Why Isn’t Cialis Working for My Erectile Dysfunction? Causes & Solutions

1. Cialis is highly effective in treating erectile dysfunction (ED). However, it may not work well for some people, with a success rate of up to 70%. 
2. The ED treatment might not be working for several reasons, ranging from incorrect dosage to not using it as directed. There might be psychological causes like stress or anxiety and underlying health conditions. 
3. It may not work properly also due to food and drug interactions or lack of sexual stimulation.
4. To increase the drug’s effectiveness and overcome ED, follow a healthy lifestyle, stay hydrated, and exercise regularly (including Kegel exercises).
5. If it doesn’t work, other options are available to get harder erections, e.g., different oral medications (e.g., Viagra, Levitra), shockwave therapy, penile injections, vacuum restriction devices, penile implants, etc.

If Cialis is not working to help with your erections, you might be wondering whether to change the dosage or try something more powerful. 

Dealing with ED itself is a very difficult experience, and not getting the desired results from your medication can make it more stressful. We’re here to help.

Cialis, or tadalafil oral tablet, helps with the treatment of men who find it difficult to get and maintain an erection. The condition is known as erectile dysfunction (ED) or impotence. It can have a serious impact on a person’s self-esteem, relationships, and quality of life. 

Tadalafil is clinically proven to be effective across a wide range of patient demographics. In fact, a study published in the Asian Journal of Andrology reveals that people most often choose tadalafil over sildenafil (Viagra) because it stays in the body for up to 36 hours, the longest duration among ED medications. 

However, many men still don’t find relief after using it and search, “Why can’t I stay hard with Cialis?” “Why has Cialis stopped working?” or “How can I get Cialis to work better?”.

Before exploring why the drug isn’t working, it is important to understand its mechanism of action.

How Does Cialis Work?

Tadalafil works by increasing levels of some chemicals your body naturally produces when you are sexually excited. One of the chemicals is nitric oxide (NO), which plays a vital role in having a hard erection during intercourse. 

Nitric oxide gets released from endothelial cells (a single layer of cells between blood and tissues) to vascular smooth muscle cells (cells in the wall of your blood vessels). 

NO activates guanylate cyclase enzyme, a substance that increases cyclic guanosine monophosphate (cGMP). cGMP is a messenger; it causes the smooth muscle cells located in the blood vessel walls to relax. This is known as vasodilation (widening or opening up your blood vessels to allow blood to flow easily). 

Smooth muscle makes up most parts of the spongy erectile tissues, e.g., corpora cavernosa, corpus spongiosum, and the glans (head or tip of the penis). 

So, when the smooth muscles are relaxed, it increases blood flow to the penis. The corpora cavernosa fills with blood, leading to an erection. When this whole process works normally, you get an ideal erection, fully rigid and suitable for sex.

Sometimes, an enzyme called PDE5 acts too quickly, creating a glitch in the process. PDE5 breaks down cGMP, reducing its blood vessel-relaxing effects. As a result, blood cannot flow easily to the penis, and the person has a soft and weak erection, not appropriate for vaginal penetration. 

ED pills like tadalafil can fix this glitch by stopping PDE5 from working too fast. This action allows blood vessels to relax, increasing blood flow to the penis as expected during sexual stimulation. 

This medication also works for other conditions like benign prostatic hyperplasia (BPH) and pulmonary arterial hypertension (pAH).

Possible Reasons Why Cialis Is Not Working for You and Solutions

PDE5 inhibitors or phosphodiesterase-5 inhibitors like Cialis are used as a gold standard for erectile dysfunction treatment in men. However, no medication is 100% effective for everyone.  

According to a study, the success rate of tadalafil is 64%-70%. This indicates that 30-40% of patients may still have erection problems after using this medication and wonder, “Why is Cialis not working for me?”.

There are also a large number of men who find this drug to be working initially, but it doesn’t work for them any longer. Why does that happen?

Here are the most common reasons why your Cialis isn’t working well enough for you: 

The Cialis dosage isn’t suitable for you.

The usual starting dosage of tadalafil to treat ED is 5 to 10 mg, taken at least 30-60 minutes before you want to have sex. This may work for mild to moderate ED.. 

However, if you still find it difficult to get hard during intercourse, your condition may be too severe for the dose to work. 

According to a study in the Journal of Sexual Medicine, 1 out of 4 men in their 40s have ED and half of them have severe ED. So, it’s not uncommon. 

Solution: Speak to your doctor. Depending on the severity of your ED and other factors, your doctor may increase your dose and strength. They will likely prescribe you an occasional “as-needed” higher strength (even when 10-20 mg Cialis is not working) or a once-daily lower dose to alleviate your condition. 

You’re not following the instructions properly. 

As per a review published in the Mayo Clinic Proceedings, about 50% of patients do not use the medications as prescribed. It’s called “medication nonadherence”. So, some men with ED may not be able to enjoy the full benefits (i.e., maintain an erect penis) due to this reason. 

Solution: Stick to the correct schedules and doses. Maintain a regular medication routine, especially if you have been prescribed a “once-daily Cialis dose.” 

Your erectile dysfunction has psychological causes.

If you have difficulty keeping an erection due to psychological issues, e.g., depression, stress, anxiety,  low self-esteem, or relationship problems, ED pills may not work for you. Stress interrupts when your brain tries to send signals that your body needs to initiate an erection. About 40% of ED cases are psychological. 

Psychological reasons can be various, e.g., generalized anxiety disorder (GAD) and cultural or religious attitudes towards sex. 

Male sexual dysfunctions can also stem from a natural situation such as personal burnout/emotional exhaustion or when starting a new relationship and feeling the pressure to satisfy your partner.

Solution: To get rid of psychological erectile dysfunction, consider relationship counseling, cognitive behavioral therapy (CBT), and relaxation techniques for stress management. 

Your doctor will likely advise you to manage the existing mental health issues. For example, if you have anxiety disorders, they will probably prescribe anti-anxiety medications like SSRIs, SNRIs, or beta blockers.

An underlying problem may need medical attention. 

ED is often the tip of the iceberg. The real problem may be a more serious illness. People with serious underlying health conditions, e.g., heart disease, liver disease, or diabetes, can have recurring problems with erections. 

For example, people with coronary artery disease (CAD) are likely to have ED due to poor blood circulation.  If you have diabetes mellitus, you have a 3.5x higher chance of developing ED than those without diabetes. 

Some of the other physical issues that can cause ED are: 

• Atherosclerosis (a vascular disease, fatty deposits clogging the arteries due to high cholesterol)
• Peyronie’s disease (an abnormal bend that makes erections painful)
• Chronic kidney disease
• Hyperthyroidism or hypothyroidism 
• Irritated or damaged genital nerves 
• Any injury to the pelvis or genitals
• Multiple sclerosis (a neurological disease)
• Obesity

If you have a problem with Cialis not working anymore, other biological factors, e.g., hormonal imbalances, might be at play. Testosterone is a hormone that supports erection by working as a vasodilator of penile arterioles and cavernous sinusoids (both help with the blood supply for the erection).

If the problem is left untreated and worsens over time, medications like tadalafil (Cialis) will not work. 

Solution: Get a full body checkup to detect and treat if there’s any underlying medical problem or disease.

You’re eating certain types of foods that may interact with Cialis

Usually, the medication doesn’t interact with food, and you can take the pill on an empty stomach as well as with food. 

The drug can interact with grapefruit or grapefruit juice, leading to unintended results.  When you take tadalafil tablets within 24 hours of consuming grapefruit, your body can’t break down (metabolize) the drug as it should. Having a higher level of drug in your bloodstream raises your risk of side effects. 

Tadalafil may not work properly if you have alcohol in your system. The combination can cause severe problems, e.g., chest discomfort and dizziness (orthostatic hypotension due to a sudden drop in blood pressure). 

Solution: Use caution when drinking alcohol if you are undergoing an ED treatment. Avoid grapefruit juice/grapefruit when taking the pill. 

Moreover, it is not fully known how tadalafil interacts with recreational drugs (substances taken for enjoyment, e.g., nicotine, cannabis, or even caffeine). So, avoid using them altogether when you’re being treated with this drug.  

You’re taking certain medications that may interact with Cialis  

Sometimes, when taken together, two medications or substances produce undesired results. They may prevent each other from working well or may cause adverse effects. Possible drug interactions with tadalafil include:  

• Angina or chest pain drugs (nitrates)
• Certain antibiotics and antifungal drugs
• Any other ED drugs
• Alpha-blockers for high blood pressure or prostate problems
• Other pulmonary hypertension drugs like riociguat

Solution: If you can’t achieve and maintain an erection even after using this medication, consult your healthcare provider to learn about possible drug interactions. Avoid taking another medication or supplement incompatible with tadalafil (Cialis).

You are expecting an automatic erection without sexual stimulation. 

PDE5 inhibitor ED drugs can work only if you are sexually aroused or “turned on.” When you have feelings of sexual excitement, the brain sends signals to set off the process of erection. Without proper sexual stimulation, ED pills cannot work alone to cause an erection.   Solution: Work on your arousal to get sexually excited with adequate physical contact, foreplay, or by indulging in sexual fantasies.

How Can I Get the Maximum Effect from Cialis?

While all the solutions mentioned above will help, follow these tips to improve Cialis’s work. 

1. Follow healthier lifestyle habits: 

Eating a balanced, nourishing diet, walking more or having more physical activity, quitting smoking, limiting alcohol consumption, and maintaining an ideal weight can help make the ED drug work better.

2. Start exercising: 

Pelvic floor muscle exercises, also known as Kegel exercises, can improve sexual performance. According to Harvard Health, only a few hours of exercise a week may help you overcome ED. 

However, start with light exercises first because this ED treatment may cause back pain or muscle pain (in the lower back, hips, and thigh muscles) as a side effect. If you experience any pain, applying compresses or OTC pain medicines may help. 

3. Stay hydrated: 

Headache is a common side effect of ED oral medications, which may become worse if you are dehydrated. Drinking more water will help you maintain your fluid and electrolyte balance and blood volume, which is crucial for your sexual health.  

4. Have smaller, frequent meals: 

Acid reflux or an upset stomach is a side effect of this medicine. To get relief, avoid processed or junk food, have easy-to-digest, regular meals to settle your stomach, and give medicine the best chance to work. 

5. Communicate with your partner: 

Transparent, compassionate communication is the key to a healthy, happy sex life. Discuss your condition and treatment options without beating around the bush. Indulge in physical intimacy other than sexual contact, e.g., touching, cuddling, holding hands, etc., to relax and ease off the tension. You can get through this together.

Mild headaches, digestion issues, muscle and back aches, stuffy/runny nose, and cough are some of this medicine’s common temporary side effects. 

If you experience any severe symptoms, e.g., extreme dizziness, vision or hearing problems, or painful erections that do not go away even after ejaculation, seek medical help right away.

What Happens If You Take Cialis Correctly and It Doesn’t Work?

Even in a situation with Cialis not working, there are other options to treat ED. 

Check with your doctor. They will examine your condition, consider your full medical history, and may suggest one of these alternatives: 

1. Other oral ED medications: If tadalafil isn’t working, other PDE5 inhibitors like Viagra (sildenafil), Levitra (vardenafil), or Avana (avanafil) may help. Each medication has a different chemical makeup, with slight variations in how they work. So, a different medication may better suit your needs. 
2. Penile injection therapy: If oral drugs seem to be ineffective (e.g., Viagra and Cialis not working), penile injections can be used. Doctors will prescribe a medicine to be injected into the penis as needed before sexual activity. 

For example, Trimix injections, used to treat erectile dysfunction, combine three ingredients: alprostadil (a prostaglandin E1 agonist medication), phentolamine, and papaverine.

3. Vacuum Erection Devices (VEDs): These are also known as vacuum pumps, “vacuum restriction devices” or penis pumps. Placed over the penis externally, they create a vacuum, helping blood enter easily into the penis for an erection.
4. Penile implant: A device surgically placed inside the shaft of the penis to allow men with ED to get and maintain erections. Some people refer to it as penile prosthesis.
5. Shockwave therapy for ED: Unlike surgeries, this ED treatment uses sound waves to stimulate blood flow to the penis.
6. Hormone therapy: In case of a hormonal imbalance, e.g., an inadequate production of testosterone, testosterone therapy may be recommended by your doctor. 
7. A combination of therapies: Your doctor may use more than one method of treatment to increase its efficacy.

Penile vascular surgery: Vascular reconstructive surgery can improve arterial blood flow to the penis, helping men with erectile dysfunction.

Here’s a quick comparison of Cialis with other erectile dysfunction treatments:

Treatment	Type	Advantages	Disadvantages
Cialis (Tadalafil)	Oral ED medication. A PDE5 inhibitor	Long duration (up to 36 hours), longest lasting among all PDE5 inhibitors	Common side effects e.g, headaches, stomach upset, cold symptoms like other ED medications.
Viagra (Sildenafil)	Same as above	Quick onset of action (i.e., starts working within 30-60 minutes)	Shorter duration  (lasts for 4-6 hours). Common side effects like other ED meds.
Levitra or Vilitra (Vardenafil)	Same as above	Some people experience side effects like pain, bruising, or scarring. Other side effects e.g., injection site ecchymosis, penile rash, penile edema	Shorter duration than tadalafil (4-6 hours).
Avana (Avanafil)	Same as above	Quick onset (15-30 minutes), fewer side effects than other phosphodiesterase type 5 inhibitors.	Relatively new ED med. More testing needed.
Penile Injection Therapy	Medication (e.g., Trimix) injected directly into the penis to induce an erection.	Highly effective even in severe cases of ED. Especially when ED pills don’t work.	Non-invasive can be used if oral medications do not work.
Vacuum Erection Devices	Improper training may lead to side effects, All exercises suit everyone. Does not provide quick, immediate relief as medical (e.g. ED pills) or other clinical procedures, such as surgery	A mechanical pump that encourages blood flow into the penis, inducing an erection.	May appear to be a bit awkward to use, possible bruising or discomfort. Other side effects e.g., fibrosis, leg spasms, petechiae
Shockwave Therapy	Uses sound waves to increase blood flow to the penis	Non-surgical, mild side effect: pain or discomfort	Sometimes less effective than high-dose PDE5 inhibitor oral tablets
Hormone Therapy	Treatment to treat hormonal imbalances e.g., low testosterone levels to overcome ED	Effective if hormonal irregularity is the cause.	Only works if the issue is hormonal, possible side effects.
Penile Vascular Surgery	Surgery done to improve blood flow to the penis by reconstructing blood vessels.	Effective if ED is caused by vascular problems.	Highly invasive, recovery time is long. Possible complications related to surgery.
Penile Implants	Surgical placement of an inflatable penile prosthesis that allows for an erection when you need it	Long-term solution	Invasive with risk of post-surgical infection, permanent once done
Lifestyle modifications	Lifestyle changes e.g., quitting smoking, avoiding alcohol, eating healthy and getting more physical activity.	No side effects. Suitable to everyone. Long-term solution.  Improves overall health	Does not provide quick, immediate relief as medical (e.g. ED pills) or other clinical procedures, such as surgery
Specific exercises e.g., Kegels and pilates	Involves pelvic floor strengthening with Kegel exercises and improving cardiovascular health with exercise to improve blood flow	Generally, there are no side effects. Long-term solution. Improves sexual stamina, performance, and overall health	Generally no side effects. Long-term solution. Improves sexual stamina, performance, and overall health

The Final Thought

When Cialis isn’t working as it should or has stopped working, there’s no need to stress over it. Use the solutions mentioned in this article and consider other erectile dysfunction treatments. By checking with your doctor and making lifestyle modifications, it is not difficult to relieve your ED and take control of your sexual life. 

FAQ

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