Will a dose increase of tadalafil (Cialis) resolve delayed ejaculation?

Increasing Tadalafil Dose Will Not Resolve Delayed Ejaculation

Increasing the dose of tadalafil is not recommended for treating delayed ejaculation (DE) and is unlikely to resolve the condition. 1

Understanding Delayed Ejaculation

Delayed ejaculation is defined as a consistent, bothersome inability to achieve ejaculation or excessive latency of ejaculation despite adequate sexual stimulation and the desire to ejaculate. It can be lifelong or acquired. 1

• Normal ejaculatory latency time in Western countries is between 5-6 minutes, while DE is typically diagnosed when latency exceeds 25-30 minutes or when men cease sexual activity due to fatigue or a sense of ejaculatory futility 1
• DE significantly impacts quality of life and sexual satisfaction for both the affected individual and their partner 1

Recommended Management Approaches for Delayed Ejaculation

First-Line Approaches:

1. Psychological and Behavioral Interventions

   • Referral to a mental health professional with expertise in sexual health is recommended 1
   • Modifying sexual positions or practices to increase arousal may benefit patients with DE 1
   • These approaches avoid the risks associated with pharmacotherapies that have limited evidence 1

2. Medication Review and Adjustment

   • Clinicians should suggest replacement, dose adjustment, or staged cessation of medications that may contribute to DE 1
   • If the patient is taking medications known to cause DE, addressing these is the priority before adding new treatments 1

3. Hormonal Assessment

   • Checking testosterone levels is recommended as low testosterone can contribute to DE 1
   • Testosterone replacement therapy should be considered in men with DE and documented testosterone deficiency 1

Pharmacological Options for DE:

If non-pharmacological approaches fail, several medications may be considered:

• Sympathomimetics/alpha-agonists:

  • Pseudoephedrine (60-120 mg, 120-150 minutes before sex) 1
  • Ephedrine (15-60 mg, 1 hour before sex) 1
  • Midodrine (5-40 mg, 30-120 minutes before sex) 1

• Other medications with potential efficacy:

  • Oxytocin (24 IU intranasal/sublingual during sex) 1
  • Bethanecol (20 mg daily) 1
  • Yohimbine (5.4 mg three times daily) 1
  • Cabergoline (0.25-2 mg twice weekly) 1
  • Imipramine (25-75 mg daily) 1

Role of PDE5 Inhibitors (Including Tadalafil)

PDE5 inhibitors like tadalafil are primarily indicated for erectile dysfunction (ED), not delayed ejaculation:

• While tadalafil has shown efficacy in treating premature ejaculation in several studies 2, 3, 4, 5, 6, there is no evidence supporting its use for delayed ejaculation
• When DE and ED coexist, treating the ED according to AUA Guidelines is recommended, but this does not necessarily address the DE 1
• Increasing the dose of tadalafil specifically to treat DE is not supported by current evidence and guidelines 1

Important Clinical Considerations

• Determine the chronology when DE and ED coexist - if DE preceded ED, focus on addressing DE causes; if ED came first, address common etiological factors 1
• Consider the psychological impact of DE on the patient and partner, as it can lead to decreased self-esteem, relationship conflict, and anxiety 1
• For men with DE who also have erectile dysfunction, treating the ED may be necessary but is unlikely to resolve the DE without additional targeted interventions 1

Common Pitfalls to Avoid

• Confusing DE with PE treatment: Treatments effective for premature ejaculation (like SSRIs or tadalafil) may actually worsen delayed ejaculation 1
• Focusing only on medications: Behavioral and psychological approaches should be first-line before pharmacological interventions 1
• Overlooking contributing medications: Many medications can cause or worsen DE, including antidepressants, antipsychotics, and certain antihypertensives 1
• Neglecting hormonal factors: Low testosterone levels can contribute to DE and should be assessed 1

In conclusion, while tadalafil is effective for erectile dysfunction and has shown benefits for premature ejaculation, increasing its dose is not a recommended strategy for treating delayed ejaculation.