When Viagra Stops Working: A Urologist Explains Your Next Options

Published: June 2026 • Written by David Robbins, MD, Board-Certified Urologist, North Miami, FL

For many men, the journey with erectile dysfunction begins with a prescription for sildenafil (Viagra) or tadalafil (Cialis). At first, the medication works well. But over time—months or years later—something changes. The pill takes longer to kick in. The erection is not as firm. Eventually, it stops working altogether.

If this is happening to you, there are two things you should know: you are not alone, and you are not out of options.

Why ED Medications Stop Working

Oral ED medications like sildenafil and tadalafil work by increasing blood flow to the penis. They require some degree of intact vascular and nerve function to be effective. Over time, the underlying conditions that cause ED—diabetes, cardiovascular disease, aging, nerve damage from surgery—can progress to the point where pills alone are no longer sufficient.

This is not a failure on your part. It is a natural progression of the condition. The good news is that the treatment options beyond pills are highly effective.

Your Next Options, Explained

Option 1: Penile Injection Therapy

Intracavernosal injection therapy (commonly called trimix or alprostadil injections) involves injecting a small amount of medication directly into the base or side of the penis before intercourse. The medication causes the blood vessels to open, producing an erection within 5 to 15 minutes that lasts approximately 30 to 60 minutes.

For men whose oral medications have stopped working, injections are often the next effective step. The needle is very small, and most men report that the injection is less painful than expected. Dr. Robbins teaches every patient how to self-administer injections comfortably during an office training visit.

Option 2: Low-Intensity Shockwave Therapy

Low-intensity extracorporeal shockwave therapy (Li-ESWT) uses acoustic waves to stimulate new blood vessel growth (neovascularization) in the penile tissue. It is a non-invasive, in-office treatment typically delivered over a series of sessions. For some men, shockwave therapy can restore enough natural vascular function to make oral medications effective again. It can also be used in combination with other treatments.

Option 3: Vacuum Erection Device (VED)

A vacuum erection device uses negative pressure to draw blood into the penis, followed by a constriction ring placed at the base to maintain the erection. While effective, many men find VEDs cumbersome and less spontaneous than other options. They are most useful as a bridge therapy or in combination with other treatments.

Option 4: The Inflatable Penile Implant

For men who have tried pills, injections, and other therapies without satisfactory results—or who simply want a definitive, always-available solution—the inflatable penile prosthesis (IPP) is the gold standard. It is the most effective ED treatment available, with patient satisfaction rates of 75 to 98 percent and partner satisfaction rates that are equally high.

The implant is completely internal, invisible, and allows a man to achieve an erection on demand by simply squeezing a small pump in the scrotum. There is no need to plan around pill timing, no injections, and no external devices. Modern implants are designed to last 15 to 20 years or more.

Many men wish they had learned about the penile implant years earlier, rather than spending years cycling through treatments that were no longer working.

The Most Important Step: Seeing a Urologist

If your ED medication has stopped working, the worst thing you can do is nothing. The underlying cause of your ED may be progressing, and a urologist can evaluate whether a different approach will be more effective. More importantly, ED that is worsening can be an early warning sign of cardiovascular disease or other systemic conditions that deserve medical attention.

At Urological Consultants of Florida, Dr. Robbins offers the full spectrum of ED treatments—from oral medications to injection therapy to penile implant surgery—and will help you determine the right next step based on your medical history, anatomy, and goals.

Visit our penile implant page, our ED treatment options page, or call (305) 575-2771 to schedule a consultation.