Why do ED medicines work for some people but not others?

Erectile dysfunction (ED) medicines like Sildenafil or Tadalafil have helped millions of men regain confidence in their sex lives. But for some, the results aren’t what they hoped for, or they don’t notice any difference at all.

If that sounds familiar, don’t feel disheartened. You’re not alone, and there are several reasons these medicines don’t always work perfectly. Understanding why they sometimes fall short can help you find a treatment approach that truly works for you so that you can get your sex life back.

ED medicines don’t “cause” an erection

The main medicines for ED are drugs like Sildenafil and Tadalafil, which belong to a class of drugs called PDE5 inhibitors (1). These medicines don’t directly cause an erection. They simply make it easier for your body’s natural processes to respond to sexual arousal (2-3).

They work by improving blood flow to the penis, making it easier to get and keep an erection when sexually aroused. Here’s what’s important to know:

• If you’re not in the mood for sex and don’t feel sexually stimulated, PDE5 inhibitors won’t give you an erection. Sexual arousal is a must.
• These drugs work best when blood flow and nerve signalling pathways are already responding naturally to sexual stimulation.
• Timing matters: you need to take ED tablets correctly around food and when you anticipate wanting sex to give them time to work.

When everything lines up, the medicine, the moment, and the mood, the results can be impressive. But if any of those factors are off, the experience can feel disappointing.

Why your ED medicine might not be working as expected

If you’ve tried a PDE5 inhibitor and it didn’t seem to work, it doesn’t necessarily mean the medicine isn’t right for you. Often, it’s a matter of timing or technique:

1. Taking it too soon after food: Some ED medicines, especially Sildenafil, are absorbed less effectively when taken after a heavy or fatty meal. This can delay how quickly they work or reduce how much of the medicine actually reaches your bloodstream.
2. Not enough sexual stimulation: ED medicines help enhance blood flow to the penis when you’re sexually aroused, but they can’t create desire. Without physical or mental sexual stimulation, they won’t trigger an erection.
3. Performance anxiety: Worrying about whether your ED medicine will work or feeling anxious about how well you “perform” can block the very mental signals that make an erection possible, even if the medicine is working physically.
4. Underlying health conditions: PDE5 inhibitors rely on the natural systems that produce an erection. Conditions that affect blood flow or nerve function, such as diabetes, high blood pressure, or high cholesterol, can reduce how well ED medicines work.
5. Alcohol or recreational drug use: Alcohol relaxes blood vessels but also slows nerve signalling. Large amounts of alcohol or certain drugs can make it harder for PDE5 inhibitors to do their job effectively, even when you’re in the mood.

How to give treatment the best chance to work

It’s tempting to decide after one or two tries that an ED medicine “doesn’t work,” but that’s often too soon. Our experts recommend trying a medicine four to six times in different settings and circumstances before deciding whether it’s effective for you.

Here are some best practices to give you the highest chance of success.

• Time it right. Sildenafil should be taken between 1 and 4 hours before sex, ideally on an empty stomach. As Tadalafil is longer-acting (up to 36 hours), you don’t need to time it as precisely, but it should still be taken at least 30 minutes before sex.
• Allow time for arousal and intimacy. As sexual arousal is essential, spend time relaxing, connecting with your partner, and focusing on foreplay.
• Skip the heavy drinking. As alcohol and recreational drugs can stop ED medicines from working as effectively, it’s best to avoid them on nights you plan to have sex.
• Stay relaxed. Anxiety can reduce the body’s natural response to sexual stimulation, so focus on connection rather than performance. Combining ED pills with relaxation techniques or talking therapy can also be very effective if you’re anxious about sex.
• Be patient. Results can improve with repeated use as you become more familiar with how the medicine works for you and how to optimise the mood and moment.

If it’s not working, don’t give up: other options exist

If your ED medicine still isn’t giving the results you want, that doesn’t mean you’re out of options. Everyone’s body responds differently, and finding the right fit can take a bit of experimentation.

Some men respond better to a different ED tablet (for example, switching from Sildenafil to Tadalafil, or vice versa) or need to increase their dose, while others prefer alternative treatments for erectile dysfunction. These can include:

• Topical treatments such as creams that increase blood flow to the penis (like Vitaros).
• Vacuum erection devices (pumps) that draw blood into the penis naturally.
• Counselling or sex therapy, especially if anxiety or stress may be affecting arousal (1).

Whatever the case, it’s important not to give up. With the right support from a qualified healthcare professional, most men find an effective, safe treatment that works for them.

Find an ED treatment that works for you

You can enjoy a fulfilling, confident sex life again. And you don’t need to figure out which treatment for erectile dysfunction will give you the best results all on your own.

At Oxford Online Pharmacy, we can help you find an erectile dysfunction treatment that actually works. Our UK-registered doctors can listen and advise why your current medicine might not be meeting your expectations and guide you towards other safe, effective options.

References

1. NHS. Erectile dysfunction (impotence) [Internet]. nhs.uk. 2019.
2. NHS. About Sildenafil (Viagra) [Internet]. nhs.uk. 2022.
3. NHS. About Tadalafil [Internet]. nhs.uk. 2022.