Viagra is a medication that has revolutionized the treatment of erectile dysfunction. Patients who do not respond to Viagra can be treated with a vacuum erection device, an intra-urethral medication called MUSE, or injection therapy for example. Dr. Ruth endorses a cream that will help achieve and maintain erections. I am not aware of what cream Dr. Ruth endorses. I suppose a cream could be very effective, depending on how it was applied, and who it was applied by.
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.