If ED medications don’t work, is there any hope?

If you’re someone who has been struggling with erectile dysfunction, you may have been prescribed sildenafil (brand name Viagra), tadalafil (brand name Cialis), vardenafil (brand name Levitra), or another medication known as a phosphodiesterase-5 inhibitor.

These medications are effective for most patients, but not all. If you’re in this frustrating situation, here are a few things to consider.

Keep in mind that ED medication is more effective once someone has used them more than once. Anxiety can be an issue, but familiarity with the effects plays a role as well. In fact, some healthcare providers recommend using the medication to masturbate first so the effects aren't unexpected in what might be a high-pressure situation.

If you aren’t able to have a satisfactory erection for sex on your current dose of ED medication, you may benefit from a higher dose. Speak with your healthcare provider to see if a higher dose of ED medication would be right for you.

Another reason drugs may not work is because your ED is caused by an underlying health condition. This can include issues with nerves, blood vessels, or hormones. If ED medication isn’t working for you, talk to a healthcare provider about getting evaluated for other things that could be causing the issue.

The simplest drug-free treatment for ED is a penis pump or vacuum device. This device creates suction around the penis, forcing blood into it causing it to swell. The placement of a ring at the base of the penis keeps blood from draining out to maintain an erection. The device should be removed after 30 minutes to prevent damage to the penis. Once removed the blood releases and recirculates back throughout the body. Some men find that the use of a ring alone helps them keep erections longer. However, using these devices is not without risks. The pressure of a pump can damage blood vessels in the penis, which could worsen erectile dysfunction.

If that isn't sufficient, a medication called alprostadil can be used as a suppository or penile injection. This drug is a vasodilator, which causes blood to rush into the penis. When inserted into the penis as a pellet with an applicator, it is called MUSE (Medicated Urethral System for Erections). It's not easily used, has a number of risks (like causing very low blood pressure), and is painful for many patients. Nevertheless, for some properly chosen patients, it works well and is satisfactory.

Some men find that the surgical placement of a rod, semirigid implant, or a newer, inflatable implant, yields better erections results.

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Current version

October 11, 2019

Written by

Health Guide Team

Fact checked by

Jefferson Chen, MD

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About the medical reviewer

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.