Erectile Dysfunction Treatment in Miami

Every ED treatment, in order — and what to do when each stops working

Most men start with sildenafil (Viagra) or tadalafil (Cialis). But roughly a third of men do not get an adequate response from ED medication — especially men with diabetes, men after prostate surgery, and men with cardiovascular disease. Stopping there is the most common mistake in ED care. Here is the whole ladder, in order, with the honest signal that it is time for the next rung.

1. Lifestyle and health first

Weight, exercise, quitting smoking, and controlling diabetes and blood pressure measurably improve erections in early ED, and they make every treatment below work better. They are the foundation, not the whole answer.
When this isn’t enough: if erections don’t recover after 3–6 months of real changes, that is not failure. It usually means the cause is vascular or neurological, and the next rung works well.

2. Pills: sildenafil, tadalafil and similar

For many men, PDE5 inhibitors restore reliable erections. They need sexual stimulation to work, and they work less well when diabetes, prostate surgery, or years of vascular disease have damaged the underlying machinery.
When this isn’t enough: pills that worked and then stopped, or never worked at full dose, are one of the most common reasons men see us. That progression is expected in ED; the treatment advances with it. See injections and devices.

3. Injections, urethral suppositories, and vacuum devices

Penile injections produce erections independent of nerve signals for most men who try them; vacuum devices help some men, with honest limits. These are real treatments, not consolation prizes. They are also where many men learn what daily life with a workaround feels like.
When this isn’t enough: if injections burn, stop working, or the routine has worn you down, you have reached the question the last rung answers: am I a candidate?

4. The inflatable penile implant

Most men reach this rung after the ones above stop working — but the ladder is a map, not a requirement: under the AUA’s ED guideline it is valid to choose any treatment, including the implant, without failing the others first. The inflatable penile implant restores erections mechanically, independent of pills, needles, and nerve damage. It is concealed entirely inside the body, produces an erection when you choose, and carries the highest patient- and partner-satisfaction rates of any ED treatment in head-to-head published studies.¹ Dr. Gheiler performs more than 400 implant procedures a year.
Next step: cost & insurance · outcomes & safety · how long an implant lasts.

Most men climb this ladder over years, alone, assuming each failed rung was the end of the road. It is not. If you recognize yourself on rung 2 or 3, the consultation is the shortcut: in one visit you learn which rungs are worth your time and which to skip.

About Dr. Edward Gheiler, MD, FACS

Dr. Gheiler teaches penile implant surgical technique to other urologists in Boston Scientific physician-education programs. At Happy Urology in Hialeah, he performs more than 400 inflatable penile implant procedures per year using his Concealed-Scar Scrotal Technique™ — a 15–20 minute outpatient surgery through a single scrotal incision, with the scar concealed in the natural scrotal skin. In his own reported single-surgeon series, his baseline infection rate for primary implants is 0.3%.² He also sub-specializes in revision surgery for implants placed elsewhere, and sees patients in English and Spanish as part of his broader men’s sexual health practice. See how long a modern implant lasts, or read our outcomes and safety approach.