ED Treatments Beyond Pills: What Else Exists
September 18, 2026 · 6 min read
Roughly 20 to 30% of men don't respond adequately to oral medication, and some can't take it at all because of nitrate use or other contraindications. Those men have real options, and they're rarely discussed outside a urologist's office.
Vacuum erection devices
A cylinder and pump draw blood into the penis; a constriction ring at the base holds it. Effective for most men including those with nerve damage, no drug interactions, and safe with nitrates. Downsides: it's mechanical and unspontaneous, the erection can feel cool or hinged at the base, and the ring must come off within 30 minutes.
Intracavernosal injections
Alprostadil, or a compounded combination, injected into the side of the penis with a very fine needle. Success rates are high — often quoted above 80% — and it works independently of nerve signalling. The needle deters people, but most who try it report far less discomfort than expected. Requires provider training and carries a priapism risk that must be understood before starting.
Urethral suppositories
A small alprostadil pellet inserted into the urethra. Less effective than injections and can cause urethral burning, but avoids needles entirely.
Penile implants and shockwave therapy
Inflatable implants are surgical, permanent and have among the highest satisfaction rates of any ED treatment — reserved for men who've failed other options. Low-intensity shockwave therapy aims to stimulate new blood vessel growth; evidence is promising but still evolving, protocols vary widely between clinics, and it remains investigational in many places. Be cautious with clinics selling expensive packages with guaranteed outcomes.
The short version
Failing pills is not the end of the ladder. A urologist has several more rungs, and satisfaction rates on some of them are very high.
This article is general health information, not medical advice, and does not create a patient–provider relationship. Prescription treatment is only available after an evaluation by a licensed provider who determines it is appropriate for you. Do not take a PDE5 inhibitor if you use nitrates or riociguat. Seek emergency care for chest pain, sudden vision or hearing loss, or an erection lasting more than 4 hours. See our Important Safety Information.