medication when deficiency is present 3. Evidence remains inconclusive for cognition, diabetes measures, energy, and fatigue 6.
Testosterone use in women has a much narrower evidence base. The consensus recognizes one evidence-based use: postmenopausal HSDD after a formal biopsychosocial assessment 11. That assessment considers medical, psychological, and social factors. A testosterone level does not diagnose HSDD; testing helps prevent excessive dosing during treatment. In the United States, this use is generally off-label because no testosterone product is FDA-approved for women 11.
Which treatment fits the problem
Safety and eligibility can narrow the options. Bremelanotide is contraindicated for people with uncontrolled high blood pressure or known cardiovascular disease. Its label reports nausea in 40% of patients taking up to 8 doses a month 1.
Viagra, Cialis, and other PDE5 inhibitors must not be taken with nitrate medications because the combination can cause a dangerous blood-pressure drop 3. Flibanserin carries a boxed warning for severe hypotension and syncope when alcohol is consumed close to the dose. It is contraindicated with moderate or strong CYP3A4 inhibitors and in hepatic impairment 7.
Systemic menopausal hormone therapy requires individualized screening. Contraindications include unexplained vaginal bleeding, liver disease, prior estrogen-sensitive cancer, coronary heart disease, stroke, myocardial infarction, or venous thromboembolism 5. Benefits and risks also depend on age, time since menopause, regimen, and route. Local vaginal estrogen has different safety considerations.
Start with the symptom or diagnosis. Confirmed hormone deficiency requires testing, while menopausal symptoms and HSDD rely on clinical assessment. A prescriber confirms the diagnosis and reviews the relevant restrictions before treatment.
Separate guides cover testosterone replacement, menopausal hormone therapy, sexual comfort after menopause, the cardiovascular meaning of erectile dysfunction, and the broader causes of low desire.
The Bottom Line
Treatments for erection problems, low desire, menopausal discomfort, and hormone deficiency answer different medical questions. Start with the symptom or diagnosis. Then compare options studied for that use and population, including the restrictions that may affect eligibility.
References
- U.S. Food and Drug Administration. "VYLEESI (bremelanotide injection) prescribing information, revised 3/2024." FDA Approved Drug Labels. Initial U.S. approval 2019; current label version effective 11/13/2025. FDA label
- Mills EG, Ertl N, Wall MB, et al. "Effects of Kisspeptin on Sexual Brain Processing and Penile Tumescence in Men With Hypoactive Sexual Desire Disorder: A Randomized Clinical Trial." JAMA Network Open. 2023. DOI
- Burnett AL, Nehra A, Breau RH, et al. "Erectile Dysfunction: AUA Guideline." Journal of Urology. 2018. DOI
- Kaufman MR, Ackerman AL, Amin KA, et al. "The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause." Journal of Urology. 2025. DOI
- "The 2022 Hormone Therapy Position Statement of The North American Menopause Society" Advisory Panel. "The 2022 hormone therapy position statement of The North American Menopause Society." Menopause. 2022. DOI
- Mulhall JP, Trost LW, Brannigan RE, et al. "Evaluation and Management of Testosterone Deficiency: AUA Guideline." Journal of Urology. 2018 (validity confirmed 2024). DOI
- U.S. Food and Drug Administration. "ADDYI (flibanserin) tablets prescribing information, revised 12/2025." FDA Approved Drug Labels. 2025. FDA label
- Silva AB, Sousa N, Azevedo LF, Martins C. "Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis." British Journal of Sports Medicine. 2017. DOI
- Ho CY, Hsu CH, Chien TJ. "Herbal dietary supplements for erectile dysfunction: A systematic review and meta-analysis of randomized-controlled trials." Journal of Traditional and Complementary Medicine. 2025 (online); 2026 (issue). DOI
- Kingsberg SA, Clayton AH, Portman D, et al. "Bremelanotide for the Treatment of Hypoactive Sexual Desire Disorder: Two Randomized Phase 3 Trials." Obstetrics & Gynecology. 2019. DOI
- Davis SR, Baber R, Panay N, et al. "Global Consensus Position Statement on the Use of Testosterone Therapy for Women." Journal of Clinical Endocrinology & Metabolism. 2019. DOI
- European Association of Urology. "EAU Guidelines on Sexual and Reproductive Health: Management of Erectile Dysfunction." EAU Guidelines, 2026 Edition. 2026. EAU guideline