PDE5 Inhibitor Treatment for Erectile Dysfunction

Sexual arousal triggers nitric oxide release in the penis, which raises levels of cyclic GMP (cGMP). cGMP relaxes smooth muscle in the cavernosal arteries so blood can fill the corpora cavernosa and produce an erection.

PDE5 (phosphodiesterase type 5) is the enzyme that breaks cGMP back down. PDE5 inhibitors block that enzyme, allowing cGMP to accumulate and the natural erectile response to proceed. They do not create erections on their own - sexual stimulation is still required.

Onset and duration differ by molecule. Sildenafil and vardenafil act in 30-60 minutes and last 4-6 hours. Tadalafil acts in 30-45 minutes and lasts up to 36 hours, which is why a low daily dose is often preferred for men who want spontaneity rather than timed dosing.

PDE5 inhibitors are first-line for most men with mild-to-moderate erectile dysfunction, regardless of underlying cause. They are particularly useful as a response test: a good response confirms intact penile vasculature and rules out severe nerve injury or end-stage vascular disease.

They are contraindicated with any nitrate medication (used for chest pain) and with riociguat. Caution is required in severe cardiovascular disease, recent stroke or heart attack, severe liver or kidney impairment, and certain retinal disorders. The Hisential consultation reviews your full medication list and cardiovascular history before any prescription is issued.

Well-conducted studies and meta-analyses consistently show PDE5 inhibitors are effective in 70-80% of men with mild-to-moderate ED. Response is best when underlying cardiovascular, metabolic and lifestyle drivers are addressed in parallel - which is why every Hisential plan combines pharmacology with metabolic optimisation.

If the first molecule and dose do not produce a satisfactory response, options include dose adjustment, switching to a different PDE5 inhibitor, daily-dose tadalafil, combining with Li-ESWT for vascular ED, or escalating to intracavernosal injection therapy.

Side effects are usually mild and transient: headache, facial flushing, nasal congestion, indigestion and, less commonly, transient changes in colour vision. Serious adverse events such as priapism (painful erection lasting more than 4 hours) and sudden hearing loss are rare but require urgent medical attention.

Your personal health concierge schedules a structured follow-up after the first prescription to review response, side effects and any need for dose or molecule change.