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What is Erectile Dysfunction?

Erectile dysfunction (ED) is the inability to get or keep an erection firm enough for intercourse. It is very common and affects patients of all ages including young men. Although older men are more likely to suffer from ED, about 40% of men will experience ED by age 40. While it may happen to any man occasionally, if the issue becomes persistent, it may require treatment.

Learn more about treatment with the medication Tadalafil and ED causes, prevention, and more below.

About Tadalafil

Tadalafil is a medication used to improve men’s erections. It works by expanding the blood vessels that go to the penis and delivering better blood flow. That in turn leads to better erection. Tadalafil is also known by its brand name Cialis. The two medications are identical, with Tadalafil being a generic, cheaper, and more available option.

Depending on the severity of your ED, you may be prescribed 5,10, or 20 mg dose. It is not safe to take more than 20 mg at a time or per 48 hr period. Tadalafil stays in your system longer (30-60 hours) and taking 20 mg on consecutive days may lead to more side effects

How to Take Tadalafil

The following recommendations will help ensure Tadalafil works for you: 

  • Take it about one hour prior to intercourse
  • Take it on an empty stomach (at least 2 hr after a meal), with a full glass of water and preferably without alcohol. Taking Tadalafil immediately after a meal or with alcohol will worsen its absorption and will not allow the medication to work as well. 
  • Take it when you will have sexual stimulation. Tadalafil works best when there is sexual stimulation, with or without a partner. It will not work well without stimulation.

Possible Side Effects of Tadalafil

Side effects with Tadalafil are not common, but may include dizziness, headaches, upset stomach, muscle aches. Rarely sudden vision or hearing changes may occur. If you experience sudden severe vision or hearing changes, report them to your doctor or seek medical help right away.

 Very rarely Tadalafil may lead to a painful erection that lasts longer than 3-4 hours or does not go away (Priapism). That is considered a medical emergency and you must seek medical help (go to the ER) immediately. 
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, or trouble breathing.

Reasons To Consider Switching Medication

If you have persistent side effects, negative interactions with your other medicines, or the medication lacks the desired effect you should talk to your provider about switching medication. 

Alternative Treatments and Prevention

Your erections are a reflection of your overall health. The healthier you are, the better your erections are going to be. Besides medication, consider the following to improve erections. 

  • Mental Health Treatments
    • Stress and anxiety are well known risk factors for ED. Try stress reductions at home and at work. Click here to learn some techniques to help with performance anxiety.
    • Untreated depression can also affect your erections. If you think you may be struggling with depression, please discuss this with your K Health physician.
  • Lifestyle Modifications
    • Sleep: Lack of sleep has negative effects on your mental health and can affect your erections. Here are some sleep tips from the CDC.
    • Weight loss:. If you are overweight, consider making weight loss a priority. Obese men are 50% more likely to suffer from ED.
    • Diet and exercise: The World Health Organization (WHO) recommends 150 minutes of moderate intensity activity per week for adults 18-64 years old.
    • Stop smoking: Smoking significantly affects your blood vessels and makes getting an erection more difficult
  • Hormone Replacement
    • For men with low testosterone levels, testosterone replacement may improve erections. 
  • Advanced options such as injections or surgery
  • If you have diabetes, try to control it with diet, exercise, and medications as best as you can. Diabetes, when not treated, leads to nerve and blood vessel damage, worsening ED

When to See a Doctor In Person

If you are taking Tadalafil and any of the following occur, please seek out care in person. 

  • You develop a painful erection or an erection lasting longer than four hours – this is a condition called Priapism and is an emergency
  • You feel like you might pass out after taking the prescribed medication, or develop sudden vision or hearing loss
  • You have chest pain
  • You experienced painful bending of your penis during intercourse with bruising and sudden loss of erection

What Causes Erectile Dysfunction

During sexual arousal a man’s brain and nerves deliver signals to the blood vessels of the penis to expand. That in turn, delivers more blood to the penis. Blood fills spongy parts of the penis called Corpus Cavernosum leading to an erection. 

In order to have a healthy and strong erection multiple parts of man’s body must work well together. That includes nerves, blood vessels, hormones, muscles, and brain. ED can result from a dysfunction in any of those. Most common causes of the ED are the following:

  • Diabetes. Men with diabetes have a higher chance of having damaged nerves and blood vessels which will lead to poor erections or no erections at all. History of poorly controlled diabetes is one of the main risk factors for ED. 
  • Heart or vascular disease. Men with cardiac or vascular disease (including high blood pressure and high cholesterol) are at a higher risk for ED 
  • Obesity
  • Neurologic diseases. Those include any back/spinal cord issues, multiple sclerosis (MS), Parkinson’s disease, diabetic neuropathy, etc. Neurologic diseases affect nerves that go to the penis causing worsening of the erections. 
  • Smoking 
  • Alcoholism or any other substance abuse
  • History of prostate cancer and treatment for prostate cancer
  • Depression, stress, and sleep disorders
  • Low testosterone 
  • Previous surgeries or injuries to the pelvis or spinal cord
  • Certain medications 
  • Older age

Natalya Lopushnyan, MD

Dr. Natalya Lopushnyan is a board certified Urologist specializing in Men's Health. She earned her degree in Biochemistry from University of Massachusetts Boston, graduating Summa Cum Laude. Her MD is from Yale. She completed Urology Residency at the University of Washington in Seattle.