I'm not a medical professional, but rather just another RP patient layman so take what I say with a grain of salt. I was 70 years old 15 months ago when I had RP. I'd suggest trying to find a good male sexual health doctor or at least discuss this with whoever you are seeing. I traveled out of town for my surgery but I continue to see my local urologist for his sexual health advice. He has me on a daily 5 mg tadalafil (for the nocturnal erections while I sleep) and he also has me use 100 mg sildenafil (an hour before on an empty stomach) when I want to have sex. He initially said to use 5 mg tadalafil every day and increase it to 20 mg of tadalafil on the days I want to have sex. I tried that, but ended up (as advised by my doctor) using 5 mg tadalafil every day and supplement it with 100 mg sildenafil on the days I want to have sex as that worked better for me. Recovery was very slow but I'm now (15 months after surgery) fully back to pre-surgery sexual performance. But I expect to be on the pills for the rest of my life as I don't do as well without them and I don't have any bad side effects from them. My doctor didn't mention it, but I also took a good multi-vitamin supplement and a magnesium supplement (I get at Costco) since I don't eat good enough to get my RDA from the foods I eat. I don't know if that helped or not, but it seemed like a good idea to make sure my nerves were getting all the basic nutrients they need. Bottom line: I'd keep trying therapy until a good sexual health doctor told me it wasn't useful to keep trying. From what you said I'd probably try the daily 5 mg tadalafil and increase to 20 mg tadalafil on days I was going to try to have sex. I'd probably give the vacuum pump another try as well, but I'd really suggest discussing all this with a good male sexual health doctor. Just my 2 cents as a layman (ie. not a medical professional). Also, I found expired sildenafil to not be as potent as fresh stuff, so I'd suggest getting new meds if you happen to have some old meds still around from before. You can get both tadalafil and sildenafil pretty cheap these days using a Goodrx coupon or at Costco with member discount. Best wishes.