What should you do if Viagra doesn't work for you?

What erectile dysfunction is, possible causes, how Viagra works and steps to take if it doesn’t work

Erectile dysfunction (ED) is an extremely common problem that affect men and intersex people of any age.  People with this condition are unable to reach or maintain an erection to take part in sexual activity. ED affects up to 22% of American men, mostly in the older age groups.  Once considered primarily a psychological disorder, it is now clear that most cases of ED have a physical cause. The leading causes are the chronic diseases that damage blood vessels and nerves vital for normal erectile function; diabetes, atherosclerosis (a condition in which plaque builds up inside your arteries) and hypertension (high blood pressure). The medications used to treat these problems and other ailments can also contribute to ED. Hormonal abnormalities are less common, but they are particularly important to detect since they can be corrected. That's also true of the psychological problems that cause up to 15% of ED.

 

For many people with ED, the hardest thing is to admit the problem. Every man and intersex individual experiences ED from time to time.  Although, ED is generally defined as the inability to get and keep an erection satisfactorily for penetration on at least 25% of attempts, this definition should not be used to exclude those with less severe difficulties from getting treatment. A simple questionnaire can help you determine if you are having ED.  Talk to a primary care doctor, urologist, or endocrinologist for advice.

 

When Viagra first appeared back in 1998 as a drug treatment for ED, it promised an exciting future for many people with the condition.  This was of particular importance given the number of men with the condition. The Massachusetts Male Ageing Study (MMAS) demonstrated that 40% of 40-year-old men reported ED, and this figure rose to almost 70% in men aged 70 years.

 

Viagra is the brand name for the active ingredient, sildenafil citrate, used for the treatment of ED.  It works by relaxing the muscles in the walls of blood vessels to increase blood flow to the penis and gives a firmer erection during sexual stimulation.  But, sometimes it doesn't work. 

 

As mentioned earlier in this article, there are many reasons why Viagra sometimes doesn’t work.  One of the causes may include narrowing of blood supply to the penis. During an erection, blood flows quickly into the penis, which increases its length, width, and firmness.  If the "in" vessels (arteries) are too narrow or if blood drains too quickly through the "out" vessels (veins), people affected by this condition may have trouble achieving or maintaining an erection.  This means that Viagra, which increases blood inflow, may not be strong enough to work its magic if the arteries are too narrow.

 

The problem is that in a significant number of patients, simply swallowing the pill isn't enough to result in a firm erection. This is understandably disappointing for patients and has led to a high drop-out rate.  Some studies have found that at least 30% don't even get past their first prescription. This means many people with ED stop using a potentially very effective drug. That’s a mistake, since other ED medications may be effective. 

 

Be sure you’ve given alternative medications a full try; but never take more than the approved maximum dosage and never use Viagra and its generic or non-branded alternatives more than once in a 24-hour period.  Men who are recovering from a nerve-sparing radical surgical procedure for the partial or complete removal of the prostate (prostatectomy) should try an ED pill every month or two, since sexual function may improve over 6–18 months.

 

The good news is that in 'non-responders', up to 60% can be rescued with the right counselling. This involves advising on a healthy lifestyle to maximise the chances of the drug working, as well as managing expectations. So it's worth remembering that Viagra may restore your vigour, but may not always turn you into a sex machine. Here's how to make sure you get the best treatment for your condition.

 

Talk to your doctor

It’s important to talk to your doctor when you start taking Viagra or other ED medication and when the medicine doesn’t work for you.  Tell them about your expectations for the medication, your results, and any side effects you experience. Your treatment plan isn’t set in stone. Work with your doctor to understand why Viagra doesn’t work and find the best treatment for you.

 

Your doctor may start with a quite simple evaluation of your condition.  A careful medical history, including a review of your health habits and medications, is the first step. It's also important to be assessed for diabetes, hypertension, atherosclerosis, and cardiac risk factors. Many doctors also check blood levels of the male hormone testosterone; it's an important test for patients who experience loss of sexual desire as well as ED, but it's less likely to help those whose spirit is willing but whose flesh is weak.  Your doctor may also want to know if you’re taking Viagra properly. There are other treatment options available to you, depending on your doctor’s advice.

 

Review your Viagra dosage with your doctor

Viagra is available in 3 doses of 25 milligram (mg), 50mg and 100mg.  The tablet is taken orally once a day by swallowing it with a drink of water.  You should take extra care to avoid mineral water that contains nitrate.  The doses all get to work in about 30-60 minutes and last for about 5-8 hours.  The best time to take Viagra is about 1 hour before sexual activity, but you can take the medication any time from 4 hours to 30 minutes before sexual activity.  So, there’s no need to rush; but your medication needs to be timed with your sexual activity, which doesn’t always work as planned. 

 

Viagra comes in different doses because the goal of ED medication is to find the least amount of medication that still gets positive result in “a satisfactory erection”.  The goal is not to find the highest dose of Viagra you can handle, but to find a dose that is safe and effective, while minimizing side effects. 

 

If you do not achieve an erection with sexual stimulation, you can increase the dosage of your medication the next time sexual activity is planned.  Don’t increase the dosage on your own. Get your doctor’s advice first, to make sure that doing so is right for you. After surgery, most men require doses of 100 mg, or more, of Viagra.  Your doctor may decrease or increase your Viagra dose, up to the maximum dose that is right for you, depending on the outcome of the evaluation of your condition, a variety of health and lifestyle factors, such as:

  • Age
  • Cardiovascular health (relating to the circulatory system, which comprises the heart and blood vessels)
  • Pre-existing conditions
  • How often you use the medication

You should always follow your healthcare practitioner’s dosing instructions, and never take more than one dose of Viagra per day or exceed 100 mg of Viagra in 24 hours.

 

Try Viagra alternatives

Once swallowed, the active ingredient (sildenafil citrate) in Viagra takes 30-60 minutes to reach suitable levels in your blood and lasts about eight hours.  If you're turned off by the need to take a tablet just before sex, you could try other alternatives, such as Cialis (brand name for the active ingredient, tadalafil), which can be taken daily.  It lasts much longer in the body and allows for more freedom to act on impulse, which is really important to some. 

 

Eat and drink smart before you start

Wining and dining a sexual partner into bed won't do you any favours if you're using Viagra or any other ED medicine containing sildenafil.  Having a substantial meal in your stomach reduces the absorption of the drug in the body. Plus your gut is then focused on digesting food and blood flow is diverted away from the penis. 

 

Avoid a fat-heavy meal before taking Viagra.  If you couldn’t resist the temptation of such meals, it is recommended waiting for two hours after eating, to take ED medication such as Viagra. This is because the fats in the meal can slow down your body’s digestive system and prevent the medication from being absorbed properly.

 

Eat lightly, to allow Viagra to be absorbed in the body and start working quicker, as well as enable you to sustain vital energy level during sex. 

 

When Viagra is taken orally by swallowing it with a drink of water, the body rapidly absorbs the medicine.  As for drinking alcohol, this increases the risk of a bad reaction and reduces testosterone levels. Eating grapefruit or drinking grapefruit juice can also affect how Viagra works in your body. Avoid consuming grapefruit products while taking the medicine because any grapefruit product may increase the level of the active ingredient in Viagra (sildenafil citrate) in your blood and so, increase the risk of Viagra side effects.

 

Lifestyle Therapy

A healthful lifestyle can go a long way toward preventing ED, but can it also help correct the condition in people who are already experiencing it?

 

According to a study in Italy, more than 30% of the men who took part in the exercise and diet group of the study corrected their ED without medication, compared with less than 6% of the men who did not receive lifestyle guidance.

 

Lifestyle therapy is slower than Viagra, but it produces major gains in cardiovascular risk factors (conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke), as well as better ED.

 

Conclusion

Viagra is one of the most effective medications for treating ED.   In most cases, it works well and has changed people's lives for the better.  In some cases, it doesn’t work. There are many reasons why Viagra sometimes doesn’t and a wide range of options on how to make it work for you.  Talk to your doctor to understand why it doesn’t work and find the best treatment for you.

 

References

  1. WebMD, Erectile Dysfunction: When Viagra Doesn't Work, [website] 2000, https://www.webmd.com/erectile-dysfunction/features/erectile-disfunction#1, (accessed October 15, 2019).
  2. Harvard Health Publishing, What to do if Viagra won't do, [website] 2014, https://www.health.harvard.edu/newsletter_article/What_to_do_if_Viagra_wont_do, (accessed October 15, 2019).
  3. VIAGRA, Eat smart before you start, [website] 2018, https://www.viagra.com/taking/tips-for-taking-viagra, (accessed October 6, 2019). hims, Avoid Heavy, Fatty Meals Before Using ED Medication, [website] 2018, https://www.forhims.com/blog/5-tips-for-taking-ed-medication-effectively, (accessed October 6, 2019).
  4. EVERYDAY HEALTH, Viagra Dose, [website] 2017, https://www.everydayhealth.com/drugs/viagra, (accessed October 2, 2019).

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