New treatments are currently under investigation. I am not aware of any new medication that will be more effective than Viagra. Before Viagra, treatment for erectile dysfunction included the vacuum pump erection device, self-injection therapy where medications are directly injected into the penis, and a penile prosthesis. Many patients are treated without any testing other than a complete history and physical exam. However, certain patients benefit from complete testing.
Many tests are available including a sleep study.
A patient with normal function will have erections during sleep. If monitoring for erections during sleep reveals an impairment, this indicates a physical problem. There are also ultrasound tests to evaluate blood flow to the penis. The main point is that patients who are taking nitrate medications for cardiac problems cannot take Viagra. A penile prosthesis is a device that is permanently implanted within the penis itself.