While our erectile dysfunction tablets usually work well for most men, some men may find that a particular ED treatment doesn’t give them the results they were hoping for. That’s why we give you the freedom to change your ED treatment prescription so that you can find the perfect treatment for your needs. All you need to do is email our clinical team and they will do their best to find you an alternative. If you change your erectile dysfunction medicine and it still doesn’t work for you, then it’s best to speak to your doctor as it may be a sign of an underlying condition that needs specific medical attention.
Men with diabetes, radical prostatectomy, and other complicating factors may still benefit from treatment with a phosphodiesterase type-5 inhibitor such as Viagra. Patients who fail a trial of PDE5 inhibitor should be informed of the benefits and risks of other therapies. This of a different PDE5 inhibitor is unlikely to have a profound effect on sexual function and someone who fails a first drug trial, but should be considered in selected cases. Second-line therapies include intra-urethral suppositories, intra-cavernous drug injection, vacuum-constriction devices, and penile prosthesis. Medicated Urethral System for Erection (MUSE). MUSE is an intra-urethral suppository of alprostadil, of vaso-active drug that relaxes smooth muscle in the penis and induces penile erection. Although not as effective as intra-cavernosal penile injection, MUSE is a less invasive treatment option. An initial trial dose of intra-urethral alprostadil should be administered under healthcare provider supervision due to the risk of fainting. The cost of intra-urethral suppositories is high with respect to the overall success and therefore should be used judiciously.

While most men will have occasional difficulty achieving a healthy erection during sexual intercourse, ED is only considered a possible medical explanation for these symptoms if erection difficulties have been affecting a man for an extended period of time. When blood flow to the two chambers of the penis, known as the corpora cavernosa, are blocked or restricted for any reason, this can result in ED.
The role of the endothelium in erectile function became clearer with the observation that the phosphodiesterase type 5 (PDE5) inhibitor, sildenafil, enhanced erectile function. Erection occurs with the release of nitric oxide (NO) from the vascular endothelial cells.17 The reduction in endothelial cell production of NO results in the negative impact on the smooth muscles in the corporal bodies and results in less relaxation of the smooth muscle cells with decrease in blood supply and resulting ED. A similar phenomenon is well known to impact the coronary arterial system resulting in CVD.