Erectile dysfunction (ED) is more than a frustration—it can affect every aspect of a man’s life, from self-esteem to relationships. As a vascular surgeon specializing in ED, I often meet patients who feel discouraged after trying oral medications like Viagra or Cialis without success.
While phosphodiesterase type 5 (PDE5) inhibitors have helped many men, they are not effective for everyone. In this article, I’ll explain why these medications may fail and why vascular health plays a central role in many cases of ED.
When ED Pills Don’t Work – What’s Really Going On?
Many patients come to me after PDE5 inhibitors have failed. What I often discover is that there are underlying vascular problems preventing these medications from working as intended.
Penile Arterial Disease: Restricted Blood Flow
PDE5 inhibitors rely on healthy blood flow to work. If the arteries supplying the penis are narrowed or blocked—what we call penile arterial disease—the medication won’t be able to deliver the necessary blood flow. This is common in men over 50, especially those with diabetes, high blood pressure, or high cholesterol.
Penile Venous Leak: Blood That Doesn’t Stay
Some men can get an erection but struggle to maintain it. This is often due to a condition called penile venous leak, where blood escapes too quickly through the veins. No matter how much blood flow is stimulated, it can’t be retained, making medications ineffective.
Refractory ED: A Vascular Diagnosis in Disguise
About 50% of men who try PDE5 inhibitors report little to no improvement. In my clinical experience, most of these men have undiagnosed vascular causes—either arterial blockage, venous leak, or both. This group is considered to have refractory ED, and their condition typically does not improve with medications alone.
What’s the Next Step?
If oral medications haven’t helped, don’t assume there are no options left. The next step is to get to the root of the issue through proper evaluation. At the Vascular Institute for Erectile Dysfunction, we offer comprehensive testing to uncover the vascular causes of ED.
With a precise diagnosis, we can offer innovative, minimally invasive treatments that go beyond pills—treatments that are designed to restore blood flow or address venous leakage directly.
Conclusion
If you’ve tried PDE5 inhibitors without success, it may be time to take a closer look at your vascular health. ED isn’t always just about hormones or performance anxiety—very often, it’s a vascular issue that can be treated with the right approach.
As one of the few specialists in the U.S. focused on vascular erectile dysfunction, I’m here to help you find answers and long-term solutions. Let’s find the treatment that works for you.
Schedule a consultation today and take the first step toward reclaiming your sexual health and confidence.
— Dr. Khalil Masabni
