Some people have become addicted to "the little blue pill" (a.k.a. Viagra) and find it sufficient to treat their erectile dysfunction (ED). However, many others find that Viagra never works for them or that it gradually stops working after successful use.
Why does Viagra work for some men but not for others? In this article, we explore the reasons and the options available to you.
What causes erections?
Excitement is a complex combination of factors—from physical responses to mood and emotions—so it is essential to understand the physiology of an erection to understand why Viagra may not work.
"Erections occur when there is a significant increase in the inflow of blood compared to the outflow in the erectile sponge bodies of the penis", says Dr. S. Adam Ramin, urologist and medical director at "Urology Cancer Specialists."
To achieve a net increase in blood flow, Dr. Ramin stated that these four crucial steps must occur:
- First, the nerves in the pelvis must send neurotransmitters to the arteries of the penis to direct the increase in flow.
- Second, the arteries must respond to the nerve command by dilating and widening their diameter to allow an increase in flow.
- Third, the erectile sponge bodies of the penis must be flexible, able to stretch and expand to accommodate the increase in blood flow.
- Finally, the veins of the penis must allow a net increase in blood flow by closing their drainage valves to retain blood in the penis.
"Viagra acts at the arterial level by enhancing the command of neurotransmitters to cause dilation and increase flow in the arteries", Mr. Ramin stated.
But if there is a problem with any of these four steps, Viagra will have no impact, according to Dr. Ramin.
What are the causes of erectile dysfunction?
The causes of erectile disorders are complex and can include both mental and physical aspects. Erections result from a complex combination of factors and are directly influenced by:
- Physical mechanisms
- Sensations
- Your emotions
5 Do's and Don'ts Regarding Viagra Use (Alcohol in Particular)
Several factors can influence the effectiveness of Viagra. These include:
- The timing of when you take Viagra
- How you take it
- What is happening in your body when you take it
According to the American Urological Association, incorrect use of phosphodiesterase type 5 inhibitors (PDE5) accounts for 56% to 81% of treatment failures.
Here are 5 common mistakes to avoid to give Viagra the best chance of working.
1. Avoid taking Viagra with a large or fatty meal
The level of Viagra in the blood peaks one hour after swallowing the pill on an empty stomach. According to Dr. Ramin, if you eat a large or fatty meal and then take Viagra, the medication will lose effectiveness and take longer to work.
2. Avoid taking Viagra with alcohol
Alcohol consumption, especially chronic use, can contribute to erectile difficulties. If Viagra is losing effectiveness, you might consider reducing or eliminating alcohol to see if that helps.
3. Don't expect Viagra to work a few minutes before sexual intercourse
If you take Viagra and then immediately try to have sex, it will not work.
The best way to take this medication is to take it on an empty stomach, without alcohol, one hour before sexual intercourse.
4. Don’t expect Viagra to work by itself
Viagra has a stimulating effect, but it cannot produce an erection by itself. For it to work, you need to be sexually aroused.
5. Make sure your testosterone levels are checked
Viagra and other PDE5 inhibitors will not work well if your testosterone levels are too low.
Testosterone therapy alongside or instead of an ED medication may be a treatment to consider. Your doctor should be able to test testosterone levels and discuss them with you.
Side Effects of Viagra – Patient Testimonials
Side Effects of Viagra – Testimony from Alain, 76 years old
"Personally, I used Viagra 50mg, but the effects faded very quickly. Then I took 100mg with quite a few side effects: migraine, visual disturbances, muscle pain, runny nose, ringing in the ears, but a good erection. But it takes about 45 minutes to achieve erections that last no more than 2 hours. After that, the sex remains slightly swollen, but penetration is not possible."
source: Treated.com
Side Effects of Viagra – Testimony from Jonathan, 35 years old
“I have used Viagra in various doses with different results. It works slowly but much longer than the 4 hours advertised by the manufacturer. What side effects? Flushing, slight headache, blue vision. The 20 mg Viagra works after an hour and works perfectly after 2 hours. The erection lasts, allowing penetration. It still works fairly well 24 hours later. Moreover, sexual excitement (just with thought) gives a stiff penis. The effect slowly decreases after 36 hours, but even with excitement, a result can still be observed. It certainly works with a lower dose. I didn’t notice any side effects.”
source: Treated.com
Side Effects of Viagra – Testimony from Bernard, 60 years old
“After a psychological shock due to a difficult separation, I found myself ‘stuck’ with my new partner. Never again! I got Viagra 100mg at the pharmacy with a prescription. After a few trials to find the dose that suits me, I take 50mg, which is half the pill, and that’s enough to be ready after 30 minutes when I’m almost fasting. Otherwise, plan for a little over an hour if it’s just after eating. The duration of intercourse is even longer than before, making it more effective, and I can perform multiple times at night without issue, even the next day. So, there’s no need to take more... But be careful not to order pills online, as they are often low-quality copies that are even totally ineffective and potentially dangerous. I did notice some slight flushing in my face and I was sweating a lot during the initial trials, but much less now. For me, it’s great! I’m being treated for hypertension, and it doesn’t pose any cardiac issues.”
source: Treated.com
What to Do If Viagra Stops Working?
Always make sure to use Viagra according to the instructions in the user leaflet.
If you have taken Viagra in the optimal situation more than five times and it hasn’t worked, it may not be the right treatment for you, according to Dr. Ramin. But before deciding that Viagra is not for you, it’s advisable to use it at least once while masturbating alone to ensure it’s not a relationship issue.
You may need to try Viagra up to ten times just to get familiar with the steps of its use and how it affects your erection, as well as to understand how it can affect your body.
Discuss your treatment with your doctor or urologist so they can adjust the dosage and help you find the most suitable treatment for your case.
If Viagra doesn’t work, it might mean the problem is not vascular—which means increasing blood flow isn’t helping. This can happen if you are dealing with neuropathy or other conditions.
What Happens If Viagra Stops Working After Successful Use?
Even if you have successfully achieved or maintained erections while taking Viagra, you may notice that it no longer works as well. But before abandoning the Viagra prescription, it’s important to consider the reasons why it might not be as effective anymore.
Viagra can lose effectiveness over time due to changes in your body or health. If this happens, you might try switching to another medication in the same class (that is, another PDE5 inhibitor).
Can You Use Other Inhibitors If Viagra No Longer Works?
Yes, if Viagra doesn’t work, you can try another PDE5 inhibitor—but don’t expect “rock-star” results.
Although changing medications may do the trick, it’s not always a guarantee. A urologist can help you decide if another PDE5 inhibitor is worth trying.
In addition to Viagra, other oral medications considered first-line treatments for erectile dysfunction, according to a 2016 study, include the following:
- tadalafil (Cialis),
- vardenafil HCL (Levitra),
- avanafil (Stendra).
The four PDE5 inhibitors are the only oral medications approved in the United States by the Food and Drug Administration for treating erectile dysfunction.
In these situations, tadalafil is likely to be a good choice.
One of the reasons this PDE5 inhibitor is preferred by many, including healthcare providers treating erectile dysfunction, is that tadalafil has a longer activity window, meaning you can take it as a daily dose.
This can eliminate some psychological aspects and uncertainty associated with taking a pill before sexual intercourse. Additionally, it can help determine the effectiveness of PDE5 inhibitors for you.
Why Doesn’t Viagra Have the Same Effects for Everyone?
Viagra may not be the most effective option for everyone, either due to its dosing schedule, its mode of action, or a health condition that makes it unsuitable.
Here are some of the most common physical and emotional reasons why Viagra might not work and may cause side effects.
1. Effects of Viagra in Cases of Nerve Dysfunction
According to Dr. Ramin, diabetics with neuropathy or those who have undergone prostate surgery and suffered nerve damage may find that Viagra does not work.
2. Effects of Viagra in Cases of Atherosclerotic Heart Disease
If Viagra doesn’t work, it might indicate a significant blockage of blood flow in the penile artery. This can be a sign of generalized atherosclerosis or plaque in the arterial system, said Mr. Spar, which is a risk factor for heart attack and stroke.
People with atherosclerotic heart disease have arteries that are clogged with cholesterol plaques or have lost their elasticity, Dr. Ramin noted. In this situation, the arteries do not respond to Viagra because it is a vasodilator. This means that it is a chemical that causes dilation or widening of the artery.
3. Side Effects of Viagra in Cases of Penile Erectile Tissue Disease
In individuals with a penile injury or Peyronie’s disease, the erectile tissue may not be able to accommodate increased blood flow, said Dr. Ramin.
4. Effects of Viagra in Cases of Venous Leak
If you have leaking valves, Dr. Ramin stated, blood may flow rapidly to your penis, but it will leak out and not remain long enough to cause an erection. It is also possible for you to achieve an erection, but venous leakage means you cannot maintain it.
One cause of venous leakage leading to erectile dysfunction is Peyronie’s disease, which affects the connective tissue of the penis.
5. Effects of Viagra on Anxiety, Depression, Stress, or Relationship Issues
Spar noted that another reason Viagra does not work for everyone relates to anxiety and emotional health. This can make sexual arousal difficult from a neurotransmitter perspective.
What Are Your Options If Viagra Doesn’t Work?
The good news is that some of the things that can have the most positive impact on ED symptoms involve actions you can take without a prescription.
Make Lifestyle Changes a Priority
In addition to medical interventions, it’s important to address lifestyle factors that play a role in erectile difficulties. Common factors that can lead to blood circulation problems include:
- lack of physical activity
- smoking habits
- stress
- alcohol consumption
To help improve your overall health and alleviate symptoms of erectile difficulties, such as circulation, consider these changes:
- Quit smoking.
- Minimize daily stress.
- Manage your weight through a healthy diet and regular activity.
- Engage in daily exercise and physical activity.
- Reduce or eliminate alcohol consumption.
- Work with a urologist.
There are several options for treating erectile dysfunction, besides oral medications like Viagra, including:
- erectile dysfunction pump (penis or vacuum pump)
- Peni injections
- Surgery for an inflatable penile prosthesis
- Therapy for emotional, psychological, and relational issues related to learning difficulties
- Suppositories (Alprostadil)
Negative effects of Viagra or side effects: Consult a urologist
Whatever treatment or medication you are trying for erectile difficulties, talking with a licensed counselor can help you make the most of your treatment and work to reduce stress, pressure, or anxiety—in general and in your bedroom.
Sex therapists, for example, focus on intimacy, communication, relationships, and, yes, sex.
Online search tools can help you find general practitioners and specialists in your area.
The side effects of Viagra on the body
Viagra is a powerful medication that increases blood flow to the penis so you can achieve and maintain an erection. It is effective, but it can also cause certain side effects.
Viagra is a brand name version of the generic medication sildenafil. It is a phosphodiesterase type 5 (PDE5) inhibitor. PDE5 is an enzyme that regulates certain chemicals in your blood but can make it harder to achieve and maintain an erection.
Viagra is used to treat erectile dysfunction. While it helps you temporarily maintain an erection for sexual activity, it does not cure erectile dysfunction. It also does not affect sexual desire. You still need mental or physical stimulation to achieve an erection.
This medication is only available by prescription.
Negative/side effects of Viagra on the circulatory system
It takes a series of finely choreographed events to produce an erection. It starts with signals of arousal from your brain, and it all depends on good blood circulation to the penis.
Inside the penis are two chambers called the corpora cavernosa. Nitric oxide (NO) is released into these chambers during sexual stimulation. NO activates an enzyme called guanylate cyclase. This increases levels of cyclic guanosine monophosphate (cGMP), which leads to muscle relaxation.
The chambers also contain a network of blood vessels. When these blood vessels relax and widen, blood rushes in. The resulting pressure is what causes an erection. PDE5 can diminish the effect of cGMP. Viagra works by inhibiting PDE5. Viagra is quickly absorbed into the bloodstream, with maximum concentrations reached in about an hour.
One of the most common side effects is flushing or redness.
This medication can also cause a drop in blood pressure, especially one to two hours after taking it. If you already suffer from low blood pressure, discuss the pros and cons of Viagra with your doctor.
For most people, sexual activity is good for cardiovascular health. However, if you have cardiovascular disease, you should ask your doctor if it is safe for you to take Viagra. You should also avoid taking Viagra if your doctor has advised you not to have sexual relations.
You should not take Viagra if you have had a stroke or heart attack or if you suffer from unstable angina. Certain drug interactions can harm your heart. Avoid taking PDE5 inhibitors if you are also using long-acting alpha-blockers or if you are taking medications that contain nitrates.
Side effects on the reproductive system
Viagra can be quite effective, but it is not a magic pill. It does nothing for libido. You still need some form of stimulation to achieve an erection.
The effects of Viagra generally last about 4 hours, although they may last longer for some men. A rare but serious side effect is priapism, which is when you have an erection that lasts too long. It can become very painful. If you have an erection lasting more than 4 hours, seek medical attention immediately.
You should also be cautious with PDE5 inhibitors if you have an anatomical abnormality of the penis. If you suffer from Peyronie's disease, your doctor may advise against taking Viagra.
Viagra is a temporary solution and does not cure erectile dysfunction. It offers no protection against sexually transmitted infections (STIs).
Negative effects on the central nervous system
Viagra helps improve blood flow to the penis, but your brain remains your most valuable sexual organ. Viagra will not work if you are not in the mood.
Some potential side effects of Viagra include headaches and nasal congestion or blockage, or even nosebleeds. Some men feel dizzy. In rare cases, Viagra can cause fainting. Some men taking PDE5 inhibitors report back or muscle pain.
While it is not common, some men experience ringing in the ears, hearing loss, or vision loss after taking PDE5 inhibitors. Avoid taking PDE5 inhibitors if you have a history of an eye condition called non-arteritic anterior ischemic optic neuropathy (NAION). NAION is characterized by a disruption of blood flow to the optic nerve.
If you experience hearing or vision loss while taking Viagra, seek medical help immediately.
Side effects on the excretory and digestive systems
Viagra is delivered in a coated tablet. You can take Viagra with or without food, and it is best to take it about an hour before planning sexual intercourse.
Do not take Viagra more than once a day. About 80% of Viagra is eliminated by your body in your feces. The remainder is excreted in urine.
A fairly common side effect of Viagra is indigestion or stomach pain. PDE5 inhibitors can sometimes cause nausea or vomiting.
Conclusions on the limitations and side effects of Viagra
If you are dealing with erectile dysfunction, you are not alone. The inability to achieve or maintain a firm enough erection for sexual intercourse can affect up to 30 million men, according to the Urology Care Foundation.
If Viagra does not work for you, you can try some solutions that increase the chances of it working. You can also try making lifestyle changes or consult a urologist.