5 Alternatives to Viagra Worth Trying

The little blue pill is only one way to get back to passionate pursuits.

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When the action isn’t happening below the belt, guys are surprisingly hesitant to seek help: Only one-quarter of men diagnosed with erectile dysfunction (ED) actually seek treatment for the problem, according to a study published in the October issue of The Journal of Sexual Medicine.

That means 75 percent of guys with ED aren’t taking anything for their performance issues — and this was no small study: More than 6 million men with erectile trouble were included. “We were kind of shocked,” said study author Dr. Kevin McVary, chair of the division of urology at the Southern Illinois University School of Medicine. “There’s no question that we have effective treatments — there are pills, pellets, shots, and there’s surgery. And they are nearly 100 percent effective in total.”

Among one-quarter of men who did seek treatment, phosphodiesterase type 5 inhibitors (PDE5i were overwhelmingly the preferred option: Three-quarters took the pills — that is, Viagra (sildenafil), Cialis (tadalafil), or Levitra (vardenafil) — which are largely considered the first line of treatment for ED.

Other options, such as injections or vacuum devices, were grossly underused. “A guy may think, ‘OK, I’ll take a pill, but I won’t take anything more than that,’” McVary told Yahoo Health. And even then, they may not stick with it: “Only 50 percent of guys that are diagnosed will [accept] a prescription,” he said. “Of that 50 percent, only 50 percent will ever fill it. And of those, only 50 percent will ever refill it. So there is much attrition every step of the way.”

That doesn’t explain the lack of treatment entirely, though. Some men may simply not respond to PDE5 inhibitors, and they don’t bother trying the other available treatments — if they even know about them. “A lot of primary-care physicians don’t want to go there at all — they don’t even want to talk about ED,” acknowledged McVary. For some patients, though, talking through options is a necessary step, since degradation of the smooth muscle cells in the penis can prevent drugs like Viagra from doing their job. “Things like diabetes, high cholesterol, and hypertension affect those muscles,” he said. “They die, and they ain’t coming back.”

Before you assume the worst, though, make sure you’ve given the pills a chance — guys who swear by PDE5 inhibitors often had to take the meds five or six times before they noticed a change, said McVary. And make sure you don’t pop your pill after downing a giant-size steak, since fatty foods can affect the absorption of Viagra and Levitra, said Dr. Darius Paduch, an associate professor of urology and reproductive medicine at Weill Cornell Medical College. “Foods with high fat content can decrease the absorption of Viagra by 50 percent, so if you take 100 milligrams, you actually are going to get 50 milligrams. That may not be enough.”

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And realize that stimulation — even just the mental kind — is still necessary to wake up your penis. “You have to have sexual thoughts. If you’re sitting there reading the Chicago Tribune, you’re not going to have an erection,” noted McVary.

Still not rising to the occasion? It may be time to try one of these second-line treatments:

Prostaglandin E1 injections

A shot to the penis may sound like the last thing any man would attempt—but prostaglandin E1 injections, or alprostadil, are actually effective in about 90 percent of men with ED, said McVary. “Once they see that it works, most men won’t go back to a pill,” he added. What’s the draw? The shots work much faster than the pills — you can expect to be erect within 10 to 15 minutes, whereas pills take can take an hour or two to kick in. “You can be more spontaneous with the needle,” he said.

The mechanism is similar to that of PDE5 inhibitors, said McVary, but with one big difference: They don’t require any help from your brain. “You don’t have to do the fantasy thing. You can read the Tribune if you want,” he said. Shots may be an especially appealing option to younger guys with lots of stress, which can prevent the pills from working. “After a couple times, they gain confidence, and they usually don’t need to use it anymore,” said Paduch.

And don’t worry, the needle is tiny. Most guys don’t find pricking themselves to be a problem — although there is a risk of bruising or scarring of the penis, noted Paduch. Plus, since many patients who use injections have diabetes — one of the reasons Viagra may not work — they’re already comfortable with insulin shots, making this a relatively easy-to-accept treatment.

Prostaglandin E1 pellets

If you’re totally opposed to using a needle, there’s another way to administer prostaglandins: Insert them as a suppository into the tip of your penis, so the meds are absorbed through the lining of your urethra. “It’s the same chemical [as in the shots], but you’re talking a 20- to 100-fold increase in dose,” since the pellets aren’t as readily absorbed as the injections, said McVary. That also means the prostaglandin pellets take longer to kick in — about 20 minutes to half an hour.

Another downside: “It dramatically increases blood flow in the pelvis, not just the penis,” said Paduch. “A lot of men will experience a menstrual-like pain.” But the option is certainly there for needle-phobic patients.

Vacuum erection devices

A penis vacuum may seem more like a gag gift than an actual medical device — but it is a viable, fairly inexpensive option (about $300-$400) for treating ED. “The vacuum device works relatively well,” said Paduch. How it does the job: You attach a pump to the end of your penis, then you place a ring — “basically a sophisticated rubber band,” said McVary — around the base of your shaft to trap the blood.

It’s a pretty straightforward process — but it’s not without its downsides: You may still experience some “floppiness,” McVary said, and your erection could feel cold to the touch, since you’re restricting new blood flow to the area. (Your penis may also take on a bluish color for the same reason, noted Paduch.)

But for some guys, this option is much more preferable to popping a pill or performing injections. “There are some older men who associate taking any medication with aging, so they don’t want to take anything,” said Paduch. “Or they have contraindications with oral medications.”

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L-arginine

This amino acid can enhance blood flow down below by boosting the production of nitric oxide, a chemical that dilates your vessels. “L-arginine definitely works,” Paduch said. “I pretty much recommend it to every patient I see.” He suggests taking just one gram per day — you should be especially cautious about exceeding that amount if you have a history of herpes flare-ups, since high doses of L-arginine may reactivate the virus, he warned.

Testosterone replacement therapy

When your penis stops working, you may automatically assume low testosterone is to blame. But the truth is, a shortage of testosterone is the cause of erectile dysfunction only about 5 percent of the time, said McVary. Signs of low T, other than ED, include a loss of libido and lethargy, but you’ll ultimately have to be tested to determine whether this is the cause of your flagging erections.

Which way should you take your T? “There’s no best mode of delivery. Shots, gels, implants — they’re probably equivalent,” McVary said. “They all upregulate the nitric-oxide system, so it’s more likely to be responsive.” That said, “with injections, you can overshoot to very high levels, and that causes your testicles to shrink,” said Paduch, who prefers topical testosterone since it’s easier to ensure that patients achieve normal levels of the hormone with this mode of delivery.