If Viagra is not working for you, the most common reason is not that the medicine has failed but how and when it was taken. Sildenafil (Viagra) and tadalafil (Cialis) are safe and effective for most men when they are prescribed and used properly, and a few adjustments often make the difference. When they still do not help and your tests come back normal, the cause may lie in stress, anxiety or habits rather than blood flow, and that is worth looking at with a professional rather than giving up.
Why isn’t Viagra working for me?
In a study of 100 men who had been told sildenafil did not work for them, 56 had been using it in a way that made failure more likely. Forty-five had never tried the highest recommended dose, 32 had taken it on a full stomach, 22 had taken it just before sex, and 12 did not know that sexual stimulation was needed for it to work. After proper instructions and at least four more attempts at home, 31 of them responded. Read the study. The men were mostly older, with an average age of 59, but the practical lessons apply at any age.
Things to check before deciding it does not work:
- Arousal. These pills make it easier for blood to flow into the penis when you are turned on. They do not create desire or an erection on their own.
- Timing. The NHS says sildenafil is usually taken about an hour before sex, and that the time it takes to work varies. NHS on sildenafil.
- Food. It may take longer to work after a large meal.
- Alcohol. The NHS advises avoiding too much alcohol, because it can make getting an erection more difficult.
- Dose. The starting dose may not be the right one for you. Changing it is a decision for the prescriber, not something to do by taking extra tablets.
- One try is not a verdict. Nerves on the first attempt, especially with a new partner, are common. Clinicians usually judge a medicine over several attempts.
Why isn’t Cialis working?
Tadalafil works in the same way but lasts longer. The NHS says it may be taken about 30 minutes before sex, or as a lower dose every day, and that its effects can last up to 36 hours. NHS on tadalafil. The NHS warns that alcohol can make getting an erection harder and, with tadalafil, can make you dizzy or light-headed. Arousal is still needed. If one medicine does not suit you, a doctor may suggest another.
Can I take two pills, or combine Viagra and Cialis?
No. The NHS says not to take more than one tablet a day, and lists other erectile dysfunction medicines among those that may not mix well with sildenafil and tadalafil. Never take them with nitrates for chest pain or with poppers, and tell the prescriber about every other medicine you take. Taking them with drugs such as cocaine, ecstasy or amphetamines raises the risk of serious side effects.
Get urgent help (999 in the UK, 911 in the US) for chest pain, a fast or irregular heartbeat, fainting or a seizure after taking one. A painful erection that lasts more than four hours also needs urgent medical help.
What if the pills are not genuine?
If you bought them from an unregulated website or a friend, you do not know what you took. The NHS warns that many websites sell fake medicines whose ingredients can vary from one pack to the next. NHS on buying online. A fake pill can fail, and it can also contain something harmful. A proper prescription is safer and gives you someone to follow up with.
Viagra not working and all tests are normal
This is a common and confusing place to be, especially for younger men. A normal blood test and examination do not mean nothing is going on. They mean the most common physical causes have become less likely.
Doctors look at the pattern. A clinical review in American Family Physician lists younger age, a sudden start, problems in some situations but not others, and still having night-time erections as pointers towards a psychological cause, and suggests sexual counselling for those men alongside any medicine. Read the review. NIDDK names anxiety, depression, stress, loneliness, low self-esteem and lack of confidence among the emotional issues that can cause erection problems or make them worse. NIDDK on causes. A pill can help blood flow, but it cannot switch off fear of failing.
The NHS notes that counselling and therapy can help when erection problems are linked to emotional or mental health problems, and that vacuum pumps are an option when medicine does not work. Other treatments exist too. If you have been told your tests are fine, go back and ask what comes next. Keep seeing your doctor. Getting help is not a sign that you have failed.
When should I go back to the doctor?
Return to your GP, clinic or urologist if:
- a pill used correctly several times has not helped;
- it used to work and has stopped;
- you have side effects, or you are unsure it is safe with your other medicines;
- you have diabetes, high blood pressure, heart problems or you smoke, or you have not had a check-up for these;
- worry about sex is affecting your mood or your relationship.
If you are having thoughts of harming yourself, get help now. In the UK, call 999 or Samaritans on 116 123; in the US, call or text 988.
Could porn or my solo habits be part of it?
This is the cause people rarely check, and it is worth checking mainly when the pills fail and the tests are normal. Research does not show that porn causes erectile problems in general. Our guide to porn and erection problems goes through that evidence. But in a survey of 3,419 men aged 18 to 35, higher scores for problematic porn use were linked with a higher chance of erectile dysfunction, while masturbation frequency did not seem to matter. The study is cross-sectional, so it cannot show which came first. Read the study.
A short self-check:
- Are erections reliable with porn, but not with a partner, even after taking a pill?
- Do you still get morning or spontaneous erections?
- Have you needed more novel or more intense content to get aroused?
- Does your solo routine depend on a grip, speed or pressure a partner’s touch does not match?
- During sex, are you watching yourself for signs of failure instead of paying attention to your partner?
- Have you tried to cut back on porn and found it harder than you expected?
Several yes answers suggest your habits and nerves are worth looking at alongside medical care, not instead of it. None of these answers is a diagnosis.
What people describe
Ryan, 32, describes short-lived erections and avoiding penetration until a sexologist prescribed medication. “Naturally, intercourse lasted much longer and the satisfaction was fine,” he writes. Then he developed high blood pressure and began to wonder whether the medicine was right for him. Questions like that are best taken back to the prescriber, who can weigh the options with you.
A 30-day experiment
If the self-check sounded familiar, you can choose a 30-day window to observe what changes. It is not a cure or a recovery timeline, and it runs alongside medical care, not instead of it.
- Use the medicine properly. Follow the prescriber’s instructions on timing, food and alcohol, and make sure you are aroused. Write down each attempt and what happened.
- Change the solo routine. Decide whether to leave porn out of masturbation for the month or to take a break from it. If you keep masturbating, use a lighter touch and a slower pace.
- Make porn harder to reach on your phone. Turn on a content blocker or your phone’s screen-time limits (step-by-step for iPhone and Android).
- Take the pressure off. Agree with your partner on touch that has no goal of intercourse. Our page on performance anxiety and comparison has more on this.
- Book a follow-up. Bring your notes to your doctor, or ask about a sex therapist.
At the end, read your notes. Several changes at once cannot tell you exactly which one helped, but they give you and your clinician much more to go on.
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