Library · Eight minutes
Viagra worked once and then stopped working
It is one of the most frightening things that can happen in this, because the thing you were relying on appears to have failed too. Here is what is usually going on.
The sequence men describe is remarkably consistent. The first time, it worked — possibly spectacularly. The second time, it mostly worked. Somewhere around the third or fourth, it did not, and the bottom fell out of everything.
That last part is worth naming, because it is the part nobody warns you about. Losing an erection is unpleasant. Losing one on medication is frightening in a different order of magnitude, because the safety net has apparently gone as well.
The drug almost certainly has not stopped working. What has changed is what you were asking it to do.
Read this bit properly. I am a therapist, not a prescriber. Nothing here is advice about your medication, and anything to do with dose, timing or whether a drug suits you belongs with your GP, pharmacist or prescriber. If a medicine is not doing what you expected, that is a genuinely good reason to go back to them — not a reason to give up on it quietly, and certainly not a reason to buy something unregulated online.
01What the tablet actually does
Broadly, PDE5 inhibitors — sildenafil, tadalafil and the rest — make it easier for blood to flow into the penis and stay there once you are aroused. They are well studied, they help a great many men, and this page is not an argument against them.
But notice the phrase once you are aroused. The medication improves the plumbing’s response. It does not create desire, it does not produce arousal out of nothing, and — this is the important one — it does nothing whatever about threat.
If your body has decided intimacy is an examination, it will keep producing the physiology of being examined, and a tablet does not have an opinion about that.
02The added-test problem
Here is the mechanism that catches most men, and it is almost cruel in its design.
Before the tablet, you had one anxious question: will it work tonight? After the tablet, you have that question plus a much worse one: and if it doesn’t work now, with medical help, what does that say about me?
You have not lowered the stakes. You have raised them, and removed your last excuse at the same time. A man who takes a tablet and then lies there thinking this had better work, I’ve got no explanation left has just done more to interfere with his own arousal than the medication can compensate for.
03Why it seemed to work the first time
Usually because the first time carried something the later times did not: a genuine expectation that it would be fine. That expectation lowered the threat, the threat coming down let arousal happen, and the medication did its part on top of a nervous system that was already cooperating.
Then a difficult occasion arrived, the fear came back with new evidence attached — it failed even with help — and from that point the tablet was being taken by a considerably more frightened man. Same drug, same dose, different conditions.
There are also perfectly ordinary practical explanations that get overlooked in the panic. How these medicines behave can be affected by timing, by alcohol, by a heavy meal, and by simply not being aroused enough for them to have anything to work with. Those are all things to raise with your prescriber, who can tell you what applies to the one you are taking. They are worth ruling out before you conclude anything about yourself.
04What this does not mean
It does not mean you are beyond help, that your case is unusually severe, or that you have burnt through the only option. Men reliably reach all three of those conclusions at about two in the morning, and none of them follows.
What it usually means is narrower and more workable: the physical side has been given some assistance, and the psychological side has not been addressed at all. That is not a failure of the treatment. It is an incomplete treatment.
05What to do
Go back to whoever prescribed it. Say it stopped working. That sentence is not an admission of anything and they will have heard it many times. There may be a straightforward explanation, and there may be alternatives.
Stop making the tablet a verdict. If you take one, take it as help with the hydraulics and nothing more — not as a test of whether you are fixed. The moment it becomes proof of something, it starts working against you.
Deal with the demand, not just the blood flow. This is the part medication cannot reach: the watching, the pressure, the pass-or-fail structure that has grown around sex. The mechanism is set out in full here, free.
The two go together well, incidentally — better than either alone for many men. A tablet can lower the stakes just enough for the confidence work to get some traction, and the confidence work can eventually make the tablet optional. That is a considerably better outcome than a monthly subscription and a fear that never got looked at.