Erectile Dysfunction Treatment Options: What Works When Pills Don't
By Dr. Christopher Vendryes, MD · Board-Certified Urologist · · 5 min read
Quick answer: Erectile dysfunction (ED) is treatable for nearly every man. First-line treatment is usually an oral medication like sildenafil (Viagra) or tadalafil (Cialis). When pills don't work or aren't safe, options include vacuum erection devices, penile injections, and penile implants, which have high satisfaction rates. ED can also be an early warning sign of heart disease, because the penile arteries are smaller than the heart's and often show problems first.
What causes ED?
- Blood flow problems from diabetes, high blood pressure, high cholesterol, and smoking
- Nerve damage from diabetes, surgery, or spinal problems
- Hormone issues, including low testosterone
- Medications, including some for blood pressure, depression, and prostate conditions
- Psychological factors like stress, anxiety, and depression
- Pelvic surgery or radiation, including prostate cancer treatment
Most cases involve more than one factor.
Is ED a sign of heart disease?
It can be. The arteries in the penis are smaller than the coronary arteries, so narrowing often shows up there first. ED can appear years before a heart problem. If you develop ED, it's a good reason to have your blood pressure, cholesterol, and blood sugar checked.
What are the treatment options?
| Option | How it works | Good to know |
|---|---|---|
| Lifestyle changes | Better blood flow and hormone balance | Exercise, weight loss, and quitting smoking help |
| Oral medications | Increase blood flow with sexual stimulation | Not safe with nitrate heart medications |
| Vacuum device | Draws blood into the penis | No medication; a band maintains the erection |
| Penile injections | Medication injected at the base of the penis | Works in minutes for most men, even when pills fail |
| Urethral suppository | Medication placed in the urethra | Less effective than injections for many men |
| Penile implant | Inflatable device placed surgically | High satisfaction, a permanent solution |
What if pills don't work?
Before giving up on pills, make sure you've tried them correctly: the right dose, enough attempts, and timing that fits the drug. Some men respond better to a different medication. Low testosterone can also reduce response; see Low Testosterone Treatment.
If pills still don't work, injections are often the next step. They work for most men, including many with diabetes or after prostate surgery.
What is a penile implant?
An inflatable implant is placed entirely inside the body. A small pump in the scrotum fills cylinders in the penis to create an erection on demand. It doesn't change sensation or the ability to have an orgasm. Penile implants have some of the highest satisfaction rates of any ED treatment.
What about shockwave therapy?
Low-intensity shockwave therapy is widely advertised. Research is ongoing, and results vary. Ask a urologist to explain the evidence before paying out of pocket.
Why see a urologist?
A urologist can find the underlying cause, check hormone levels, review medications, and offer every treatment option, not just pills. Many men wait years before asking for help. There's no reason to.
Frequently Asked Questions
Talk to a Board-Certified Urologist
Dr. Vendryes sees patients in Plantation and across Broward and Palm Beach Counties for men's health, fertility, kidney stones, urologic cancers, and bladder problems.
References
- American Urological Association. Erectile Dysfunction Guideline.
- Urology Care Foundation. Erectile Dysfunction.
- National Institute of Diabetes and Digestive and Kidney Diseases. Erectile Dysfunction.