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What if Oral ED Medications Don’t Work?

What if Oral ED Medications Don’t Work?Ever since the U.S. Food and Drug Administration (FDA) approved Viagra in 1998, pills called phosphodiesterase type 5 (PDE5) inhibitors have become one of the most popular treatments for erectile dysfunction (ED).  Medications like Viagra, Levitra, and Cialis are heavily marketed and sometimes portrayed as a magic pill that can make a man’s erection problems disappear.

But it isn’t quite that easy.

First, not every man can take PDE5 inhibitors. For example, these drugs can interact with nitroglycerin, a medication often taken for chest pain and coronary artery disease. The combination can cause a dangerous drop in blood pressure.

Men with heart problems, diabetes, high or low blood pressure, or a history of heart attack or stroke should be careful if they take PDE5s. Their doctor can best determine whether the drugs are safe.

Second, some men find that PDE5 inhibitors just don’t work for them. Or, the drugs might not be as effective as they expected. It’s also possible for the medications to become less effective over time.

What happens then? Fortunately, there are other avenues for treating ED. Today, we’ll take a look at some of them.


Alternatives to PDE5 Inhibitors

The following is a brief overview of other ED treatments that may help. For further information, just click on the corresponding links.

·         Injections. Some men with ED give themselves injections of a drug called alprostadil, which can improve blood flow to the penis and, in turn, create a firm erection. Injections should be given about five to ten minutes before sex. While the idea of injection a needle into one’s penis may be nerve-wracking, a urologist can show you the proper technique.

For more information:

Self-Injections – Erectile Dysfunction

How Do I Learn the Technique of Penile Injection Therapy? (video)

Penile Injections Sound Painful. Who Would Consider That for ED? (video)

·         Suppositories (MUSE). Suppositories, sometimes called transurethral agents, are another way to administer alprostadil. MUSE stands for Medicated Urethral System for Erection and is currently the only suppository approved by the FDA for ED.

To use MUSE, a man uses a special applicator. Inside this device is a small pellet of medicine. The applicator tip is placed inside the urethra – the tube that allows urine and semen to exit the body – and the pellet is dispensed. Most men get an erection about five or ten minutes after application.

Using transurethral agents can be a bit tricky. A urologist can teach you the best way to administer them.

For more information:

Transurethral Agents – Erectile Dysfunction

Can MUSE Help Me? ED Medication Did Not Work (video)

How Do You Insert the Urethral Pellet Medication for ED? (video)


·         Vacuum erection devices (VEDs). These devices come in three parts: a clear plastic cylinder, a pump, and a constriction ring. The cylinder is placed over the penis and the pump is used to create a vacuum, which increases blood flow to the penis. Once the erection is achieved, a constriction ring is placed at the base of the penis to keep the blood in. This keeps the erection firm. To avoid injury, the constriction ring should be removed within thirty minutes.

For more information:

Vacuum Devices – Erectile Dysfunction

Did You Know? – Vacuum Erection Devices

Blog – Vacuum Erection Devices (includes instructions for using one as well as the advantages and disadvantages)

·         Implants. Penile implants, or prostheses, are usually considered the last resort for men with ED. These devices are surgically implanted and permanent. In the procedure, the corpora cavernosum – spongy chambers that typically fill with blood during an erection – and replaced with artificial cylinders.

Nowadays, most penile implants are an inflatable type. To get an erection, a man activates a pump that is also surgically implanted. The pump causes a saline fluid to travel to the cylinders, filling them until the penis is erect. When the man no longer wishes to have to have the erection, he deactivates the pump.

For more information:

Penile Implants – Erectile Dysfunction

Penile Implant Surgery for Erectile Dysfunction – Resources (includes interactive program)

What Are The Different Types of Penile Implants? (video)

How Long Do Implants Work For? (video)

Who Decides Which Patients Need an Implant? (video)

Will a Penile Implant Make a Difference for my Partner? (video)


Talk to Your Doctor

If you’re taking a PDE5 inhibitor and it doesn’t seem to be working, don’t hesitate to call your doctor. It’s possible that another PDE5 inhibitor brand may be effective. Or, making lifestyle changes, such as losing weight or quitting smoking, may help you get better results.

However, don’t be afraid to ask about alternatives either. While treatments like injections and vacuum pumps may not seem very romantic, they can still allow you to enjoy satisfying sex again.

Print this article or view it as a PDF file here: What if Oral ED Medications Don’t Work?


“7 Ways to Treat Erectile Dysfunction”,,20307067,00.html


“Erection problems”

(Updated: September 19, 2011)


(Revised: August 1, 2010)

Sexual Medicine Society of North America

“Penile Implants – Erectile Dysfunction”

“Self-Injections – Erectile Dysfunction”

“Transurethral Agents – Erectile Dysfunction”

“Vacuum Erection Devices”

(May 30, 2013)