For most men, tablets such as sildenafil or tadalafil are still the first treatment to try for erectile dysfunction (ED). They have years of research behind them and help many men. ED gels and creams are an alternative if tablets don't suit you, give you side effects, or you'd simply rather not take a tablet. In the UK there are two main options: Eroxon, a gel sold in pharmacies without a prescription, and alprostadil cream, which needs a prescription. Here's how they compare.
ED gel vs tablets at a glance
| Eroxon gel | Alprostadil cream | Sildenafil tablets | Tadalafil tablets | |
|---|---|---|---|---|
| What it is | A gel classed as a medical device; it contains no medicine | A prescription medicine (brand name Vitaros) | A PDE5 inhibitor medicine | A PDE5 inhibitor medicine |
| How you use it | Rub onto the head of the penis just before sex | Apply to the tip of the penis 5 to 30 minutes before sex | Swallow about an hour before sex | Swallow at least 30 minutes before sex, or take a low dose every day |
| How quickly it works | Within about 10 minutes for men it helps | Usually within 5 to 30 minutes | Usually 30 to 60 minutes | From about 30 minutes |
| Prescription needed? | No, sold in pharmacies | Yes | Yes, except the 50mg pharmacy pack (Viagra Connect) | Yes |
| Common side effects | Warmth, tingling or burning where it's applied | Burning or redness of the penis; a partner may get burning or itching | Headache, flushing, indigestion, blocked nose | Headache, indigestion, back or muscle aches, flushing |
What is ED gel?
Eroxon gel
Eroxon is a clear gel that you rub onto the head of the penis for a short time just before sex. It doesn't contain a medicine. It's a medical device, thought to work through a cooling and then warming effect on the nerve endings, which helps blood flow into the penis. It has been sold in UK pharmacies without a prescription since 2023, for men aged 18 and over, and it's mainly aimed at men with mild to moderate ED.
Because it isn't absorbed into the body like a tablet, it doesn't have the headaches or flushing some men get with tablets. Follow the leaflet, and stop using it if it irritates your skin or your partner's. We don't stock Eroxon, but any pharmacy that sells it can advise you.
Alprostadil cream
Alprostadil cream (Vitaros) is a prescription medicine applied into and around the opening at the tip of the penis, 5 to 30 minutes before sex. Alprostadil relaxes the blood vessels in the penis so it fills with blood. Don't use it more than once in 24 hours, and follow the leaflet on how many times a week you can use it. It's often considered when tablets haven't worked or aren't suitable.
The cream can pass to a partner. Use a condom if your partner is pregnant, could become pregnant or is breastfeeding.
How ED tablets work
Sildenafil, tadalafil, vardenafil and avanafil belong to a group of medicines called PDE5 inhibitors. They increase blood flow to the penis, but you still need to be sexually aroused for them to work.
- Sildenafil (Viagra): take it about an hour before sex. It can start working from about 30 minutes and lasts around 4 hours. A heavy, fatty meal can slow it down. Sildenafil 50mg is also sold by pharmacies without a prescription as Viagra Connect, after a pharmacist has asked a few questions.
- Tadalafil (Cialis): take it at least 30 minutes before sex. It can keep working for up to 36 hours. A low daily dose of tadalafil (2.5mg or 5mg) suits some men who have sex often and don't want to plan around a tablet.
If a tablet doesn't work the first time, don't give up straight away. It often works better after a few tries at the right dose and timing. If it still doesn't help, or the side effects bother you, talk to a pharmacist or GP about other options, including gels and creams.
Who shouldn't use them
- Never take ED tablets if you use nitrate medicines (such as GTN spray or isosorbide mononitrate) or recreational "poppers". Together they can make your blood pressure drop dangerously.
- ED tablets aren't suitable for some men with heart problems, very low blood pressure, or a recent heart attack or stroke. The prescriber or pharmacist checks this before supplying them.
- Alprostadil cream isn't suitable for some men, including those with a curved or scarred penis, or conditions that make long-lasting erections more likely, such as sickle cell disease.
- Whatever you use, get urgent medical help if an erection lasts longer than 4 hours.
When to see a GP
ED is common, and it often has a physical cause. It can be an early sign of heart disease, diabetes or high blood pressure, so it's worth seeing your GP for a check, even if a gel or tablet helps. See a GP too if ED comes with pain, a lump or a bend in the penis, or problems peeing. Our guide to what causes erectile dysfunction explains more.
You can compare the tablets we supply, and start a confidential consultation with a UK prescriber, on our erectile dysfunction treatment page.
ED gel FAQs
Does ED gel really work?
It can. In clinical studies, Eroxon gel worked within about 10 minutes for many men with mild to moderate erectile dysfunction, and alprostadil cream is a licensed prescription medicine. Tablets such as sildenafil and tadalafil have more evidence behind them, so they're usually tried first.
Is Eroxon better than Viagra?
Not for most men. Sildenafil (Viagra) has far more research behind it and suits a wider range of men. Eroxon may be worth trying if tablets give you side effects or you'd rather not take a medicine. A pharmacist can help you decide.
Can I buy ED gel without a prescription?
Yes. Eroxon is sold in pharmacies without a prescription to men aged 18 and over. Alprostadil cream is a prescription-only medicine.
Can I use gel and tablets together?
Ask a pharmacist or your prescriber before combining treatments. Don't use alprostadil cream with ED tablets unless a doctor has told you to.
How fast does ED gel work?
Eroxon is designed to work within about 10 minutes of applying it. Alprostadil cream usually works within 5 to 30 minutes.
Further reading
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