Vacuum Pumps
The least invasive method has to be the vacuum pump: Put your johnson in a tube, pump out the air, and voila — the resulting vacuum causes blood to fill the corpora cavernosa (that’s a good thing). To keep matters in this desirable state and help prevent urine leakage, slide a constriction ring around the base of the penis. Note: The ring should not be worn for more than 30 minutes at a time. Vacuum pumps are available without a prescription and some are battery-operated. Side effects are fairly uncommon but may include bruising, pain or discomfort, numbness, pinching of the scrotal tissue and a sensation that the penis is cold. Also some guys don’t like this method because they say the erection feels “wobbly.”

Oral Drugs
Let’s face it: A pill just sounds easier. Just make sure you are a good candidate — no nookie is worth hospitalization or worse.

So, how do the pills work? Cialis (tadalafil), Levitra (vardenafil), and Viagra (sildenafil citrate) are phosphodiesterase-5 inhibitors, which relax the penis muscles and allow the corpora cavernosa to fill with blood. Cialis can work for up to 24 to 36 hours, and both Viagra and Levitra generally are effective for about four hours. High-fat meals can inhibit the effectiveness of both Viagra and Levitra, and Viagra especially is not recommended for men with either high or low blood pressure. Also, all of the ED meds require some penile stimulation.

Although most studies show these drugs are safe for men with spinal cord injuries, they don’t often look at how men with different levels of injury are affected. One notable exception is “The effects of sildenafil on the cardiovascular response in men with spinal cord injury at or above the sixth thoracic level,” published in the Fall 2003 Journal of Spinal Cord Medicine. According to this study, quadriplegics are at high risk of hypotension — dangerously low blood pressure — when taking Viagra.

None of the PDE-5 meds are recommended for men taking any medication containing nitrates, and men taking an alpha-blocker should check with their doctors before filling a PDE-5 prescription. Side effects may include headache, skin flushing, indigestion, and nasal congestion. Also, some men report a bluish tinge to their vision and/or sensitivity to light.

The MUSE System
This one shouldn’t be any worse than cathing, but most guys cringe a little at the thought anyway.

MUSE, short for “medicated urethral system for erections,” is basically a small pellet of alprostadil inserted into the tip of the penis. The pellet becomes absorbed through the tunica albuginea and results in an erection about 10 minutes later. The erection usually lasts between 30 minutes to an hour.

Most doctors administer the first dose of MUSE in their office, to ensure the guy isn’t allergic or prone to getting priapism, which is a painful, long-lasting erection. MUSE is only effective for about 30 to 65 percent of men, and side effects may include infection, a burning sensation, decreased blood pressure and fainting. Also, the man’s ejaculation sometimes irritates his partner’s vagina, and oral sex should be avoided.

The Injection Erection
And if that method makes you shudder, this one may put you over the top. It’s good for that.

With a success rate of 85 percent, penile injection therapy is one of the most effective treatments for ED. The biggest downside to this treatment is it’s injected directly into the side of the penis, which, although done with a very small needle, understandably makes some men squeamish.

This therapy uses the drugs Caverject (alprostadil), Pavabid (papaverine hydrochloride), and Regitine (phentolamine mesylate) either separately or mixed together as one treatment commonly called “Trimix.” As with MUSE, most doctors administer the first dose in their office in order to make sure the man’s not allergic and won’t get priapism.

Side effects such as bruising or pain may be prevented by slowly injecting the med, but scarring and infection can also occur. This method is not recommended for use more than once a week.

Penile Implants
Penile implants were big in the ’80s. But like big hair and cocaine, popularity cooled as less terrifying and cheaper options became available.

Today, implants are usually the treatment of last resort since they require a surgical implantation of a prosthetic right in the penis. There is a high risk for infection, and men who can’t feel pain in the genital area may not know until too late if the prosthetic is breaking through the skin. These implants are expensive, and if they become infected, they must be removed. Most men stay in the hospital for one or two days after penile implant surgery and take antibiotics for up to two weeks.

Rigid and semi-rigid implants are always firm, and semi-rigid implants can be bent into different positions, which helps hide them behind clothing. Inflatable implants are cylinders pumped full of saline stored in a reservoir in the lower abdomen. A release valve on the pump, located in the scrotum, drains the saline out of the cylinders and back into the reservoir.

Still, regardless of the high risks involved, men who choose this option say the erection feels more natural. Ejaculations and orgasms are not guaranteed, and implants neither increase nor decrease sexual pleasure.