All About Sex

The best sex ever

The Most Popular Erection Drug Is Not Viagra

Why consumers overwhelmingly prefer Cialis.

Since its 1998 introduction, Viagra (sildenafil) has become one of the world’s most recognizable brand names, up there with Coca-Cola and Rolls Royce. But in terms of user satisfaction, Viagra runs a distant second behind Cialis (tadalafil).

Remarkable Preference for Cialis

Men express remarkable preference for Cialis. I found 12 studies in which men tried both drugs and then reported which they chose to continue. The score was a shut-out: Cialis 12, Viagra 0. And the 8,300 participants favored Cialis by a wide margin, on average, three to one. In studies that also included the third major erection drug, Levitra (vardenafil), Cialis was substantially more popular than either competitor.

Women also prefer Cialis. In four studies, couples used Viagra then Cialis, or visa versa. Another shut-out. In all four trials, the women strongly preferred Cialis.

Why? Because Cialis has a longer duration of action. Viagra and Levitra last for around four hours, but Cialis lasts for 36. If a man takes Cialis on Friday evening, he has erection assistance through Sunday afternoon. Both men and women say they like the fact that Cialis allows them to take their eyes off the clock and make love whenever they wish. So Cialis has a clear advantage for dating couples or new lovers still in the hot-and-heavy period who value sexual spontaneity.

But oddly, Cialis is also the clear favorite among long-term spouses who are less likely to be sexually spontaneous and more likely to make sex dates. The larger window of opportunity apparently makes for friendlier spousal negotiations. How about tonight? No, I’m exhausted. How about tomorrow? Okay, when? Maybe in the afternoon, maybe the evening. Can we check in after lunch?

Except for duration of action, the erection medications are all quite similar. They begin to work in about an hour. They work equally well if taken on an empty stomach or after a meal. None produce spontaneous erections–no embarrassing bulges in the supermarket. They enhance firmness only in the context of erotic fondling. And their side effects are very similar: headache (16 percent of users), stomach upset (7 percent), and nasal congestion (4 percent). Important note: Never use erection medications if you’re taking nitroglycerin for angina. If you do, the combination can be fatal.

Why So Few Older Men Use Erection Drugs

But while Cialis clearly trumps Viagra and Levitra, the surprising little secret is how few older men use any of them. Sales are only about half of what pundits predicted when “vitamin V” was first approved. Cornell researchers surveyed 6,291 older men on the subject. Almost half–48 percent–reported some ED. How many had ever tried an erection drug? Just 7 percent.

Why so few? One reason is that, compared with women, men are less willing to take medication.

But the main reason is that the drugs enhance intercourse, while older couples generally evolve away from the old in-out toward genital hand massage, oral sex, and vibrator play. For many older lovers, intercourse is a hassle. Even with drugs, men’s erections may be iffy, and despite lubricant, vaginal dryness and/or atrophy cause many women pain during intercourse. So older lovers who remain sexual generally switch from intercourse toward other pleasures. And if you’re no longer having intercourse, erections aren’t necessary, so why take a drug?

In addition, men don’t need erections to have orgasms. That’s right, with sufficient fondling, men can have marvelous orgasms with semi-firm or even flaccid penises.

Among men who try erection medications, only half refill their prescriptions. Why? Effectiveness is one reason. The manufacturers claim the drugs are 70 to 85 percent effective, but the research shows effectiveness in the range of 50 to 60 percent, and possibly lower for men with diabetes, heart disease, or high cholesterol or blood pressure. In addition, in the studies, “effectiveness” does not mean rock-hard porn-star erections. It means any increase in firmness that enables intercourse. Drug-fueled erections can be on the soft side, so many men feel disappointed.

Side effects may also be problematic. Medically, they’re minor, but headaches, stomach distress, and nasal congestion can be annoying enough to disrupt sex.

Bottom line: If you’re over 40 and have never tried an erection medication, you’re in the majority. But if you use one, you’ll probably be happiest with Cialis.

References:

Ahn, TY, et al. “Treatment Preferences in Men with Erectile Dysfunction: An Open Lavbel Study in Korean Men Switching from Sildenafil to Tadalafil,” Asian Journal of Andrology (2007) 9:760.

Banner, L.L. and R.U. Anderson. “Integrated Sildenafil and Cognitive-Behavior Sex Therapy for Psychgenic Erectile Dysfunction: A Pilot Study,” Journal of Sexual Medicine (2007) 4(4, Pt 2):1117.

Brock, G. et al. “The Treatment of Erectile Dysfunction Study: Focus on Treatment Satisfaction of Patients and Partners,” BJU International (2007) 99:376.

Chia, S.J. et al. “Clinical Application of Prognostic Factors for Patients with Organic Causes of Erectile Dysfunction on 100 mg of Sildenafil Citrate,” International Journal of Urology (2004) 11:1104.

Conaglen, H.M. and J.V. Conaglen. “Investigating Women’s Preference for Sildenafil or Tadalafil Use by their Partners with Erectile Dysfunction: The Partner’ Preference Study,” Journal of Sexual Medicine (2008) 5:1198.

Dean, J. et al. “Psychosocial Outcomes and Drug Attributes Affecting Treatment Choice in Men Receiving Sildenafil and Tadalafil for Treatment of Erectile Dysfunction: Results of a Multicenter, Randomized, Open Label, Crossover Study,” Journal of Sexual Medicine (2006) 3:650.

Dzelaludin, J and S. Bajramovic. “Evaluation of Therapeutic Responses Of Patients with Erectile Dysfunction,” Medicinski Arhiv [Bosnian journal] (2009) 63:274.

Eardley, I. et al. “Factors Associated with Preference for Sildenafil or Tadalafil for Treating Erectile Dysfunction in Men Naïve to PDE-5 Inhibitor Therapy: Post Hoc Analysis of Data from a Multicenter, Randomized Open-Label, Crossover Study,” BJU International (2007) 100:122.

Eardley, I. et al. “An Open-Label, Multicenter, Randomized, Crossover Study Comparing Sildenafil and Tadalafil for Treating Erectile Dysfunction in Men Naïve to PDE-5 Inhibitor Therapy,” BJU International (2005) 96:1323.

Fonseca, V. et al. “Impact of Diabetes Mellitus on the Severity of Erectile Dysfunction and Response to Treatment: Analysis of Data from Tardenafil Clinical Trials,” Diabetologia (2004) 47:1914.

Fusco, F. “Tadalafil Versus Sildenafil in the Treatment of ED: Italian Patients’ Preferences and Explanatory Notes,” Urologia (2008) 75:24.

Gong, B.S. “ED Patients and their Female Partners Prefer Tadalafil,” Zhonghua, Nan Ke Xue [Chinese journal] (2011) 17:571.

Hatzichristou, D. et al. “Patterns of Switching PDE-5 Inhibitors in the Treatment of Erectile Dysfunction: Results from the Erectile Dysfunction Observational Study,” International Journal of Clinical Practice (2007) 61:1850.

Lee, J. et al, “Physician-Rated Patient Preference and Patient- and Partner-Rated Preference for Tadalafil and Sildenafil: Results from the Canadian Treatment of Erectile Dysfunction Observational Study,” BJU International (2006) 98:623.

Melnik T. and C.H. Abdo. “Psychogenic Erectile Dysfunction: Comparative Study of Three Therapeutic Approaches,” Journal of Sex and Marital Therapy (2005) 31:243.

Morales, A.M. et al. “Patients’ Preference in the Treatment of Erectile Dysfunction: A Critical Review of the Literature,” International Journal of Impotence Research (2011) 23:1.

Mulhall, J. et al. “Importance of and Satisfaction with Sex Among Men and Women Worldwide: Results of the Global Better Sex Survey,” Journal of Sexual Medicine (2008) 5:788.

Von Keitz, A. et al. “A Multicenter, Randomized, Double-Blind, Crossover Study to Evaluate Patient Preference Between Tadalafil and Sildenafil,” European Urology (2004) 45:499.

 

 

San Francisco journalist Michael Castleman, M.A., has written about sexuality for 36 years. more...

Subscribe to All About Sex

Current Issue

Let It Go!

It can take a radical reboot to get past old hurts and injustices.