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What to Do When the Pills Don’t Work?


When men are diagnosed with erectile dysfunction, the first treatment that doctors prescribe is a type of drug called a PDE-5 inhibitor. These drugs include Viagra, Cialis, Levitra, Standra, and their generic equivalents. Most guys are surprised to learn that these drugs are only effective for about 65% of men! Even if they are initially effective, they may stop working as a man ages, and underlying conditions worsen.

When the ED drugs stop working, many men give up, often without realizing that there are other options.

The first step is to talk to your doctor about the underlying cause of your condition. In some cases, even severe ED can be improved by addressing the root causes.

It may also be possible to improve ED with a multi-treatment approach. In this article, we will describe a number of alternate treatments for men with severe erectile dysfunction. All of these treatments have been clinically shown to work, although the best treatment option will depend on the patient’s specific medical condition and the underlying cause(s) of his erectile dysfunction. Click the links throughout this article for more information on specific treatment.

The first and simplest option is to try a different PDE-5 inhibitor. Men often respond better to one than another. Switching drugs may give a few more years of satisfying erections.

If switching medications doesn’t work, your doctor may prescribe Intracavernous Penile Injections of alprostadil or Trimix. A small needle is used to inject the drug directly into the side of the penis shortly before having sex. Injections are more effective than oral medications, and allow about 85% of men to achieve a satisfactory erection.

It’s also worth having your doctor test your testosterone levels; low testosterone can cause or contribute to ED, especially as men age. If you have low testosterone, your doctor can prescribe testosterone replacement therapy (TRT).

Addressing Your Health Issues

Another option is to address underlying health issues. Many men find that they are able to get their bodies back to a point where the oral drugs work again. This may require a serious commitment and significant lifestyle changes, including:

  • Switching to a low-sodium, heart-heart-healthy Mediterranean diet.
  • Getting plenty of aerobic exercise.
  • Establishing a regular sleep schedule.
  • Quitting smoking and vaping.
  • Consuming alcohol only in moderation, or not at all.
  • Finding ways to reduce stress.

Even if these changes don’t reduce the severity of your erectile dysfunction, they will make a big impact on your overall health!

Restoring Blood Flow to the Penis

Strong blood flow is essential for good erections, as well as the overall health of the penis. In fact, scientists believe that regular nocturnal erections (“morning wood”) are essential to providing an adequate blood and oxygen supply. Without this mechanism, the tissues of the penis atrophy, and the penis can actually shrink.

Many men with long-term ED no longer have nocturnal erections; this leads to a cycle where the ED symptoms get worse and worse. To break this cycle, men need to improve the blood flow in the penis. In addition to the general health advice mentioned above, there are some specific treatment options that can promote blood flow, and re-oxygenate the penis. These treatments have even been shown in independent clinical studies to restore lost length to the penis.

Vacuum Pump Therapy – regular daily use of a vacuum pump draws blood into the penis, providing the necessary oxygen to restore damaged tissue and even regain lost length.

Low-Intensity Extracorporeal Shockwave Therapy (LI-ESWT) – breaks up plaque blocking blood vessels, and promotes the growth of new blood vessels. There are many clinical studies showing shockwave therapy to be safe and effective. The treatments can be administered in a clinic, or using a home treatment device.

Kegel Exercises – some studies have shown that Kegel exercises can improve erectile dysfunction by strengthening Pelvic Floor Muscles (PFM). There are electrical stimulation devices, similar to those used by physical therapists, that can improve the effectiveness of Kegel exercises.

Penile Implants – the Ultimate Solution

There is also a surgical procedure to insert an inflatable prosthesis directly into the penis. A small fluid reservoir is implanted in the abdomen, and an inconspicuous pump is inserted in the scrotum.

Implants allow men to achieve an erection any time they want, for as long as they want. Although the concept can be frightening, implants have a higher rates of patient satisfaction (well over 90%) of any form of treatment! The most common comment among men who have had the procedure is, “I wish I’d done it sooner.”


It’s important to understand that there are many options beyond the usual pills for treating ED. Doctors and scientists are continuing to develop new and experimental treatments for erectile dysfunction.

Talk to your urologist to find the options that are right for you.

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