Ask Beth: What are my options if I can’t take the “little blue pill”?


Hi, I’m Beth Boatman and I am a professional human sexuality educator and consultant dedicated to enlightening adults about all things related to sexuality.

My interest in sexuality started as a curious child who asked my parents LOTS of questions. Fortunately, my parents were excellent at providing me with both honest and age-appropriate information. While searching for my life goals in my early college years, I found my calling at Widener University, which houses the only fully accredited doctoral program in human sexuality in the country.

I am a lifelong resident of the Dallas-Fort Worth, Texas area and have provided individuals with sexuality education on topics ranging from sexual transmitted infection prevention to female ejaculation.

When I’m not teaching about sexuality I’m doing yoga, window-shopping at fancy grocery stores, spending time with people I love, and experimenting in the kitchen with new recipes.

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Q: I’m getting older and sometimes have ED. What are my options if I can’t take the “little blue pill”?

Posted by Beth, The Sex Consultant on Oct 21, 2013

A: Thanks for your question. If you pay attention to the media (especially during football season and other male directed TV programs) you may think your only option for erectile dysfunction (ED) is the little blue pill. Actually, there are a quite few options you can choose from.

Having a “not as firm” erection is a normal part of the aging process, but erectile dysfunction is when you cannot maintain an erection at all. Below are the various options for ED. Bear in mind I am not a medical doctor. Please speak with your medical provider or a urologist to find out which option is right for you.


There is a common misconception that penis pumps increase size, but they are really meant to help you maintain an erection.

  • Penis pumps are hard-plastic cinders that fit over the penis and create a vacuum using suction. They are used to help men get an erection or simulate oral sex. Pumps are not medical devices used for penis enlargement or a cure for erection difficulties. The pump creates a vacuum around the body party on which it is placed and draws blood into the area. The body part will swell slightly as a result of the increased blood flow to the area. This size change is temporary. It is recommended that you limit pumping to no longer than 20 minutes, twice a week.
  • The band (cock ring) prevents blood from returning to the body and acts as a tourniquet. You can only keep the band on for a max of 30 minutes. Otherwise, you run the risk of starving your penis of oxygen rich blood which will lead to tissue damage (VERY BAD).
  • Often, there is a “hinging” effect on the penis while using the band (penis swings back and forth at base due to the band).


  • PDE-5 inhibitors (Viagra, Cialis, Levitra)-A pill. PDE-5 inhibitors work by relaxing smooth muscle, allowing the penis to fill with blood. Sometimes insurance will cover some or most of the cost.
  • Intra-urethal alprostadil (Muse)*– You use an applicator to insert a small “seed” or pill into your urethra. It relaxes the smooth muscles and allows blood to fill the penis. I hear it “stings like crazy” and its about $30 a dose ($30 per erection).
  • Intra-cavernosal injection*– Using a small (insulin size) needle to inject medicine into the side of the penis. This is cheaper ($2-$3 a dose) and works for everybody.

*Muse and the injection may not seem very comfortable, but if you have a heart condition, are a survivor of prostate cancer, or have another medical condition prohibiting the use of PDE-5 inhibitors these may be an excellent option for you


You can also get various types of penile implants surgically placed to give your penis an erection. Some are stiff rods (you always have an erection) and some “pump up” when needed. (You actually squeeze an airbag placed in your scrotum to inflate it.) Of course with surgery there is always a risk. Talk with your doctor to find out more.

Mental  and Physical Health

Sometimes ED is caused by psychological stuff (stress at work, depression, etc.) and can be helped by talking with a licensed mental health professional. Also, in order for a penis to get an erection you need to have healthy blood flow. Eating right and exercising (including kegel exercises) can help strengthen your erection.

Once again, talk with your doctor about all your options and what may be the best for you.