Role of Tadalafil in Sexual Arousal and Ejaculation
Tadalafil improves ejaculatory function, orgasmic function, and sexual satisfaction in men with erectile dysfunction, but has limited direct effect on premature ejaculation when used alone. 1, 2
Mechanism and Primary Indications
Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor with a long half-life of 17.5 hours, allowing for significant activity up to 24 hours post-dosing 3. It is FDA-approved for:
- Treatment of erectile dysfunction (ED)
- Treatment of symptoms of benign prostatic hyperplasia (BPH)
- Treatment of both ED and BPH simultaneously 4
Effects on Ejaculatory Function
Positive Effects
- Improves ejaculatory function: In men with erectile dysfunction, tadalafil 5mg daily significantly improves ejaculation and orgasm compared to placebo 1
- Increases ejaculatory frequency: Studies show significant improvement in IIEF-Orgasmic Function domain scores, particularly for ejaculatory frequency (IIEF-Q9) 2
- Benefits across severity levels: Tadalafil shows improvement in ejaculatory function across all baseline ED and ejaculatory dysfunction severity strata 2
Clinical Evidence
- In a 12-week study, 66% of subjects with severe ejaculatory dysfunction reported improved function with tadalafil compared to 36% with placebo (P<0.001) 2
- Tadalafil 5mg daily improved ejaculatory function in men with LUTS/BPH and ED, while tamsulosin (an alpha-blocker) actually decreased ejaculatory frequency 1
Effects on Sexual Arousal
In Men
- Tadalafil enhances erectile function, which indirectly improves sexual arousal and confidence 1
- Increases sexual satisfaction scores and overall satisfaction with sexual activity 2
In Women
- Limited evidence suggests tadalafil 5mg daily may improve genital arousal in women with type 1 diabetes by increasing clitoral blood flow 5
- Improved subjective sexual aspects including arousal, orgasm, and sexual enjoyment in premenopausal diabetic women 5
Role in Premature Ejaculation (PE)
Limited Direct Effect
- Tadalafil alone does not significantly improve intravaginal ejaculatory latency time (IELT) in men with premature ejaculation 6
- When used alone, tadalafil does not significantly change Chinese Index of Premature Ejaculation (CIPE-5) scores 6
Combination Therapy
- Tadalafil combined with topical anesthetics: The combination of tadalafil with lidocaine spray is superior to tadalafil alone for treating comorbid ED and PE 6
- This combination significantly improves IELT, CIPE-5 scores, and sexual satisfaction compared to tadalafil monotherapy 6
Role in Peyronie's Disease
- Tadalafil 5mg daily may help manage active-phase penile pain in Peyronie's disease 7
- Studies show tadalafil can improve pain and erectile function in Peyronie's disease patients 7
- Daily tadalafil 5mg demonstrated lower curvature progression rates and improved symptoms versus controls 7
Clinical Recommendations
For erectile dysfunction: Tadalafil is a first-line treatment that also improves ejaculatory function and sexual satisfaction 1, 2
For comorbid ED and PE: Consider combination therapy with tadalafil and topical anesthetics (lidocaine/prilocaine) for better outcomes 6
For PE without ED: PDE5 inhibitors like tadalafil have been demonstrated to enhance confidence and sexual satisfaction but do not significantly improve IELT 7
For patients with both ED and PE: Treat ED first or concomitantly, as acquired PE may be secondary to ED in some cases 7
Safety Considerations
- Contraindications: Never take with nitrates or guanylate cyclase stimulators as it can cause dangerous drops in blood pressure 4
- Common side effects: Headache, dyspepsia, back pain, myalgia, nasal congestion, and flushing 4
- Precautions: Use with caution in patients with cardiovascular disease, uncontrolled hypertension, liver or kidney problems 4
Tadalafil offers significant benefits for sexual function beyond just erectile function, making it a valuable option for addressing multiple aspects of male sexual health simultaneously.