The Most Popular Erection Drug Is Not Viagra

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 vice 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 erectile dysfunction. 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.