What is The Difference Between Cialis and Viagra ?

How Viagra and Cialis work

Viagra and Cialis are part of a family of medications called PDE-5 inhibitors. PDE-5 (phosphodiesterase type-5) is an enzyme that’s the bouncer of the reproductive system: It curtails an erection by hustling blood out of the penis (through a chain reaction involving other molecules). Viagra and Cialis work by blocking PDE-5.

This maintains elevated levels of a substance known as cGMP, which relaxes smooth muscle and encourages blood vessels to widen. That makes blood flow more freely, including to the penis.

Viagra vs. Cialis

Viagra and Cialis can be effective in as little as 1 hour, though for some patients, these medicines can work more rapidly.

Viagra leaves the body in about 6 to 8 hours, while Cialis can work for 24 to 36 hours. Nevertheless, the effect of a medication may not be needed beyond 6 or 8 hours, and any side effects (in addition to any positive effect) they cause will fade rapidly as the medication leaves the bloodstream. That means that someone who experiences nasal congestion or flushing when they use either Cialis or Viagra may find it useful to take the shorter acting medication, Viagra.

The length of time a medicine works is important to some. Let’s consider two men. One might be able to predict when sexual activity will occur. A drug that works rapidly and leaves his system quickly thereafter would be perfect, as with Viagra. Another man might know sex will occur during the course of a weekend but cannot know exactly when that will occur. For him, a drug with a prolonged period of activity is far more important than how long it takes for a medicine to start working. He would prefer Cialis. Also, Cialis can be taken in a low daily dose, and for a solid subset of patients, this is preferred.

Side effects of Viagra and Cialis

Common side effects of Viagra and Cialis include dizziness, headache, flushing, upset stomach or indigestion, blurred vision, changes in vision color, flu-like symptoms (such as a runny or stuffy nose or sore throat), memory problems, muscle or back pain, insomnia, or abnormal ejaculation.

Less common side effects of Viagra and Cialis include priapism (a prolonged erection that won’t go away), heart attack-like symptoms, eye problems such as sudden vision loss, ringing in ears or hearing loss, seizures, or swelling in the extremities.

The side effects you experience might determine whether Viagra or Cialis is the right choice for you. For example, if you experience a flushed face or headache when you use Cialis, you might find the shorter-acting medication, Viagra, to be a better option.

But do not take Viagra or Cialis if you:

    • Take nitrates or alpha-blockers
    • Have high blood pressure or low blood pressure
    • Take riociguat for pulmonary arterial hypertension
    • Are allergic to sildenafil or tadalafil or any of the inactive ingredients in Viagra or Cialis
    • Are not healthy enough for sexual activity

Don’t use Viagra or Cialis with amyl nitrate (poppers). That can cause an unsafe drop in blood pressure that can be fatal.
If you experience side effects while taking Viagra or Cialis, talk to your doctor right away. You should stop using Viagra or Cialis and seek immediate medical help if you experience:

    • Sudden vision loss in one or both eyes
    • Sudden decrease or loss in hearing
    • Chest pain, dizziness, or nausea during sex
    • An erection lasting longer than four hours (priapism)

Before taking Viagra, Cialis, or any ED medication, talk with your healthcare provider about possible side effects and whether you’re healthy enough for sex.

Fast Facts on Erectile Dysfunction and What Are Surgical Treatment Options for ED?

Fast facts on erectile dysfunction:

      • Erectile dysfunction (ED) is defined as persistent difficulty achieving and maintaining an erection sufficient to have sex.
      • Causes are usually medical but can also be psychological.
      • Organic causes are usually the result of an underlying medical condition affecting the blood vessels or nerves supplying the penis.
      • Numerous prescription drugs, recreational drugs, alcohol, and smoking, can all cause ED.

The following list summarizes many of the most common physical or organic causes of ED:

      • heart disease and narrowing of blood vessels
      • diabetes
      • high blood pressure
      • high cholesterol
      • obesity and metabolic syndrome
      • Parkinson’s disease
      • multiple sclerosis
      • hormonal disorders including thyroid conditions and testosterone deficiency
      • structural or anatomical disorder of the penis, such as Peyronie disease
      • smoking, alcoholism, and substance abuse, including cocaine use
      • treatments for prostate disease
      • surgical complications
      • injuries in the pelvic area or spinal cord
      • radiation therapy to the pelvic region

Atherosclerosis is a common cause of blood flow problems. Atherosclerosis causes a narrowing or clogging of arteries in the penis, preventing the necessary blood flow to the penis to produce an erection.

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you’re concerned about erectile dysfunction, talk to your doctor — even if you’re embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

Inflatable penile prostheses are implanted during outpatient surgery. Once they are part of a man’s body, they enable him to have an erection whenever he desires. The use of a prosthesis preserves penile sensation, orgasm and ejaculation for most men.

The most commonly used penile implant consists of a pair of inflatable cylinders that are surgically implanted in the erection chambers of the penis. The cylinders are connected through tubing to a reservoir of fluid under the lower abdominal muscles, and to a pump inside the scrotal sac.

To inflate the penile prosthesis, the man compresses the pump a number of times to transfer fluid from the reservoir to the cylinders. This causes the penis to become erect. When inflated, the prosthesis makes the penis stiff and thick, which is very similar to a natural erection.

A penile prosthesis does not change the sensation on the skin of the penis or a man’s ability to achieve orgasm or ejaculate. Pressing on a deflation valve attached to the pump returns the fluid to the reservoir, which returns the penis to a flaccid state.

The surgical procedure is performed through one or two small incisions that are generally well hidden. Other people will be unable to tell that a man has an inflatable penile prosthesis. Complications following surgery are not common, but primarily include infection and mechanical device failure.

Approximately 95% of penile implant surgeries are successful in producing erections that enable men to have sexual intercourse. Moreover, patient satisfaction questionnaires show that up to 90% of men who have undergone penile implants say they would choose the surgery again, and overall satisfaction ratings are higher than those reported by men using oral medication or penile injection therapy.

Education and Communication and other Non-surgical Treatments for Erectile Dysfunction (ED)?

Education and communication

Education about sex, sexual behaviors, and sexual responses may help a man overcome his anxieties about sexual dysfunction.

Talking honestly with your partner about your needs and concerns may also help to overcome many barriers to a healthy sex life.

Medication

Medications such as

    • sildenafil (Viagra®),
    • vardenafil (Levitra®),
    • or tadalafil (Cialis®)

may help improve sexual function in men by increasing blood flow to the penis. Men who are on medicines that contain nitrates such as nitroglycerine should not take oral ED medications. The combination of nitrates and these specific medications can cause low blood pressure (hypotension).

The most common side effects of these medications are indigestion, nasal congestion, flushing, headaches and a temporary visual disturbance.

Mechanical aids

Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men.

A vacuum constriction device (above) is a cylinder that is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off of the base of the cylinder and onto the base of the penis. The band can stay in place for up to 30 minutes. The vacuum device can be safely used to treat most causes of erectile failure. Lack of spontaneity, discomfort, and cumbersomeness of the device seem to be the biggest concerns of patients.

Figure 3. Choosing an injection site

Penile injection therapy (intracavernosal injection therapy)

Men are taught how to inject medications directly into the erection chambers of the penis to create an erection. Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve and psychological conditions.

The tissue that causes you to get an erection (erectile tissue) is a muscle. Going long periods of time without an erection is unhealthy for erectile tissue and may damage it.

We believe that having erections keeps erectile tissue healthy. A penile injection helps you have an erection. It works best if it’s given about 5 to 15 minutes before you want an erection.

Using a tiny needle and syringe, the man injects a small amount of medicine into the side of his penis. The medicine relaxes the blood vessels, allowing blood to flow into the penis. This treatment has been widely used and accepted since the early 1980s. The three most common medicines are prostaglandin E1 (alprostadil), papaverine (Papacon®), and phentolamine (Regitine®).

The most common side effects are pain and penile scarring (fibrosis). In extremely rare cases, patients with cerebral and vascular disease or severe cardiovascular diseases might not be able to tolerate the dizziness and high blood pressure occasionally caused by injection therapy.

A painful erection that lasts longer than two to three hours is called priapism and may occur with injection therapy. This can be lessened with proper dosing and by following the treatment guidelines.

The 3 most commonly used medications for injection therapy are Trimix, Bimix, and Papaverine. Most men begin injection therapy with Trimix, which is a mixture of 3 ingredients: alprostadil, phentolamine, and papaverine. These ingredients work by relaxing the smooth muscle and opening the blood vessels in your penis, causing an erection. Your APP will decide whether Trimix or a different medication is best for you.

 

Psychology and sex therapies

Psychological causes may contribute to erectile failure even when there is a clear organic cause.

Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual dysfunction.

Sex therapy can be beneficial to most men when counseling is provided by a skilled sex therapist. Sex therapy also helps a man’s partner accept and cope with the problems.

A patient whose ED has a clear psychological cause should receive sex therapy counseling before any invasive treatments are pursued.

When you seek out sex therapy, you need to look for a relationship or marriage counsellor, psychotherapist or psychologist who uses specialised clinical skills and theoretical knowledge about human sexuality. In addition to having post-graduate training in couples and marriage counselling, we get specific sex therapy training to help you deal with your sexual difficulties or concerns.

Sex therapists are qualified counsellors or healthcare professionals who have had extensive training in human sexuality, in addition to being well-trained couples and marriage counsellors and therapists.

Sexual issues can often cause distress and conflict in relationships and sex therapists can assist you with these difficulties.

Some sexual concerns include:

      • Lack of sexual knowledge or education
      • Believing wrong/harmful information about sex from the media or religious institutions
      • Struggle to understand sex, desire, eroticism, privacy versus secrecy
      • Erectile and/or ejaculation difficulties
      • Performance anxiety and lack of confidence
      • Problems reaching orgasm
      • Low sexual desire concerns for both men and women
      • Intimacy problems
      • Relationship and marriage difficulties
      • Painful sex or intercourse
      • Sexual problems or changes due to illness, ageing, surgery or stress
      • Compulsive sexual behaviours, or out of control sexual behaviours (wrongly called sexual addiction)
      • Sexual trauma
      • Questioning your sexual identity, orientation or preferences
      • LGBTQI issues
      • Gender identity issues
      • Interest in kink
      • Cross dressing or other fetishes

Hormone

Low hormone levels may play a role in ED. Hormone replacement in the form of topical gels, creams, patches, injections and pellets are only used after physician evaluation.

Which Drugs are Good for Erectile Dysfunction?

What are the differences between erectile dysfunction drugs? About half of men ages 40 to 70 have erectile dysfunction (ED) to some degree, although only one in 10 report a complete inability to have erections. Taking an ED drug produces an erection sufficient to start intercourse in about 70% of otherwise healthy men.

Does it make any difference which of the four drugs for erectile dysfunction you take? “Yes, there can be differences,” says Dr. Louis Liou, chief of urology at Harvard-affiliated Cambridge Health Alliance in Boston. “For new patients, I have them try different ones to see what works best.”

Sildenafil (Viagra) is often the first drug your doctor offers. It’s been on the market longest and its side effects and the medications and foods it interacts with are well known.

But the main challenge to finding the best ED drug for you may turn out to be health insurance rules—not biochemistry. It’s a common practice among insurers to limit the number of pills you can obtain per month. After you hit your limit, the out-of-pocket cost for a single pill can be very high. “The main obstacle in my practice is the cost,” Dr. Liou says. You’ll need to work with your doctor to get the pill you need at a price you can afford.

What erectile dysfunction pills are available?

In addition to Viagra, other ED drugs available in the United States include avanafil (Stendra), tadalafil (Cialis) and vardenafil (Levitra). These all improve blood supply to the penis. In combination with sexual stimulation, the drugs can produce an erection sufficient to initiate and complete intercourse.

There is also a fast-dissolving form of Levitra, called Staxyn, that you put under your tongue.

  • Viagra
  • Cialis
  • Levitra

One ED drug, Cialis, is FDA-approved for use daily in a dose of 2.5 or 5 milligrams. This helps to produce erections on demand and may also help relieve urinary problems, like difficulty starting urination, that result from an enlarged prostate.

 

How well do ED pills work?

ED drugs produce an erection sufficient for intercourse in about 70% of men. But the results vary quite a bit from one individual to another. A man with nerves or arteries damaged by prostate surgery, diabetes, or cardiovascular disease will not respond as strongly to ED drugs. “There are some men in whom none of these drugs work,” Dr. Liou says.

 

How quickly do ED pills work?

How soon the drugs start working ranges from 15 to 60 minutes. Neither Viagra nor Levitra will work if you take them after a meal, which blocks their absorption. However, neither Cialis nor Stendra interact with food this way. The onset time determines how soon you can engage in intercourse. Stendra and daily-use Cialis are closest to being an “on demand” erectile drug; using the others requires more planning.

 

How to use ED pills properly

Dr. Liou says that some men come to him after getting a prescription from their primary care doctors, claiming that the drug doesn’t work. Sometimes it’s because they used it incorrectly. “The biggest misconception is that these drugs are an on/off switch for erections,” Dr. Liou says. But the drugs don’t work well without sexual stimulation. “During that time, you need to be with your partner and have foreplay,” Dr. Liou says. “Don’t take it, do the taxes or the dishes, and then meet at the bedroom thinking you’ll be ready to go. It’s not like that.”

 

How long do ED pills last?

The ED drugs break down at different rates in the body. The durations of action range from four hours to more than a day (for Cialis in the higher doses). Each dose should be sufficient to provide a full cycle of intercourse, from erection to climax.

“Will it last through another cycle? It’s not guaranteed,” Dr. Liou says. To have sex more than once a day, Cialis is your best bet.

 

What are the side effects of ED pills?

The most common side effects of ED drugs, in order of most to least common are headache, flushing, upset stomach, nasal congestion, vision problems, diarrhea, dizziness, and rash. A man who has an erection that lasts four hours or more needs to get to a hospital or risk permanent damage.

None of the ED drugs is safe to take with cardiac drugs called nitrates because it could cause a dangerous drop in blood pressure. Drugs that many men take for urinary symptoms, called alpha blockers, can also lower blood pressure, so take them at least four hours apart from ED drugs. Your doctor may start you on a smaller dose of the ED drug if you already take an alpha blocker or may recommend the alpha blocker tamsulosin (Flomax), which affects blood pressure less.

 

Heart health and erectile dysfunction

ED is often an early warning sign of underlying cardiovascular disease, such as clogged arteries (atherosclerosis). “It can predate a diagnosis of cardiovascular disease by at least a few years,” Dr. Liou says. We don’t have strong proof yet that starting to live a healthier lifestyle can reverse erectile problems, but it can’t hurt.

 

ED drugs: How soon they start working and how long they last

Medication Onset Duration
avanafil (Stendra) 15-30 minutes 6-12 hours
sildenafil (Viagra) 30-60 minutes 4-5 hours
tadalafil (Cialis) 30-45 minutes 24-36 hours
tadalafil (Cialis) daily continuous continuous
vardenafil (Levitra) 30-60 minutes 4-5 hours

Looking for natural solutions to ED?

What kinds of Health Conditions May Cause ED ?

What is Erectile dysfunction (ED) ?

Erectile dysfunction (ED) is the inability to get and keep an erection firm enough for sexual intercourse. Estimates suggest that one of every 10 men will suffer from ED at some point during his lifetime. It is important to understand that in most cases, ED is a symptom of another, underlying problem. ED is not considered normal at any age, and may be associated with other problems that interfere with sexual intercourse, such as lack of desire and problems with orgasm and ejaculation.

How common is erectile dysfunction?

Approximately one in 10 adult males will suffer from ED on a long-term basis.

Many men do experience occasional failure to achieve erection, which can occur for a variety of reasons, such as drinking too much alcohol, stress, relationship problems, or from being extremely tired.

The failure to get an erection less than 20% of the time is not unusual and typically does not require treatment. However, the failure to achieve an erection more than 50% of the time generally means that there is a problem and treatment is needed.

ED does not have to be a part of getting older. While it is true that some older men may need more stimulation, they should still be able to achieve an erection and enjoy intercourse.

Erectile dysfunction or ED May be Caused by following Health Conditions [1]

An erection occurs when blood flows into the corpora cavernosa (erection bodies) and gets trapped there. If the blood has problems getting to or staying in those erection bodies, you may have erectile dysfunction.

Physical causes of erectile dysfunction

In many cases, erectile dysfunction is caused by something physical. Common causes include:

  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
  • Parkinson’s disease
  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use
  • Peyronie’s disease — development of scar tissue inside the penis
  • Alcoholism and other forms of substance abuse
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Low testosterone

Psychological causes of erectile dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

  • Depression, anxiety or other mental health conditions
  • Stress
  • Relationship problems due to stress, poor communication or other concerns

There are many potential causes for erectile dysfunction, such as these conditions/circumstances:

  • Vascular conditions:
    • High blood pressure
    • Elevated cholesterol
    • Cardiovascular disease
  • Diabetes
  • Trauma:
    • Spinal cord injury
    • Pelvis injury
  • Neurologic disease:
    • Stroke
    • Parkinson’s disease
    • Alzheimer’s disease
  • Radiation to the pelvis for cancer
  • Endocrine:
    • Hypogonadism (low testosterone)
    • Hyperprolactinemia (high prolactin levels)
  • Pelvis surgery:
    • Radical prostatectomy (a surgical procedure for the partial or complete removal of the prostate)
    • Surgeries for rectal cancer or bladder cancer
  • Medication side effects:
    • Antidepressants
    • Antihypertensives (high blood pressure medicine)
    • Antiandrogens (testosterone blockers)
    • Antiarrhythmics (heart rhythm medicine)
  • Alcohol
  • Cigarette smoking
  • Cocaine and marijuana

What medications could cause erectile dysfunction (ED)?

Erectile dysfunction (ED) is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man’s hormones, nerves or blood circulation, resulting in ED or increasing the risk of ED.

If you experience ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:

  • Diuretics (pills that cause increase urine flow).
  • Antihypertensives (high blood pressure drugs).
  • Antihistamines.
  • Antidepressants.
  • Parkinson’s disease drugs.
  • Antiarrhythmics (drug for irregular heart action).
  • Tranquilizers.
  • Muscle relaxants.
  • Nonsteroidal anti-inflammatory drugs.
  • Histamine H2-receptor antagonists.
  • Hormones.
  • Chemotherapy medications.
  • Prostate cancer drugs.
  • Anti-seizure medications.

Other substances or drugs that can cause or lead to ED include these recreational and frequently abused drugs:

  • Alcohol.
  • Amphetamines.
  • Barbiturates.
  • Cocaine.
  • Marijuana.
  • Methadone.
  • Nicotine.
  • Opiates.

These drugs not only affect and often suppress the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.

Diabetes & ED

Half of men with diabetes will experience ED within 10 years of their diagnosis. High blood sugar levels can damage the nerves that control sexual stimulation. They can also damage the blood vessels needed to provide adequate blood flow to the penis in order to have and maintain an erection.

While oral medications are a common first step for therapy, they only tend to work in about 50 percent of men with diabetes. Diabetic men are more likely to move on to other treatment options, such as the pump, penile injection therapy, and penile implants. However, the penile implant has the highest satisfaction rate of all treatment options.

ED & Heart Disease

Erectile dysfunction can be a warning sign of current or future heart disease sometimes. In fact, ED can precede coronary artery disease in almost 70 percent of cases.

When you have heart disease, or coronary artery disease (blocked blood vessels), it will affect the tiny arteries in your penis sooner. Many times, we will refer you to a cardiologist to determine if you have cardiovascular disease that is causing your ED.

Improving your heart health can help lower your risk for ED. You can start by:

  • increasing physical activity,
  • quitting tobacco products,
  • losing weight, and
  • consuming a healthy, well-balanced diet.

Prostate Cancer & ED

Erectile dysfunction is a potential complication following prostate cancer treatments. The nerves that control an erection lie very close to the prostate and may be injured during treatment. However, some men may regain their previous level of erectile function with nerve-sparing procedures. But it may take up to a year while some men may never recover their ability to have a natural erection.

Radiation for prostate cancer can cause ED symptoms to appear gradually, usually within two to three years after treatment. If you are experiencing ED after undergoing prostate cancer treatment, you can get a healthy sex life back. We can help you choose the best treatment options for you.

What prescription drugs may cause erectile dysfunction?

Erectile dysfunction (ED) is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man’s hormones, nerves or blood circulation. The result may be ED or an increase in the risk of ED.

If you have ED and think that it may be a result of the medication you are using, do not stop taking the medication. If the problem persists, contact your doctor and he or she may be able to prescribe a different medication. Common medications that may list ED as a potential side effect include:

  • Diuretics (pills that cause an increase in urine flow).
  • Antihypertensives (medication for high blood pressure).
  • Antihistamines.
  • Antidepressants.
  • Parkinson’s disease drugs.
  • Antiarrhythmics (medication for irregular heart action).
  • Tranquilizers.
  • Muscle relaxants.
  • Non-steroidal anti-inflammatory drugs.
  • Histamine H2-receptor antagonists.
  • Hormones.
  • Chemotherapy medications.
  • Prostate cancer drugs.
  • Anti-seizure medications.

What other substances or drugs may cause erectile dysfunction?

opioids and Pain Medications
opioids and Pain Medications

Other substances or drugs that can cause or lead to ED include these recreational and frequently abused drugs:

  • Alcohol.
  • Amphetamines.
  • Barbiturates.
  • Cocaine.
  • Marijuana.
  • Methadone.
  • Nicotine.
  • Opiates.

Aside from the well-known complications that the use and abuse of these drugs can cause, ED is not often mentioned. However, use of these drugs is a risk factor for ED. These drugs not only affect and often times slow down the central nervous system, but can also cause serious damage to the blood vessels, leading to permanent ED.

Best Alternatives to Viagra: Treatments That Last Longer and What is the Difference Between Cialis and Viagra ?

Viagra is the most popular medication for erectile dysfunction. It was the first medicine approved to treat ED in 1998. It works quickly and can be used to treat men of all age groups. If you cannot use this drug for some reason or just want to try similar medications, you should know that there are good alternatives to sildenafil.

Cialis is the best analogue of Viagra, which has won an excellent reputation among men. The main active ingredient of Cialis is tadalafil, which, like sildenafil, belongs to the category of PDE5 inhibitors. Tadalafil causes an active blood flow to the perineum and penis of a man, due to which a good persistent erection occurs. The drug works only in the presence of natural stimulation, instantly increasing libido and sexual desire. Many men prefer Cialis because this is an ultra-long-acting ED drug – its duration is up to 36 hours;

Levitra is another worthy substitute for Viagra. The main active ingredient of Levitra is vardenafil, This drug is ideal for the symptomatic treatment of male sexual impotence. This medicine, like other drugs for improving potency, is prescribed by the doctor on an individual basis after a thorough examination. Levitra lasts about 8-12 hours and, unlike Viagra, is compatible with alcohol

Stendra is one more medication used to treat erectile dysfunction. It contains the active ingredient avanafil. It has a quick onset of action in comparison to other ED drugs available and starts working just 15 minutes after taking the pill. It is one of the newest drugs to be released for ED. Avanafil remains effective for 6 hours and may maintain benefits longer in some patients.

Compare the information about popular ED drugs in the table below:

Cialis vs. Viagra quick comparison

Cialis Generic
Cialis Generic
  • Cialis (tadalafil) and Viagra (sildenafil) are phosphodiesterase-5 (PDE5) inhibitors used for treating impotence (erectile dysfunction, or ED).
  • Adcirca is another brand name of tadalafil.
  • Common side effects of Cialis and Viagra that are similar include flushing (redness or warmth of the face, neck, or chest), headaches, stomach pain or upset, flu-like symptoms (such as stuffy nose, sneezing, or sore throat), memory problems, muscle or back pain, blurred vision and changes in color vision (such as an inability to differentiate between the colors green and blue), dizziness, diarrhea, nausea, low blood pressure, abnormal ejaculation, and prolonged erections (priapism), loss of hearing, and ringing in the ears.
  • One difference between the drugs is how long they stay in your system. Cialis provides penile hardness (the ability to obtain an erection) over a longer period than Viagra because it lasts up to 18 hours, while Viagra only lasts for about 4 to 6.

 

What are Cialis and Viagra?

 

Cialis (tadalafil) and Viagra (sildenafil) are oral drugs that are used for treating impotence (the inability to attain or maintain a penile erection) and benign prostatic hyperplasia (BPH). They are in a class of drugs called phosphodiesterase-5 (PDE5) inhibitors that also includes vardenafil (Levitra, Staxyn ODT), and avanafil (Stendra).

Penile erection is caused by the engorgement of the penis with blood. Under normal conditions, sexual stimulation leads to the production and release of nitric oxide in the penis. Nitric oxide then activates the enzyme, guanylate cyclase, which causes the production of cyclic guanosine monophosphate (cGMP). It is the cGMP that is primarily responsible for the erection by affecting the amount of blood that the blood vessels deliver and remove from the penis. Cialis and Viagra inhibit an enzyme called phosphodiesterase-5 (PDE5) which destroys the cGMP. Thus, Cialis and Viagra prevent the destruction of cGMP and allows cGMP to accumulate and persist longer. The longer cGMP persists, the more prolonged the engorgement of the penis.

What is the dosage of Cialis vs. Viagra?

 

Cialis

For most individuals, the recommended starting dose of tadalafil is 10 mg per day taken before sexual activity (tadalafil for use as needed).

Depending on the adequacy of the response or side effects, the dose may be increased to 20 mg or decreased to 5 mg a day. The effect of tadalafil may last up to 36 hours. Individuals who are taking medications that increase the blood levels of tadalafil should not exceed a total dose of 10 mg in 72 hours (See drug interactions). For once daily use without regard to sexual activity, the recommended dose is 2.5 to 5 mg daily. Tadalafil should not be taken more than once daily.

The recommended dose for BPH, or BPH and ED is 5 mg daily taken about the same time each day. Tadalafil may be taken with or without food since food does not affect its absorption from the intestine.

The dose of tadalafil may require adjustment for patients with reduced kidney or liver function.

Viagra

  • The usual recommended dose is 25 to 100 mg 1 hour before sexual activity.
  • The maximum dose is 100 mg daily.
  • The elderly (over 65 years of age) should start at 25 mg before sexual activity.
  • Sildenafil is rapidly absorbed. Maximum observed plasma concentrations are reached within 30 to 120 minutes (median 60 minutes) of oral dosing in the fasted state. When sildenafil is taken with a high fat meal, the rate of absorption is reduced, with an average delay in the time to maximal concentration of 1 hour.

What is the Common Side effects of Erectile Dysfunction Medicines ?

What is erectile dysfunction?

 

The malady formerly known as impotence, erectile dysfunction (ED) is the inability to get or maintain an erection sufficient for satisfying sex. That might include erections that don’t last as long as you want or aren’t as firm as you’d like. ED is very prevalent among American men: Experts estimate that more than 30 million American men have experienced these kinds of erection issues (Nunes, 2012).

What Is the Erectile dysfunction Medications ?

 

Erectile dysfunction (ED), also called impotence, can affect your quality of life by decreasing your satisfaction from sex. ED can have many causes, both psychological and physical. ED from physical causes is fairly common in men as they age. Medications are available that can help treat ED for many men.

The most well-known ED medications include:

  • tadalafil (Cialis)
  • sildenafil (Viagra)
  • vardenafil (Levitra)
  • avanafil (Stendra)

These prescription drugs increase the levels of nitric oxide in your blood. Nitric oxide is a vasodilator, meaning it makes your blood vessels widen to help increase the blood flow. These drugs are especially effective at widening the blood vessels in your penis. More blood in your penis makes it much easier for you to get and maintain an erection when you are sexually aroused.

However, these drugs can also cause side some effects. Here are seven of the most common side effects from ED medications.

 

Headaches

Headaches are the most common side effect associated with ED medications. The sudden change in blood flow from the increased levels of nitric oxide causes the headaches.

This side effect is common with all forms of ED medications, so switching brands won’t necessarily alleviate your symptoms. If you have headaches from your ED drug, talk to your doctor about how to prevent them.

Body aches and pains

Some people have muscle aches and pains throughout their bodies while taking ED medications. Others have reported specific pain in their lower back. If you have these types of pain while taking ED medication, over-the-counter (OTC) pain medication may help.

However, you should talk to your doctor about other possible causes of your pain. Your doctor can help you choose an OTC medication that is safe to take with your ED medications and with any other medications you take.

Digestive system problems

Your ED medication may cause uncomfortable digestive system side effects. The most common are indigestion and diarrhea.

To help relieve minor problems, consider making dietary changes to reduce upset stomach. Drinking water instead of caffeinated beverages, alcohol, or juice may help. If changing your diet doesn’t work, talk to your doctor about OTC remedies that may help.

Dizziness

An increase in nitric oxide can cause some men to become dizzy. The dizziness caused by ED medications is generally mild. However, any dizziness can cause discomfort during everyday activities.

In rare cases, dizziness from ED medications has led to fainting, which can become a serious health issue. You should tell your doctor if you experience dizziness while taking ED medications. If you faint while taking these medications, see your doctor right away.

Vision changes

ED medications can change the way you see things — literally. They can temporarily alter your eyesight and even cause blurry vision. ED medications aren’t recommended if you have had vision loss, or a retinal disorder called retinitis pigmentosa.

A complete loss of vision or changes that don’t go away can signify a more serious issue with your ED medication. Seek emergency medical care if you experience these symptoms.

Flushes

Flushes are temporary periods of redness of the skin. Flushes usually develop on your face and may also spread to parts of your body. Flushes can be mild, like blotchy skin, or severe, like rashes. Although the appearance may make you uncomfortable, flushes typically aren’t harmful.

Flushes from ED medications may get worse when you:

  • eat hot or spicy foods
  • drink alcohol
  • are outside in warm temperatures

Congestion and runny nose

Congestion or a runny or stuffy nose can be a common symptom of ED medications. In most cases, these side effects go away without treatment. Talk to your doctor if they persist.

Recognizing uncommon, severe side effects

Minor side effects are common when taking ED medication. Still, there are a few side effects that aren’t as common, and some can even be dangerous. Severe side effects of ED medications can include:

      • priapism (erections that last longer than 4 hours)
      • sudden changes in hearing
      • vision loss

Contact your doctor immediately if you have any of these severe side effects.

Certain men are more at risk of these side effects than others. This may be because of other conditions they have or other medications they take.

 

Serious side effects of ED medication

Go to the emergency room immediately if you experience any of the following symptoms or side effects:

      • Chest pain
      • Shortness of breath
      • Severe headaches
      • Fainting
      • Erections that last longer than four hours
      • Visual changes (like loss of sight)
      • Or anything out of the ordinary—even lightheadedness

If you notice any severe or prolonged symptoms at all, contact a healthcare provider immediately. It doesn’t matter how rare a side effect is if you’re the one experiencing it.

When discussing ED treatment with your doctor, it’s important to tell them about all drugs that you take and other health conditions you have. If ED drugs aren’t right for you, your doctor may suggest other treatment options, such as surgery or vacuum pumps.

What drugs interact with Cialis and Viagra?

Cialis

The breakdown and elimination of tadalafil from the body may be decreased by erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), indinavir (Crixivan) and ritonavir (Norvir). Therefore, these drugs may increase the levels of tadalafil in the blood. If these drugs are being used at the same time as tadalafil, the dose of tadalafil should be reduced to 10 mg every 72 hours when used as needed or 2.5 mg when used daily in order to avoid side effects from high levels of tadalafil.

Rifampin, carbamazepine (Tegretol, Tegretol XR, Equerto, Carbatrol), phenytoin (Dilantin, Dilantin-125), and phenobarbital may decrease blood levels of tadalafil, possibly reducing the effect of tadalafil.

Tadalafil exaggerates the increases in heart rate and lowering of blood pressure caused by nitrates, for example, nitroglycerin, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating heart pain (angina). In patients who take nitrates for angina, tadalafil could cause heart pain or possibly even a heart attack by exaggerating the increase in heart rate and the lowering of blood pressure. Therefore, tadalafil should not be used with nitrates.

Tadalafil also exaggerates the blood pressure lowering effects of some alpha-blocking drugs for example, terazosin (Hytrin) that primarily are used for treating high blood pressure or enlargement of the prostate (BPH). Individuals who take these alpha-blockers should be on a stable dose of the alpha-blocker before tadalafil is started. In such situations, tadalafil should be started at the lowest dose. If the patient is already taking tadalafil, the alpha-blocker should be started at the lowest dose. Combining tadalafil with alpha-blockers for treatment of BPH is not recommended.

Tadalafil and alcohol both lower blood pressure. Therefore, combining tadalafil with alcohol may cause excessive drops in blood pressure and cause dizziness, headaches, and increased heart rate.

PDE5 inhibitors may affect platelet function and therefore prolong bleeding. Tadalafil should be used cautiously in patients with bleeding disorders or active ulcers. Tadalafil should not be combined with Adcirca (another form of tadalafil) or other PDE5 inhibitors, for example, vardenafil (Levitra) or sildenafil (Viagra, Revatio).

Viagra

Viagra increases the effects of the blood pressure lowering medications. It also increases the blood pressure lowering effects of nitrates, for example, isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur, Transderm-Nitro) that are used primarily for treating angina. Patients taking nitrates should not receive Viagra.

Patients should not combine Viagra with other PDE5 inhibitors (for example, vardenafil [Levitra], tadalafil [Cialis]).

Cimetidine (Tagamet), erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), atazanavir (Reyataz), and mibefradil (Posicor) can cause marked increases in the amount of Viagra in the body. Patients taking these medications should be observed carefully if sildenafil is used.

It is expected that rifampin will decrease blood levels of Viagra and probably reduce its effectiveness.

What is Erectile Dysfunction and Why I Get ED ?

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you’re concerned about erectile dysfunction, talk to your doctor — even if you’re embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

Flaccid and erect penis

 

Symptoms

Erectile dysfunction symptoms might include persistent:

  • Trouble getting an erection
  • Trouble keeping an erection
  • Reduced sexual desire

 

Why I get Erectile Dysfunction ?

Depression – The brain is an often-overlooked erogenous zone. Sexual excitement starts in your head and works its way down. Depression can dampen your desire and can lead to erectile dysfunction. Ironically, many of the drugs used to treat depression can also suppress your sex drive and make it harder to get an erection, and they can cause a delay in your orgasm.

Alcohol – You might consider having a few drinks to get in the mood, but overindulging could make it harder for you to finish the act. Heavy alcohol use can interfere with erections, but the effects are usually temporary. The good news is that moderate drinking — one or two drinks a day — might have health benefits like reducing heart disease risks. And those risks are similar to erectile dysfunction risks.

Medications – The contents of your medicine cabinet could affect your performance in the bedroom. A long list of common drugs can cause ED, including certain blood pressure drugs, pain medications, and antidepressants. But do not stop taking any medicines without talking to your doctor first. Street drugs like amphetamines, cocaine, and marijuana can cause sexual problems in men, too.

Stress – It’s not easy to get in the mood when you’re overwhelmed by responsibilities at work and home. Stress can take its toll on many different parts of your body, including your penis. Deal with stress by making lifestyle changes that promote well-being and relaxation, such as exercising regularly, getting enough sleep, and seeking professional help when appropriate.

Anger – Anger can make the blood rush to your face, but not to the one place you need it when you want to have sex. It’s not easy to feel romantic when you’re raging, whether your anger is directed at your partner or not. Unexpressed anger or improperly expressed anger can contribute to performance problems in the bedroom.

Anxiety – Worrying that you won’t be able to perform in bed can make it harder for you to do just that. Anxiety from other parts of your life can also spill over into the bedroom. All that worry can make you fear and avoid intimacy, which can spiral into a vicious cycle that puts a big strain on your sex life — and relationship.

Middle-Aged Spread – Carrying extra pounds can impact your sexual performance, and not just by lowering your self-esteem. Obese men have lower levels of the male hormone testosterone, which is important for sexual desire and producing an erection. Being overweight is also linked to high blood pressure and hardening of the arteries, which can reduce blood flow to the penis.

Self-Image – When you don’t like what you see in the mirror, it’s easy to assume your partner isn’t going to like the view, either. A negative self-image can make you worry not only about how you look, but also how well you’re going to perform in bed. That performance anxiety can make you too anxious to even attempt sex.

Low Libido – Low libido isn’t the same as erectile dysfunction, but a lot of the same factors that stifle an erection can also dampen your interest in sex. Low self-esteem, stress, anxiety, and certain medications can all reduce your sex drive. When all those worries are tied up with making love, your interest in sex can take a nosedive.

Your Health – Many different health conditions can affect the nerves, muscles, or blood flow that is needed to have an erection. Diabetes, high blood pressure, hardening of the arteries, spinal cord injuries, and multiple sclerosis can contribute to ED. Surgery to treat prostate or bladder problems can also affect the nerves and blood vessels that control an erection.

 

Causes of Erectile Dysfunction

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.

Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

ED is not the same as premature ejaculation.

The major causes of ED include:

  • Vascular (blood vessel) disease — Erections happen when blood collects in the shaft of the penis. Vascular disease can limit the amount of blood flowing to or staying in the penis. Both can result in problems with erections.
  • Vascular disease is the most common medical cause of impotence.
  • Nerve damage — Nerves must be working normally for a man to get and keep an erection. Nerves can be damaged by diabetes, multiple sclerosis, prostate surgery or damage to the spinal cord.
  • Psychological factors — Psychological issues such as depression, anxiety, guilt or fear can sometimes cause sexual problems. At one time, these factors were thought to be the major cause of impotence. Doctors now know that physical factors cause impotence in most men with the problem. However, embarrassment or “performance anxiety” can make a physical problem worse.
  • Medications — Many medications cause problems with sexual function. These include drugs for high blood pressure, depression, heart disease and prostate cancer.
  • Hormonal problems — Abnormal levels of certain hormones can interfere with erections and sex drive. Hormonal problems, such as a low testosterone level, are an uncommon cause of impotence.

 

Physical causes of Erectile Dysfunction

In many cases, erectile dysfunction is caused by something physical. Common causes include:

  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
  • Parkinson’s disease
  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use
  • Peyronie’s disease — development of scar tissue inside the penis
  • Alcoholism and other forms of substance abuse
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Low testosterone

Psychological causes of erectile dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

  • Depression, anxiety or other mental health conditions
  • Stress
  • Relationship problems due to stress, poor communication or other concerns

Risk factors

As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection.

Various risk factors can contribute to erectile dysfunction, including:

  • Medical conditions, particularly diabetes or heart conditions
  • Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction
  • Being overweight, especially if you’re obese
  • Certain medical treatments, such as prostate surgery or radiation treatment for cancer
  • Injuries, particularly if they damage the nerves or arteries that control erections
  • Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions
  • Psychological conditions, such as stress, anxiety or depression
  • Drug and alcohol use, especially if you’re a long-term drug user or heavy drinker

Complications

Complications resulting from erectile dysfunction can include:

  • An unsatisfactory sex life
  • Stress or anxiety
  • Embarrassment or low self-esteem
  • Relationship problems
  • The inability to get your partner pregnant

Prevention

The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example:

  • Work with your doctor to manage diabetes, heart disease or other chronic health conditions.
  • See your doctor for regular checkups and medical screening tests.
  • Stop smoking, limit or avoid alcohol, and don’t use illegal drugs.
  • Exercise regularly.
  • Take steps to reduce stress.
  • Get help for anxiety, depression or other mental health concerns.

Diagnosis

For many people, a physical exam and answering questions (medical history) are all that’s needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.

Tests for underlying conditions might include:

  • Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
  • Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
  • Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
  • Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems.This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.
  • Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.

Treatment

The first thing your doctor will do is to make sure you’re getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner’s preferences also might play a role in your treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

  • Sildenafil (Viagra)
  • Tadalafil (Adcirca, Cialis)
  • Vardenafil (Levitra, Staxyn)
  • Avanafil (Stendra)

All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing normal penile function in some people. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in people who get normal erections.

The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.

Your doctor will consider your particular situation to determine which medication might work best. These medications might not treat your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor’s OK. Medications for erectile dysfunction do not work in everyone and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:

  • Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil, Bidil)
  • Have heart disease or heart failure
  • Have very low blood pressure (hypotension)

Other medications

Other medications for erectile dysfunction include:

  • Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).Each injection is dosed to create an erection lasting no longer than an hour. Because the needle used is very fine, pain from the injection site is usually minor.Side effects can include mild bleeding from the injection, prolonged erection (priapism) and, rarely, formation of fibrous tissue at the injection site.
  • Alprostadil urethral suppository. Alprostadil (Muse) intraurethral therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include a burning feeling in the penis, minor bleeding in the urethra and formation of fibrous tissue inside your penis.
  • Testosterone replacement. Some people have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies.
A battery-powered penis pump
Penis pumps, surgery and implants

Penis pumps, surgery and implants

If medications aren’t effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include:

  • Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it’s made by a reputable manufacturer.
  • Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among those who have tried and failed more-conservative therapies. As with any surgery, there’s a risk of complications, such as infection. Penile implant surgery is not recommended if you currently have a urinary tract infection.

What is Erectile Dysfunction and How to Treat ED ?

Erectile dysfunction, or ED, is the most common sex problem that men report to their doctor. It affects as many as 30 million men.

ED is defined as trouble getting or keeping an erection that’s firm enough for sex.

Though it’s not rare for a man to have some problems with erections from time to time, ED that is progressive or happens routinely with sex is not normal, and it should be treated.

ED can happen:

  • Most often when blood flow in the penis is limited or nerves are harmed
  • With stress or emotional reasons
  • As an early warning of a more serious illness, like: atherosclerosis (hardening or blocked arteries), heart disease, high blood pressure or high blood sugar from Diabetes

Finding the cause(s) of your ED will help treat the problem and help with your overall well-being. As a rule, what’s good for your heart health is good for your sex health.

How Erections Work

During sexual arousal, nerves release chemicals that increase blood flow into the penis. Blood flows into two erection chambers in the penis, made of spongy muscle tissue (the corpus cavernosum). The corpus cavernosum chambers are not hollow.

Diagram of How Erections Work

Enlarge

During erection, the spongy tissues relax and trap blood. The blood pressure in the chambers makes the penis firm, causing an erection. When a man has an orgasm, a second set of nerve signals reach the penis and cause the muscular tissues in the penis to contract and blood is released back into a man’s circulation and the erection comes down.

When you are not sexually aroused, the penis is soft and limp. Men may notice that the size of the penis varies with warmth, cold or worry; this is normal and reflects the balance of blood coming into and leaving the penis.

Updated June 2018

Symptoms

With Erectile Dysfunction (ED), it is hard to get or keep an erection that is firm enough for sex. When ED becomes a routine and bothersome problem, your primary care provider or a Urologist can help.

ED may be a major warning sign of cardiovascular disease indicating blockages are building in a man’s vascular system. Some studies have shown men with ED are at significant risk of getting a heart attack, stroke or circulatory problems in the legs. ED also causes:

  • Low self-esteem
  • Depression
  • Distress for the man and his partner

If ED is affecting a man’s well-being or his relationships, it should be treated. Treatment aims to fix or enhance erectile function, help circulatory health and help the quality of a man’s life.

Updated June 2018

Causes of ED

ED can result from health problems, emotional issues, or from both. Some known risk factors are:

  • Being over age 50
  • Having high blood sugar (Diabetes)
  • Having high blood pressure
  • Having cardiovascular disease
  • Having high cholesterol
  • Smoking
  • Using drugs or drinking too much alcohol
  • Being obese
  • Lacking exercise

Even though ED becomes more common as men age, growing old is not always going to cause ED. Some men stay sexually functional into their 80s. ED can be an early sign of a more serious health problem. Finding and treating the reason for ED is a vital first step.

Physical Causes of ED

ED happens when:

  • There is not enough blood flows into the penis
    Many health issues can reduce blood flow into the penis, such as hardened arteries, heart disease, high blood sugar (Diabetes) and smoking.
  • The penis cannot trap blood during an erection
    If blood does not stay in the penis, a man cannot keep an erection. This issue can happen at any age.
  • Nerve signals from the brain or spinal cord do not reach the penis
    Certain diseases, injury or surgery in the pelvic area can harm nerves to the penis.
  • Diabetes can cause small vessel disease or nerve damage to the penis
  • Cancer treatments near the pelvis can affect the penis’ functionality
    Surgery and or radiation for cancers in the lower abdomen or pelvis can cause ED. Treating prostate, colon-rectal or bladder cancer often leaves men with ED. Cancer survivors should see a Urologist for sexual health concerns.
  • Drugs used to treat other health problems can negatively impact erections
    Patients should talk about drug side effects with their primary care doctors.

Emotional Causes of ED

Normal sex needs the mind and body working together. Emotional or relationship problems can cause or worsen ED.

Some emotional issues that can cause ED are:

  • Depression
  • Anxiety
  • Relationship conflicts
  • Stress at home or work
  • Stress from social, cultural or religious conflicts
  • Worry about sex performance

Diagnosis of ED

Finding the cause of your ED will help direct your treatment options.

Diagnosing ED starts with your health care provider asking questions about your heart and vascular health and your erection problem. Your provider may also give you a physical exam, order lab tests or refer you to a Urologist.

Health and ED History

Your doctor will ask you questions about your health history and lifestyle. It is of great value to share facts about drugs you take, or if you smoke or how much alcohol you drink. He/she will ask about recent stressors in your life. Speak openly with your doctor, so he/she can help you find the best choices for treatment

What Questions Will the Health Care Provider Ask?

Questions about your health:
  • What prescription drugs, over-the-counter drugs or supplements do you take?
  • Do you use recreational drugs?
  • Do you smoke?
  • How much alcohol do you drink?
  • Have you had surgery or radiation therapy in the pelvic area?
  • Do you have any urinary problems?
  • Do you have other health problems (treated or untreated)?

Questions About ED

Knowing about your history of ED will help your health provider learn if your problems are because of your desire for sex, erection function, ejaculation, or orgasm (climax). Some of these questions may seem private or even embarrassing. However, be assured that your doctor is a professional and your honest answers will help find the cause and best treatment for you.

Questions about your ED symptoms:

  • How long have you had these symptoms? Did they start slowly or all at once?
  • Do you wake up in the morning or during the night with an erection?
  • If you do have erections, how firm are they? Is penetration difficult?
  • Do your erections change at different times, like when going in a partner, during stimulation by mouth, or with masturbation?
  • Do you have problems with sex drive or arousal?
  • Do you have problems with ejaculation or orgasm (climax)?
  • How is this problem changing the way you enjoy sex?
  • Do you have painful with erections, feel a lump or bump in the penis or have penile curvature? These are signs of Peyronie’s Disease which can be treated but calls for an expert in urology to assess and manage.

Questions About Stress and Emotional Health

Your health care provider may ask you questions about depression or anxiety. He or she may ask about problems in your relationship with a partner. Some health care providers may also ask if they may talk to your sex partner.

  • Are you often under a lot of stress, or has something recently upset you?
  • Do you have any anxiety, depression or other mental health issues?
  • Are you taking any drugs for your mental health?
  • How satisfied are you with your sex life? Has there been any changes lately?
  • How is your relationship with your partner? Has there been any changes lately?

Physical Exam

A physical exam checks your total health. Examination focusing on your genitals (penis and testicles) is often done to check for ED. Based on your age and risk factors, the exam may also focus on your heart and blood system: heart, peripheral pulses and blood pressure. Based on your age and family history your doctor may do a rectal exam to check the prostate. These tests are not painful. Most patients do not need a lot of testing before starting treatment.

Lab Tests

Your health care provider may order blood tests and collect a urine sample to look for health problems that cause ED.

Other Tests

Questionnaires are often used by health experts to rate your ability to initiate and keep erections, gauge your satisfaction with sex and help identify any problems with orgasm.

Advanced Erectile Function Tests

For some men with ED, specialized testing may be needed to guide treatment or re-assess you after a treatment fails.

  • Blood work to check Testosterone and other male hormones
  • Blood work to measure blood sugar (Diabetes)
  • Ultrasonography (penile Doppler) to check blood flow
  • A shot into the penis with a vascular stimulant to cause an erection
  • Pelvic x-rays like arteriography, MRI or CT scanning are rarely needed to check ED unless there is history of trauma or cancer
  • Nocturnal penile tumescence (NPT), an overnight test to check for sleep erection

Treatment

The treatment for ED starts with taking care of your heart and vascular health. Your doctor may point out ‘risk factors’ that can be changed or improved.

You may be asked to change certain food habits, stop smoking, increase workouts or stop using drugs or alcohol. You may be offered alternatives to the drugs you take. (Never stop or change prescription drugs without first talking to your health care provider.)

Your health care provider may also suggest treating emotional problems. These could stem from relationship conflicts, life’s stressors, depression or anxiety from past problems with ED (performance anxiety).

The treatments below are available to treat ED directly.

ED Treatments

Non-invasive treatments are often tried first. Most of the best-known treatments for ED work well and are safe. Still, it helps to ask your health care provider about side effects that could result from each option:

  • Oral drugs or pills known as phosphodiesterase type-5 inhibitors are most often prescribed in the U.S. for ED (Viagra, Cialis, Levitra, Stendra)
  • Testosterone Therapy (when low testosterone is detected in blood testing)
  • Penile Injections (ICI, intracavernosal Alprostadil)
  • Intraurethral medication (IU, Alprostadil)
  • Vacuum Erection Devices
  • Penile Implants
  • Surgery to bypass penile artery damage for some younger men with a history of severe pelvic trauma. Penile vascular surgery is not recommended for older men with hardened arteries.

Oral Drugs (PDE5 inhibitors)

Drugs known as PDE type-5 inhibitors increase penile blood flow. These are the only oral agents approved in the U.S. by the Food and Drug Administration for the treatment of ED.

  • Viagra ® (sildenafil citrate)
  • Levitra ® (vardenafil HCl)
  • Cialis ® (tadalafil)
  • Stendra ® (avanafil)

For best results, men with ED take these pills about an hour or two before having sex. The drugs require normal nerve function to the penis. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis. Use these drugs as directed. About 7 out of 10 men do well and have better erections. Response rates are lower for Diabetics and cancer patients.

If you are taking nitrates for your heart, you SHOULD NOT take any PDE5 inhibitors. Always speak with your health care provider before using a PDE5 inhibitor to learn how it might affect your health.

Most often, the side effects of PDE5 inhibitors are mild and often last just a short time. The most common side effects are:

  • Headache
  • Stuffy nose
  • Facial flushing
  • Muscle aches
  • Indigestion

In rare cases, the drug Viagra ® can cause blue-green shading to vision that lasts for a short time. In rare cases, the drug Cialis ® can cause or increase back pain or aching muscles in the back. In most cases, the side effects are linked to PDE5 inhibitor effects on other tissues in the body, meaning they are working to increase blood flow to your penis and at the same time impacting other vascular tissues in your body. These are not ‘allergic reactions’.

Testosterone Therapy

In those rare cases where a low sex drive and low blood levels of Testosterone are at fault for ED, Testosterone Therapy may fix normal erections or help when combined with ED drugs (PDE type 5 inhibitors).

Vacuum Erection Device

A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body. A pump at the other end of the tube makes a low-pressure vacuum around the erectile tissue, which results in an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. With proper training, 75 out of 100 men can get a working erection using a vacuum erection device.

Diagram of a Erectile Dysfunction Vacuum

Penis Enlarge

Intracavernosal (ICI) and Urethra (IU) Therapies

If oral drugs don’t work, the drug Alprostadil is approved for use in men with ED. This drug comes in two forms, based on how it is to be used: intracavernosal injection (called “ICI”) or through the urethra (called “IU therapy”).

Self-Injection Therapy

Alprostadil is injected into the side of penis with a very fine needle. It’s of great value to have the first shot in the doctor’s office before doing this on your own. Self-injection lessons should be given in your doctor’s office by an experienced professional. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment. Many men who do not respond to oral PDE5 inhibitors can be ‘rescued’ with ICI.

ICI Alprostadil may be used as a mixture with two other drugs to treat ED. This combination therapy called “bimix or trimix” is stronger than alprostadil alone and has become standard treatment for ED. Only the Alprostadil ingredient is FDA approved for ED. The amount of each drug used can be changed based on the severity of your ED, by an experienced health professional. You will be trained by your health professional on how to inject, how much to inject and how to safely raise the drug’s dosage if necessary.

ICI therapy often produces a reliable erection, which comes down after 20-30 minutes or with climax. Since the ICI erection is not regulated by your penile nerves, you should not be surprised if the erection lasts after orgasm. The most common side effect of ICI therapy is a prolonged erection. Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office.

Men who have penile erections lasting longer than two to four hours should seek Emergency Room care. Priapism is a prolonged erection, lasting longer than four hours. It is very painful. Failure to undo priapism will lead to permanent penile damage and untreatable ED.

Intraurethral (IU) Therapy

For IU therapy, a tiny medicated pellet of the drug, Alprostadil, is placed in the urethra (the tube that carries urine out of your body). Using the drug this way means you don’t have to give yourself a shot, unfortunately it may not work as well as ICI. Like ICI therapy, IU Alprostadil should be tested in the office, before home usage.

The most common side effects of IU alprostadil are a burning feeling in the penis. If an erection lasts for over four hours, it will need medical attention to make it go down.

Surgical Treatment

The main surgical treatment of ED involves insertion of a penile implant (also called penile prostheses). Because penile vascular surgery is not recommended for aging males who have failed oral PDE5 inhibitors, ICI or IU therapies, implants are the next step for these patients. Although placement of a penile implant is a surgery which carries risks, they have the highest rates of success and satisfaction among ED treatment options.

Penile implants are devices that are placed fully inside your body. They make a stiff penis that lets you have normal sex. This is an excellent choice to improve uninterupted intimacy and makes relations more spontaneous.

There are two types of penile implants.

Semi rigid Implant (Bendable)

The simplest kind of implant is made from two easy-to-bend rods that are most often made of silicone. These silicone rods give the man’s penis the firmness needed for sexual penetration. The implant can be bent downward for peeing or upward for sex.

Inflatable Implant

With an inflatable implant , fluid-filled cylinders are placed lengthwise in the penis. Tubing joins these cylinders to a pump placed inside the scrotum (between the testicles). When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff. Inflatable implants make a normal looking erection and are natural feeling for your partner. Your surgeon may suggest a lubricant for your partner. With the implant, men can control firmness and, sometimes, the size of the erection. Implants allows a couple to be spontaneously intimate. There is generally no change to a man’s feeling or orgasm.

Penile Implant

Enlarge Penis

What is the Surgery Like?

Penile implants are most often placed under anesthesia. If a patient has a systemic, skin, or urinary tract infection, this surgery should be postponed until all infections are treated. If a man is on blood thinners, then he may need to talk with a medical expert about stopping the medications for elective surgery and healing.

Most often, one small surgical cut is made. The cut is either above the penis where it joins the belly, or under the penis where it joins the scrotum. No tissue is removed. Blood loss is typically small. A patient will either go home on the same day or spend one night in the hospital.

Recovery Time after Penile Implants:

  • Most men will feel pain and will feel better with a narcotic pain-relief drug for one to two weeks. After the first week, over- the-counter pain drugs (such as acetaminophen or ibuprofen) may be substituted for narcotic pain drugs.
  • Discomfort, bruising and swelling after the surgery will last for a few weeks.
  • For the first month, men should limit their physical activity. The surgeon will explain when and how much exercise to do during the healing period.
  • Men most often start having sex with their penile implants by eight weeks after surgery. If there is persisting swelling or pain, the use of the implant may be delayed. The surgeon or health care expert in the surgeon’s office will talk about how to inflate and deflate the implant.

There are risks to prosthetic surgery and patients are counselled before the procedure. If there is a post-operative infection, the implant will likely be removed. The devices are reliable, but in the case of mechanical malfunction, the device or a part of the device will need to be replaced surgically. If a penile prosthesis is removed, other non-surgical treatments may no longer work.

Most men with penile implants and their partners say that they’re satisfied with the results, and they return to more spontaneous intimacy.

Clinical Trials

Several restorative or regenerative treatments are under investigation for the future treatment of ED:

  • Extracorporeal shock wave therapy (ESWT) – low-intensity shock waves that aim to fix the erectile tissues and help restore natural erections.
  • Intracavernosal injection of stem cells – to help cavernous tissue regrowth
  • Intracavernosal injection autologous platelet rich plasma (APRP) – to help cavernous tissue regrowth

These are not currently approved by the FDA for ED management, but they may be offered through research studies (clinical trials). Patients who are interested should discuss the risks and benefits (informed consent) of each, as well as costs before starting any clinical trials. Most therapies not approved by the FDA are not covered by government or private insurance benefits.

Supplements

Supplements are popular and often cheaper than prescription drugs for ED. However, supplements have not been tested to see how well they work or if they are a safe treatment for ED. Patients should know that many over-the-counter drugs have been found on drug testing to have ‘bootlegged’ PDE 5 Inhibitors as their main ingredient. The amounts of Viagra, Cialis, Levitra or Stendra that may be in these supplements is not under quality control and may differ from pill to pill. The FDA has issued consumer warnings and alerts.

More information may be found here.

Updated June 2018

After Treatment

All of the treatments for ED (except for implant surgery) are used as needed for sex and then wear off. The treatments help the symptoms, but do not fix the underlying problem in the penis.

If medical treatments don’t work as well as hoped:

  • Changing the dosage (for PDE5i, IU or ICI alprostadil) as prescribed by the doctor may help
  • Reviewing the instructions again may reveal a missing step in a treatment plan
  • Considering a different path may be necessary: emotional/relationship counselling, a vacuum erection device or penile implant are all good alternatives when others methods fail. Don’t give up!

ED Diagnosis

Your doctor will ask you about your medical history. He or she will want to learn if any medical conditions might be causing the impotence. These may include vascular, neurological and hormonal disorders.

Vascular disorders affect the entire body. Many men who have impotence because of vascular disease also have a history of heart disease, stroke or poor circulation in their legs.

Neurological problems can contribute to impotence in men with a history of diabetes and spinal cord injury. They also can cause symptoms in other parts of the body.

In men with abnormal hormone levels, a reduced sex drive often accompanies impotence.

Your doctor will review the medications you take. These include over-the-counter products and herbal remedies.

Your doctor will ask about your sex life. He or she will ask about the quality of your sexual relationships.

Your doctor will examine you to look for evidence of medical problems. This will include an examination of your penis and testes. Your blood may be tested for blood sugar, cholesterol and levels of certain hormones.

Occasionally, a doctor may order additional tests. One such test is a nocturnal penile tumescence study. This is a way to determine how often you get erections while you sleep.

Another test that may be done is a Doppler ultrasound of the blood vessels in the penis. This test measures how well the blood is flowing in your penis.

Your doctor may not be able to give you a specific reason why you have impotence. But many of the treatments work well no matter what caused the problem. So extensive testing may not be necessary.

More Information

Frequently Asked Questions

How do I know my ED is physical and not mental?

It’s hard to know. Health providers now realize that most men have an underlying physical cause of ED. For most patients, there are both physical and emotional factors that lead to ED. It is impossible to prove that there is no psychological part to a man’s ED.

If I worry about being able to get an erection, can I make a bad condition worse?

Nothing happens in the body without the brain. Worrying about your ability to get an erection can make it difficult to get one. This is called performance anxiety and can be overcome with education and treatment.

Can I combine treatment options?

This is often done. However, only combine treatments after talking with your health care provider about this. Erections can last too long with drug therapy, which is dangerous. Ask your doctor for proper instructions.

I was fine until I began taking this new drug, what should I do?

Never stop or change a prescription medication without first talking with your health care provider.

Many drugs can cause ED, but some cannot be changed because the drug’s benefits are too important for you. If you feel sure that a specific drug has caused the ED problem, ask your health care provider if you can change drugs. If you must stay on the drug that is causing the problem, there are ED treatments that can help.

Is Viagra Bad for Your Heart ?

Taken alone, Viagra won’t hurt your heart. But don’t take it if you’re already taking nitrates for heart health, Dr. Montague says.

Viagra was originally intended to treat angina (chest pain), which it does well — just no better than other medications. Stiffer erections were a side effect.

“Here’s a drug that not only treats angina and is good for the heart, but it works on the penis when other medications don’t,” he says.

Like nitrates, it helps dilate blood vessels constricted by coronary artery disease.

But it also similarly lowers blood pressure.

If you take the two medications together, your blood pressure could drop too low, putting you at risk for a heart attack.

Is it safe to take Viagra with my heart medications?

Sexual activity plays a crucial role in the psychological health and quality of life scores in patients with cardiovascular disease. Unfortunately, intimacy is frequently an issue in patient with cardiovascular disease.

The causes of sexual dysfunction following myocardial infarction are multiple and include anxiety, depression, medication effect and vascular insufficiency.

Regardless of the cause, the results can be devastating to relationships and the psyche.

There are three phosphodiesterase-5 inhibitors currently available in the United States: sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). For simplicity and because of its name recognition, I will use the trade name Viagra to represent all phosphodiesterase-5 (PDE5) inhibitors even if the studies were completed using one of the other drugs.  I do not endorse Viagra above any of the others. Viagra has been shown to be effective in the treatment of erectile dysfunction. Viagra works by increasing the amount of nitric oxide available which enhances erectile function.

So can I take Viagra with my heart medications?

Viagra has been shown to be safe in stable cardiovascular diseases including heart failure, hypertension, and coronary artery disease. Although many have looked, there has been no clear evidence that Viagra is associated with increased rate of heart attacks or cardiovascular events. When Viagra is combined with most blood pressure medicines, there is a small but real additive effect but no change in cardiovascular events.

However, when Viagra is combined with doxazosin and tamsulosin, two alpha-blocking medications often used to treat BPH (benign prostate hypertrophy) some patients develop low blood pressures. It is recommended that if these prostate medications are required, the smallest doses of each respective medication should be used.  Patients already receiving Viagra and other PDE5 inhibitors for pulmonary hypertension should not receive a second PDE5 for the treatment of erectile dysfunction.

On the whole, Viagra can be considered safe with almost all of your cardiac medications. Unfortunately, the combination of Viagra with nitrates should never be considered safe. Together they can cause life threatening hypotension, also known as low blood pressure.  Nitrates should not be taken within 24 hours of sildenafil or vardenafil and within 48 hours of tadalafil.

I have included a short list of commonly prescribed nitrates to help you avoid them.

  1. Nitroglycerin
    1. Sublingual nitroglycerin tablets (Nitrostat)
    2. Sublingual nitroglycerin spray
    3. Nitro patch
    4. Nitro paste
    5. Isosorbide mononitrate (Imdur, ISMO)
    6. Isosorbide dinitrate (Isordil)