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What Should You Do if ED Drugs Don’t Work?

Kristin Hall, FNP
Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 4/26/2020

The little blue pill known as Viagra® (generic name sildenafil) was first developed in the mid 1980s as a treatment for high blood pressure and angina. After discovering the drug’s benefits for treating the symptoms of erectile dysfunction in the early 1990s, scientists rebranded the drug as a treatment for erectile dysfunction.

Once the drug was approved by the FDA in 1998, prescriptions for Viagra exceeded five million over the next six months, and that number continues to climb. In 2012, 8 million prescriptions were written for Viagra alone — that doesn’t account for the other ED drugs on the market.

Unfortunately, ED drugs don’t work for everyone who takes them. If you suffer from erectile dysfunction and your ED drugs aren’t working as well as you’d like them to, don’t immediately abandon them or switch to another drug. Take the time to learn how ED drugs work and what might be causing your issues. From there, you can consult with your doctor and decide whether to give the drugs another shot or move on to an alternative treatment.

How Are ED Drugs Supposed to Work?

The risk factors for erectile dysfunction are vast and varied but, for the most part, the underlying issue comes down to one thing: circulation. 

Like any other organ in the body, the penis requires a supply of oxygenated blood in order to perform basic functions. When it comes to sexual function, circulation is key to achieving and maintaining an erection — the penis fills with blood, and the resulting pressure traps it inside, allowing the penis to expand in size and to become very firm.

Erectile dysfunction is a condition which, among other symptoms, makes it difficult for a man to achieve and maintain an erection. The primary function of ED drugs is to resolve those vascular issues, restoring blood flow to the penis to facilitate an erection. 

More specifically, ED drugs belong to a class of drugs known as type-5 phosphodiesterase (PDE5) inhibitors, and they enhance the effects of nitric oxide in the body, which works with other substances to open the blood vessels, increasing blood flow to the penis.

What Are the Risks and Downfalls of ED Drugs?

Though many men experience an improvement in ED symptoms after they start taking prescription medications, many men do not.  

In one study of 170 men experiencing ED due to spinal cord injuries, nearly 90 percent of subjects saw an improvement in their erection quality.

One meta analysis of 6,659 men from 27 different studies concluded that, in all the research available, sildenafil was more likely to lead to successful sexual intercourse over placebo (57 percent versus 21 percent, respectively), and that 83 percent of men were able to successfully have sex at least once throughout the study. 

There is some evidence to suggest that this number is high because many men fail to take ED drugs properly which can inhibit a favorable response. Even so, an article published by Harvard Health Publishing suggests that ED drugs fail to work for 30 percent of the men who take them.

Not only is there a risk that erectile dysfunction drugs might not work, but they could trigger some unpleasant side effects. Using Viagra as an example, some of the most common side effects are:

  • Headache
  • Flushing of the skin
  • Upset stomach
  • Changes in vision
  • Runny or stuffy nose
  • Back pain
  • Muscle aches
  • Nausea
  • Dizziness or fainting
  • Rashes

If you are taking prescription drugs for erectile dysfunction but you don't see the results you want, there are several options available to you. Before you consider an alternative course of treatment, ask yourself whether you are using the drug correctly. Many men fail to read the instructions or follow their doctor’s advice when it comes to ED drugs.

Here are six common mistakes men make when taking drugs for erectile dysfunction:

  1. Expecting a miracle – Drugs for ED are designed to improve blood flow to the penis, but they won’t enhance your arousal — you still need to become aroused to achieve an erection. You should also know that these drugs may not work immediately.
  2. Taking the wrong dose –  Every man — and their needs — are different. Naturally, every man’s ED treatment is going to be different, as well. If you’re finding ED drugs aren’t as effective as you’d like (or aren’t effective at all), talk to your healthcare provider. They’ll be able to prescribe a different dosage of your current drug, or even prescribe you another drug to try out. The process can take some time to dial in. 
  3. Not waiting long enough – Again, ED drugs are not a magical pill that will immediately give you an erection – you need to give the drug some time to work. ED medications like sildenafil may begin working in under an hour, but others (like Cialis) may take longer to be effective
  4. Giving up too soon – It is impossible to tell how your body is going to respond to a drug — any drug — so don’t be discouraged if your ED drug doesn’t work the first time. If you’re not getting the results you want after some time has passed, speak to your healthcare provider. 
  5. Trying only one drug – Like we said above, everybody responds differently to different medications.. If the first erectile dysfunction drug your healthcare provider prescribes isn’t working or giving you the results you want, talk to them about trying another medication.

After reviewing the mistakes from the list above, ask yourself honestly whether you are using your ED drugs correctly. If you are and you still aren’t experiencing any relief from your symptoms, it may be time to consider an alternative treatment. Keep reading to learn more.

Alternative Treatments for ED

When erectile function drugs don’t provide the results you want, you may need to consider other options. Some of the most common alternative treatments for ED include the following:

  • Injections
  • Suppositories
  • Vacuum constriction devices
  • Penile implants

Injections. When oral medications don’t work, another option is to inject the drug directly into the penis. Alprostadil (brand names Cavarject® and Edex®) is the only FDA-appvoed injectable ED drug, and it can create an erection within five to 20 minutes that lasts up to an hour. 

This drug is effective in between 50 percent and 85 percent of cases, though it comes with a risk for mild side effects such as pain at the injection site.

Suppositories. If you don’t like the idea of sticking yourself with a needle, a urethral pellet or suppository is another option. 

Known as the medicated urethral system for erection (MUSE), this treatment involves inserting a pellet of alprostadil into the urethral opening in the tip of the penis. 

The drugs are absorbed through the urethral wall and can trigger an erection within 10 minutes that lasts up to an hour. This treatment is a little less effective than injections and slightly more likely to cause pain or irritation.

Vacuum Constriction Devices. A completely non-medical treatment alternative for erectile dysfunction comes in the form of vacuum constriction devices. 

These devices consist of a cylinder that is placed over the penis and use a pump to create pressure inside the tube, drawing blood into the penis. Once the penis is erect, a rubber ring is usually placed around the base to prevent the blood from escaping. 

Penile Implants. In particularly stubborn cases of erectile dysfunction, surgical treatment may be worth considering. Penile implants are one of the most common options.

There are two types of penile implants.

The first — and most common — are inflatable implants. With this procedure, two hollow cylinders are placed in the penis, and involve physically pumping saline solution into them to achieve an erection.

The second — and less common — are semi-rigid implants, which consist of implanting semi-rigid rods in your penis. The upside is that patients largely report satisfaction with them. The downside is that once they’re implanted, you’re always erect, which obviously may not be the most ideal.  

Therapy. In addition to considering these alternative treatments, you may also want to consider psychotherapy as a supportive treatment if the cause of your ED is primarily psychological. 

Research suggests that some impotence cases have an underlying psychological trigger such as anxiety, depression or stress. 

Relationship troubles, fear of failure and low self-confidence can also contribute to psychological ED. 

Talking to a therapist can help you resolve any underlying issues that might be affecting your libido and inhibiting healthy sexual function.

Could Diet and Lifestyle Changes Help?

While erectile dysfunction drugs and other treatments may help to reduce symptoms or facilitate an erection, they don’t always address the underlying issues that caused the ED in the first place. 

Some of the most common risk factors for ED include obesity, smoking, diabetes, high cholesterol, stress, alcohol intake, poor diet and an inactive lifestyle. All of these are things that can theoretically be changed which could improve your erectile dysfunction.

Two  things you can do to naturally resolve ED is to improve your diet and exercise habits. 

Generally speaking, a healthy diet is made up of lean proteins, whole grains, fresh fruits, vegetables, and healthy fats. This type of diet is good for your heart, which means that it is also good for circulation — which, as mentioned above, is a key factor in your ability to achieve and maintain an erection. You may also want to reduce your intake of saturated fats and sugars as well as fried food, processed foods and alcoholic beverages.

In addition to making improvements to your diet, getting more regular exercise can benefit your sexual health. 

A meta analysis of 10 different research papers studying the effects of physical activity on erectile function concluded that 40 minutes of moderate to vigorous intensity exercise four days a week (or 160 total minutes per week) for six months can reduce instances of erectile dysfunction in men who are obese or experience ED due to things like hypertension, physical inactivity, cardiovascular disease or metabolic syndrome.  

Erectile dysfunction is a condition that affects millions of men over the course of their lifetime. 

As common as ED issues are, many men feel the stigma and fail to seek treatment — which only makes matters worse. 

If you’ve been taking prescription drugs to manage your erectile dysfunction, take the time to think about whether they are really working for you. 

If they aren’t, talk to a healthcare professional about dosage, or switch to another product. When you’ve exhausted your options, consider whether an alternative treatment like those discussed here might be your next best choice.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.