There may come a point in your ED treatment journey that you find that oral medication does not work for you. Or has stopped working. Or you need every increasing doses to achieve the same effect. This may be a sign that your ED is worsening. However, there may be other reasons for the medications not working.
In either case, don’t worry!
There are definitely options to improve the situation. Most important is that you provide your doctor with feedback on your response (or lack of) to the medication.
Why are my ED medicines not working?
Questions I usually ask my patients when they tell me the medications are not working include:
- Did you give the medication enough time to work? – Cialis can take up to 45 minutes to take effect
- After waiting, was the area stimulated to achieve an erection? – Contrary to popular belief, taking ED medication does not automatically give you an erection, instead it sensitizes the area to make achieving and maintaining erections easier.
- Have you tried changing the dose or dosing regimen? Sticking to the dosage regimen recommended by your Doctor is very important. If you have changed your dose, please do inform your Doctor.
- Are you on the correct dose or do you need to increase the dose? Sometimes your Doctor will start you on a lower dose and work the dose up depending on your response to the medicines.
- Have you tried other medicines? Different ED medicines have different effects on an individual
- Did you take your pills on an empty stomach? Heavy oily meals will significantly reduce the absorption of Viagra and Levitra.
- Did you drink a significant amount of alcohol before or after taking your pills? Excessive alcohol can cause ED and also reduce the efficacy of the medicines.
- Are there any underlying conditions not previously detected? Examples include Diabetes and low Testosterone levels. If these are not addressed the controlled, the response to ED treatments will be sub-optimal.
- Are the known underlying conditions such as Diabetes well controlled? Removing other factors that may contribute to ED may improve your condition. For example ensuring chronic diseases like Diabetes are well controlled. And switching our medicines that may cause ED as a side effect.
My ED medicines are still not working!
If all these questions have been addressed and the medications are still not working, you may need to change to or add other treatments for your ED. These include
- Injectable medications (Intra-Cavernosal Injections)
- PRP injections for ED
- Electro Shockwave Therapy (ESWT for ED)
- Vacuum Devices
Penile Injections (Intra-Cavernosal Injections)
The most common injectable is Alprostadil (Caverject). It comes in a single dose disposable syringe and is injected into the shaft of the penis. This medication acts directly on the blood vessels – opening them up and allowing for blood to enter the penis and create an erection. Duration of action is about 2 hours. Because it does not rely on the same mechanism as the oral ED medications, it is a useful alternative.
The drawback is that patients need to learn how to inject themselves. It is not as painful or scary as it sounds. Also, Doctors will usually start you on a small dose and increase the dose until an optimum dose is found for you. This is because over-dosage with Alprostadil can cause priapism which is a painful erection that does not go down for more than 4 hours.
Aside from Caverject which is commercially available, compounding pharmacies can also prepare penis injections that contain Papaverine and Phentolamine. This is commonly known as Bi-Mix. If the injection contains 3 active ingredients (i.e. Papaverine, Phentolamine and Alprostadil) it is known as Tri-Mix. The drawback with Bi-Mix and Tri-Mix injections is that they have to be compounded only when ordered and kept on ice. Their shelf life is therefore extremely short.
Similar to Caverject, patients have to self-inject their penises with Bi-Mix or Tri-Mix just before sex.
These injectable treatments will cause an erection even without stimulation.
PRP injections for ED
Another injectable medication for ED that is currently under much research is Platelet Rich Plasma (PRP). Already being used widely in fields such as orthopaedics and aesthetics, PRP uses the healing chemicals from your blood to repair damage to the affect area and improve function. Click here to read my blog post on PRP for ED.
ESWT for ED
Low-Intensity Electro Shock Wave is another option for patients suffering from ED. As intimidating as the name sounds, it is pain-FREE. In this treatment, shockwaves are used to agitate the affected areas and push the body to start the healing process. In the context of ED, the penile tissue is usually damaged due to poor blood flow, hence ESWT helps by stimulating more blood flow to the area. It also stimulates the body to create new healthy blood vessels. The increased blood flow carries with it more nutrients that will contribute to the repair of the area. Click here to read my blog post on ESWT for ED.
Vacuum Devices – Penis Pumps
Vacuums are another device used to improve blood flow to the area. By creating a negative pressure environment around the penis, the vacuum pulls blood into the penis to create an erection. Once created, patients usually place an elastic ring around the base of the penis to keep the blood in the penis. It is crucial though that the ring is released after a maximum of 30 minutes to allow the blood back into circulation. It is important to note that an erection created by a vacuum is not a physiological one, meaning it is artificial because an external force was required to produce it. In contrast, all the other methods described rely on your own body creating the erection.
Vacuum pumps can easily be purchased online or from adult shops.
In conclusion
Oral medication are the most convenient treatment for ED. However they are not the only treatment available. Other treatments such as PRP injections and Shock Wave Therapy can offer a non-chemical alternative for ED treatment. Or can be done in conjunction with oral medication for maximum results and benefits. You need to have an open discussion with your Doctor which treatment or which combination of treatments is right for you.
Have a question? Feel free to post it in the comments section below.