What Should You Do If Sildenafil No Longer Works For You?

by Peter Franks

Sildenafil, more commonly known as the “tiny blue pill” (or its other names like Viagra, among similar drugs of its ilk), has been used as a successful treatment for erectile dysfunction, or ED.

ED can be unnerving for those of us who have come to rely on sildenafil to function well between the sheets.

And it can get really stressful for men who have had success using it in the past—only to find out that your little blue pill no longer works as well as it used to.


The science of arousal

Sexual arousal is dependent on a complex array of determining factors. This may include physiological responses to mood, emotions, and sexual stimuli. Thus, in order to understand why sildenafil appears to no longer work for you, it is crucial to understand the mechanisms of erections.

In a nutshell, erections happen when there is increased blood flow into spongy penile tissue. Sildenafil works by boosting vasodilation and therefore increase blood flow through the arteries, leading to the desired effect.

However, if there is a dysfunction in any of the steps needed to obtain an erection, sildenafil wouldn’t work as well (if at all).


Why isn’t sildenafil working for you?

What Should You Do If Sildenafil No Longer Works For You?ED has a laundry list of complex causes ranging from the physical to the mental. In the same vein, several factors can influence the effectiveness of sildenafil, such as when you take it, how you take it, and what’s goes on in your body while taking it.

Here are the top 5 mistakes men make when taking sildenafil (Viagra)—and what to do to ensure it works.


  • Avoid taking sildenafil with a heavy meal. Sildenafil concentrations in the bloodstream reach their highest an hour after taking it on an empty stomach. On the other hand, taking a fat-laden or heavy meal with sildenafil will reduce its effectiveness and take longer to absorb.
  • Don’t take sildenafil with alcohol. Alcohol is the main culprit of ED. If sildenafil doesn’t work as well as it used to for you, you might want to reduce or curtail alcohol consumption entirely to see if it rekindles that Viagra magic.
  • Sildenafil doesn’t work immediately. Having sex immediately after taking Viagra doesn’t work. Instead, it is better to take sildenafil on an empty stomach an hour before engaging in sexual activity, and without alcohol present in your bloodstream.
  • Sildenafil doesn’t produce erections by itself. Sildenafil is a proven ED treatment. But the prerequisite for its effects is sexual arousal. Sildenafil doesn’t work without you being aroused.
  • Get your testosterone levels examined. If sildenafil and other PDE-5 inhibiting medicines for ED don’t work as they should consult your doctor to see whether your testosterone levels are deficient.


ED medication, paired with testosterone therapy or supplementation, as well as lifestyle changes, maybe a treatment your doctor might suggest. Your primary health care provider will be able to best evaluate your testosterone levels.


Why did sildenafil stop working for me?

You might have had past success treating ED issues with sildenafil. However, you might also have noticed that its effect diminishes over time.

Sildenafil loses its effectiveness over time as a result of physiological or physical changes. Fortunately, there are several alternatives in the same class of PDE-5 inhibitors that will do in a pinch.


Can I use other PDE-5 inhibitors?

What Should You Do If Sildenafil No Longer Works For You?Yes. If sildenafil can no longer cut the mustard, there are other PDE-5 inhibitors you could try as first-line ED treatments. These include tadalafil (brand name Cialis), vardenafil (brand name Levitra), and avanafil (brand name Stendra). These PDE-5 inhibitors are approved for use by the United States Food and Drug Administration (FDA) as treatments for erectile dysfunction. Consult your doctor whether taking a different PDE-5 inhibitor might work for you.


Top 5 reasons why sildenafil doesn’t work

Sildenafil may not be the most effective ED treatment for some due to its mechanism, dosing, or pre-existing health conditions.

Here are the top 5 reasons why sildenafil may not work:

  • Atherosclerotic cardiovascular disease. Obstructions in the penile arteries can be a reason for sildenafil not working. Such inability to obtain an erection may be a sign of arterial plaque or general atherosclerosis, which is a precursor risk to more serious conditions like heart attacks and strokes. Moreover, individuals with the atherosclerotic disease receive significantly less blood flow and elasticity. In severe cases, sildenafil’s vasodilatory properties won’t work due to plaque buildup preventing blood from flowing.
  • Nerve malfunction. Individuals with nerve injuries arising from prostate surgery or diabetic neuropathy may encounter issues with sildenafil’s efficacy.
  • Penile injuries. Individuals with Peyronie’s disease or acute penis injuries may no longer be able to deal with heightened blood flow.
  • Leaky valves. Leaky valves might mean that while your arteries can accommodate the increased rate of blood flow to the penis, it might leak out, leading to an inability to maintain an erection, if it all get hard enough to engage in sexual activity.
  • Mood swings or relationship problems. One of the reasons sildenafil might not work has to do with depression and anxiety, which interferes with the ability to enjoy sexual arousal.


Other options

ED is a cardiovascular issue. Therefore, some of the things you can do that impact ED symptoms the most have to deal with simple lifestyle changes that address blood circulation. Exercising more often, smoking cessation, reducing stress, and consuming less alcohol all play a role in helping improve blood circulation.

Yet another option is to consult a urologist to help determine the best course of treatment for your erectile dysfunction symptoms. Apart from oral medications and supplements, tools such as penis pumps, sex or psychological therapy, or alternative courses of treatment may be administered.

The important thing to remember is that erectile dysfunction affects millions of men all over the world. It’s not the end of the world, and you’re not alone. You have options. Consult your doctor, urologist, or therapist, or simply implement reasonable lifestyle changes and see where it takes you. Chances are, it’s all you might need.

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