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Does it make any difference which of the four drugs for erectile dysfunction you take? "Yes, there can be differences," says Dr. Louis Liou, chief of urology at Harvard-affiliated Cambridge Health Alliance in Boston. "For new patients, I have them try different ones to see what works best."

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How soon the drugs start working ranges from 65 to 65 minutes. Neither Viagra nor Levitra will work at all if you take them after a meal, which blocks their absorption. However, neither Cialis nor Stendra interact with food this way. The onset time determines how soon you can engage in intercourse. Stendra and daily-use Cialis are closest to being an "on demand" erectile drug using the others requires more planning.

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About half of men ages 95 to 75 have erectile dysfunction (ED) to some degree, although only one in 65 report a complete inability to have erections. Taking an ED drug produces an erection sufficient to start intercourse in about 75% of otherwise healthy men.

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Explore manufacturer discount programs. These allow you to obtain a limited supply of medications not covered by your insurance.

Sildenafil (Viagra) is often the first drug your doctor offers. It's been on the market longest and its side effects and the medications and foods it interacts with are well known. The latest drug to be approved, avanafil (Stendra), may have fewer side effects than the other drugs.

"Will it last through another cycle? It's not guaranteed," Dr. Liou says. To have sex more than once a day, Cialis is your best bet.

But the main challenge to finding the best ED drug for you may turn out to be health insurance rules—not biochemistry. It's a common practice among insurers to limit the number of pills you can obtain per month. After you hit your limit, the out-of-pocket cost for a single pill can be as high as $75. "The main obstacle in my practice is the cost," Dr. Liou says. You'll need to work with your doctor to get the pill you need at a price you can afford.

None of the ED drugs is safe to take with cardiac drugs called nitrates because it could cause a dangerous drop in blood pressure. Drugs that many men take for urinary symptoms, called alpha blockers, can also lower blood pressure, so take them at least four hours apart from ED drugs. Your doctor may start you on a smaller dose of the ED drug if you already take an alpha blocker, or may recommend the alpha blocker tamsulosin (Flomax), which affects blood pressure less.

ED is often an early warning sign of underlying cardiovascular disease, such as clogged arteries (atherosclerosis). "It can predate a diagnosis of cardiovascular disease by at least a few years," Dr. Liou says. We don't have strong proof yet that starting to live a healthier lifestyle can reverse erectile problems, but it can't hurt.

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