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Erectile dysfunction (ED) is thought to affect over half of men over the age of 40 in the UK. The good news is that it is no longer a problem that is put down to the inevitable side effects of getting older, and there are various safe and effective treatments available, including sildenafil (Viagra) and tadalafil (Cialis).

These medications have undergone years of research and development, and have been proved to work for the majority of men during extensive clinical trials. Sildenafil and tadalafil contain PDE5 inhibitors, which relax the blood vessels in the penis, making it easier for the blood to flow to the erectile tissues.

Most patients will notice an immediate improvement in their sexual function shortly after embarking on a course of ED treatment. However, occasionally, some men may find that a particular treatment isn’t working for them. There could be several reasons for this. Here are some of the most common ones and what you can do about it.

The medication is taken at the wrong time

To work effectively, sildenafil needs to be taken with water one hour before sex. It will remain effective for up to four hours after taking one tablet, so there is no need to rush or take more than the recommended dosage. Tadalafil works in 30 minutes, and can remain effective for up to 36 hours.

Too high an intake of alcohol

Drinking alcohol before sex is a habit for many people, because it can help to lower inhibitions and put them in the right mood. One or two drinks may be OK, but any more than this can have an adverse effect on sexual function.

This is because the body becomes dehydrated after a certain level of alcohol intake, which affects the blood pressure and makes getting and maintaining an erection more difficult. Too much alcohol also reduces the body’s ability to become sexually aroused. Over the long term, chronic alcohol abuse can cause severe damage to the blood vessels.

Eating a large fatty meal beforehand

For men taking sildenafil, it’s advisable to avoid eating a large meal at least two hours before taking the medication. This is because a full stomach reduces the rate at which the medication is absorbed into the bloodstream, meaning that it won’t be effective at the right time.

Grapefruit should also be avoided, as it contains chemicals called furanocoumarins that interfere with the absorption of the medication.

A lack of sexual arousal

It is a common misconception that taking medication automatically increases libido and desire. In fact, it is still necessary to be sexually aroused in order to achieve an erection. If a patient is finding it difficult to become aroused despite taking the medication, this may be due to a psychological or physical issue.

Depression, stress, poor body image and tiredness can all lower the libido. In this case, it may be necessary to reach out to your partner, a mental health charity, or your GP for further advice.

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