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Second-line treatments for men who do not respond to or cannot tolerate PDE5 inhibitors include: Intracavernosal injections (alprostadil) Intraurethral alprostadil Topical alprostadil cream Vacuum erection devices Penile prosthesis surgery (for refractory cases) When to seek urgent medical attention: Men should contact their GP promptly if ED develops suddenly, particularly if accompanied by chest pain, breathlessness, or other cardiovascular symptoms, as ED may indicate previously undiagnosed heart disease
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