En español | If you watch TV or read magazines, you could easily conclude that men seeking treatment for erectile dysfunction (ED) have but one option: pills. The three dominant brands — Cialis, Levitra and Viagra — are locked in an expensive battle for men’s allegiances, and have, through their suggestive advertising, triggered both satire and controversy in the 14 years since the Food and Drug Administration approved Viagra.

See also: Keep track of your health records — easily.

Think about improving your heart health first before pursuing ED treatments. — Photo by Paul Bradbury/OJO Images/Getty Images

But steamy commercials aside, what if the pills don’t work for you, as is the case in 25 to 30 percent of men with ED, or they stop working after a few years — a common problem for men whose ED is caused by an underlying cardiovascular condition?   

“A lot of patients think that pills will give them complete restoration,” says Ajay Nehra, M.D., a urology professor at the Mayo Clinic College of Medicine in Rochester, Minn. But many patients instead find that even if they take the pills, they are “not the same” sexually as they were before the onset of their ED, he says.

If you are among the men who want — or need — to try other therapies for ED, here are the three main options, some of which are cheaper and more effective than the pills. All costs stated below will vary, depending on your insurance plan.  

Before pursuing ED treatments, though, bear in mind that improving heart health by losing weight, eating a healthier diet, exercising more and quitting smoking typically enhances erectile performance as well as one’s overall health. In addition, sex therapy counseling sessions can often ease or eradicate ED symptoms, if the underlying cause is psychological in nature, says Drogo Montague, M.D., director of the Center for Genitourinary Reconstruction at the Cleveland Clinic. 

1. Vacuum erection device (penis pump)

Penis pumps produce erections by drawing blood, via air suction, into the penis. The devices consist of a cylindrical tube, 12 to 18 inches long, connected by a small air hose to a hand pump (on many models this resembles the squeeze mechanism on a blood pressure monitor). Users place the tube over the penis then pump to produce an erection. They must then place an elastic band around the base of the penis to keep the blood there and maintain the erection.  

“Obviously this isn’t the most spontaneous thing,” says Tobias Kohler, M.D., assistant professor of urology at Southern Illinois University School of Medicine. “You can imagine someone having sex with a partner for the first time and pulling out this lunch box.”

While the pumps produce erections for 90 percent of users, most abandon it for other treatments, says Trinity J. Bivalacqua, M.D., assistant professor of urology and oncology at the Johns Hopkins Medical Institution.

The pumps are “very cumbersome and clumsy,” Bivalacqua says. Despite reliably producing erections, pumps have the lowest satisfaction rate of any erectile dysfunction treatments. “In my practice, most men who try it will say, ‘Not for me,’ ” he adds.

Insurers typically cover 80 percent of the roughly $500 cost for a prescription pump, leaving consumers with around $100 in out-of-pocket expenses.

If you opt for a pump, experts say it’s important to get one through a doctor’s prescription. The pumps sold in sex shops tend to be novelty items that don’t work and may even cause injuries.

Next: No. 2: Penile suppositories or injections. »