Is Erectile Dysfunction Treatment Guaranteed? Success Rates and Options
No treatment for erectile dysfunction carries a 100% guarantee — but the evidence is reassuring. The vast majority of men with ED respond well to MHRA-approved oral medication, and those who do not respond to a first-line approach have a range of effective alternatives available. This guide covers success rates for each treatment type, explains why some men respond less well, and sets out the full range of options when first-line treatment is insufficient.
Medical disclaimer: This article is for informational purposes only. ED treatments are prescription-only medicines. Always complete a clinical consultation before use. Our prescribers are GPhC-registered pharmacist independent prescribers.
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How Effective Are ED Treatments? — By the Numbers
| Treatment | Success Rate | Notes |
|---|---|---|
| Sildenafil (Viagra) | ~82% | First-line; take on-demand 30–60 min before sex; lasts 4–6 hours |
| Tadalafil (Cialis) | ~81% | 36-hour duration; also available as 5mg daily |
| Vardenafil (Levitra) | ~80% | Useful when sildenafil is ineffective |
| Avanafil (Spedra) | ~77% | Fastest onset (~15 min); good tolerability |
| Penile injection therapy (alprostadil) | ~85% | Effective when oral drugs fail; requires injection training |
| Vacuum erection device (VED) | ~75% | Non-pharmacological; useful for men who cannot take oral medication |
| Penile implant surgery | 90–95% satisfaction | Used when all other treatments fail; permanent solution |
| Lifestyle changes alone | Variable | Most effective for younger men with lifestyle-related ED; can reverse symptoms entirely |
| Psychological therapy (CBT/sex therapy) | Highly effective for psychological ED | Addresses root cause; often combined with medication |
Success rates for oral PDE5 inhibitors represent men achieving erections satisfactory for sexual intercourse in controlled clinical trials. Real-world outcomes are influenced by how correctly the medication is used (timing, food, stimulation).
Primary vs Secondary ED
| Type | Description | Prognosis |
|---|---|---|
| Primary ED | Rare — man has never been able to sustain an erection | Requires specialist assessment; complex underlying cause |
| Secondary ED | Common — previously normal erectile function that has declined | Usually treatable; often reversible with appropriate treatment |
The vast majority of men presenting with ED have secondary ED — and this is associated with a significantly better treatment prognosis.
Why Does Treatment Sometimes Not Work?
Suboptimal Use of Medication
The most common reason oral PDE5 inhibitors appear to fail is not a genuine non-response — it is incorrect use:
- Taking sildenafil after a large, high-fat meal (delays and reduces absorption)
- Not allowing enough time before sexual activity
- Insufficient sexual stimulation present
- Performance anxiety preventing full arousal
Clinical trials show that men who are coached on correct use achieve substantially better outcomes. Before concluding a medication does not work, ensure it has been tried at least four times under optimal conditions.
Physical Causes Limiting Response
- Severe vascular disease — when blood flow to the penis is severely compromised, PDE5 inhibitors may improve but not fully restore erectile function
- Nerve damage — men who have had both cavernous nerves removed during prostate surgery may have limited response to oral medication
- Poorly controlled underlying conditions — uncontrolled diabetes, severe depression, or undertreated hypertension limit treatment response
What If First-Line Treatment Doesn’t Work?
Step 1: Optimise Before Switching
Check timing, food, stimulation, and anxiety before concluding a drug has failed. Try at the maximum dose (100mg for sildenafil) at least four times under good conditions.
Step 2: Try a Different PDE5 Inhibitor
Men who do not respond to sildenafil may respond to tadalafil or vardenafil — and vice versa. Differences in pharmacological selectivity mean that the drugs are not identical in their clinical effects for all men.
Step 3: Address Underlying Causes
Treat poorly controlled diabetes, reduce weight, address depression, review medications that may be contributing. These changes can restore response to oral medication that was previously ineffective.
Step 4: Second-Line Treatment
Penile injection therapy (alprostadil): Injected directly into the corpus cavernosum, alprostadil causes vasodilation and erection independent of nerve function. Success rate ~85%. Highly effective, including for men with nerve damage.
Vacuum erection device (VED): Effective in approximately 75% of men. Non-pharmacological. Useful for men who cannot take oral medication (e.g., those on nitrate medicines) or who prefer a drug-free approach.
Step 5: Penile Implant Surgery
Inflatable or semi-rigid penile prostheses provide reliable, on-demand erections with 90–95% patient satisfaction. This is appropriate after other options have been exhausted, particularly in men with severe vascular disease or significant nerve damage.
The Role of Lifestyle and Psychology
For men with lifestyle-related or psychologically-driven ED, addressing root causes is both the most effective treatment and the most durable:
- A 2004 JAMA study found one third of obese men with ED recovered normal sexual function through weight loss and exercise alone
- CBT and sex therapy are highly effective for performance anxiety-driven ED — and produce lasting results that medication alone does not
- Quitting smoking, reducing alcohol, and improving cardiovascular fitness can meaningfully restore erectile function without drugs
For younger men in particular, a combined approach — medication short-term to restore confidence, while lifestyle and psychological work address the root cause — tends to produce the best long-term outcomes.
For lifestyle guidance, see: Lifestyle Changes for Erectile Dysfunction. For an overview of all treatment options, see: Understanding and Overcoming Erectile Dysfunction.
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Frequently Asked Questions
Are ED medications guaranteed to work?
No treatment is 100% guaranteed, but MHRA-approved PDE5 inhibitors have high success rates in clinical trials: sildenafil ~82%, tadalafil ~81%, vardenafil ~80%, avanafil ~77%. For men who do not respond to first-line medication, effective second-line options exist, including injection therapy and penile implants.
What if ED medication doesn’t work?
First, check whether the medication was used correctly — timing, food, stimulation, and anxiety all significantly affect outcomes. If correct use consistently fails, your prescriber may try a different PDE5 inhibitor, investigate underlying causes, or recommend second-line treatment options such as alprostadil injections or a vacuum erection device.
Can lifestyle changes cure erectile dysfunction?
For men with lifestyle-related ED — particularly younger men with obesity, poor cardiovascular fitness, or high alcohol intake — lifestyle changes can resolve symptoms entirely without medication. A 2004 JAMA study found one third of obese men with ED recovered normal function through weight loss and exercise alone.
Is ED treatment available on the NHS?
Yes, under specific criteria. NHS guidance permits sildenafil prescribing for men with ED associated with certain conditions (diabetes, multiple sclerosis, prostate cancer, and others) or where ED causes severe distress. Men who do not meet criteria can access treatment quickly and discreetly through Access Doctor.
Does treating diabetes help ED?
Yes — in men whose ED is partly driven by diabetes, improving blood glucose control reduces nerve and vascular damage, which can improve erectile function alongside targeted ED treatment. Tight glycaemic control from an early stage of diabetes gives the best long-term prognosis for erectile health.
What is the most effective ED treatment overall?
For most men, oral PDE5 inhibitors (sildenafil or tadalafil) are the most effective, convenient, and well-tolerated first-line treatment. For men who cannot take oral medication or do not respond to it, penile implants have the highest satisfaction rates of any ED treatment at 90–95% — but represent a surgical intervention appropriate only after other options have been exhausted.
References
- NICE. Erectile dysfunction. CKS 2023. cks.nice.org.uk
- NHS. Erectile dysfunction. nhs.uk
- GPhC. Standards for registered pharmacies. pharmacyregulation.org
- Esposito K et al. Effect of lifestyle changes on erectile dysfunction in obese men. JAMA 2004.
- Lue TF. Erectile dysfunction. N Engl J Med. 2000.