Do you know the difference between sildenafil and tadalafil or viagra and cialis? Well, today that's
what we're going to talk about. I'm Dr. Rena Malik, urologist and pelvic surgeon, and here
we talk about all things sexual education, bladder health, and much much more. If you like what you
see make sure you don't forget to subscribe and share this channel with your friends.
So before we get into the actual treatment with these medications for erectile dysfunction it's
important for you to understand how an erection happens so the first component of an erection is
arousal you see something you smell something you hear something or you feel something that
gets you aroused that causes your body to release something called nitric oxide and nitric oxide is
like the ignition for erections so in order to get an erection you need arousal and you need nitric
oxide so once you get that nitric oxide and that arousal what happens is your body starts releasing
a number of chemical messengers and one of these is called cgmp or cyclic guanosine monophosphate
and as these messengers are released the muscles or the smooth muscles in the penis relax this
allows blood to flow in and at the same time the veins of the penis get blocked off so that blood
flow stays in the penis causing a firm erection and then what stops the erection well there's
three major things first that nitric oxide or the stimulus for arousal goes away second is that
chemical messenger cgmp starts to degrade or break down and lastly your body has a nervous response
to ejaculation so when ejaculation happens your nervous system revs up and causes those smooth
muscles to now contract forcing the blood out of the penis and into the rest of the body which then
causes your penis to become flaccid so all of these medications for erectile dysfunction they
work by blocking the breakdown of that chemical messenger cgmp and they do so by blocking an
enzyme called phosphodiesterase so before i get into the difference between sildenafil
and tadalafil or viagra and cialis i want you know there are some side effects that are common with
all of these medications that includes headaches flushing nasal congestion heartburn and sometimes
vision changes also there is one medication that if you're taking you absolutely cannot
take these medications and that's called a nitrate medication or a medication with a nitrate in it
something called nitroglycerin is very commonly prescribed to people who have chest pain or angina
is the medical term for it and what that is is it's usually a pill that's given to
you to take and put underneath your tongue if you have chest pain that won't go away so if
you're on that medication you cannot take any of these medications for erectile dysfunction
the reason being is if you take both of these at the same time your blood pressure can drop
so low that you may actually have a risk of death or dying also there are certain medications that
can cause drug to drug interactions and if you have kidney or liver problems you might have to
change the dosing of the medication that you're receiving so you definitely want to get these
under the care of a physician you may find some over-the-counter supplements even though
they're not supposed to have these medications in them that do have them and those are dangerous
because you need to make sure that you're not getting too much or too little of the medication
there's also a couple of very rare but very serious side effects with these medications
one of these is called priapism and priapism is an erection that lasts longer than four hours
and that is actually not a good thing when you have an erection that lasts longer than four hours
it actually starts causing damage to the tissues in the penis that can cause irreversible damage
if not treated right away you can learn more about priapism in a video that i made reacting to grey's
anatomy about priapism right here but this is fortunately very very rare with these medications
especially when taken appropriately the only time we really see it is if someone overdoses on these
medications takes too many and then can have this problem the other rare side effect that is
potentially dangerous is hearing loss i have never seen that in my career but it has been reported as
a very rare but serious side effect the success rate for both of these medications is about 60 to
80 percent so if you're looking as far as efficacy they're both about the same and why am i talking
specifically about viagra and cialis or sildenafil and tadalafil well because at least in the united
states there are the cheapest options for erectile dysfunction and because they are equally effective
i tend to prescribe these both most often as far as sildenafil is concerned the origin story
of how they came up with sildenafil is actually really interesting so it was originally made as
a treatment for high blood pressure so they did these clinical trials on patients to see if it
would improve their blood pressure and what they found was that it didn't do anything for blood
pressure but in fact people started reporting stronger and firmer erections and so that's
how viagra was born so specifically talking about sildenafil it is the oldest medication available
for erectile dysfunction so it has the longest data on its efficacy and its use so when you take
viagra you need to take it about 30 minutes to an hour before intercourse and on an empty stomach
if you have a lot of high fat foods before taking viagra it reduces the efficacy of the medication
so ideally you want to take out an empty stomach or if you had a very light meal it lasts in the
bloodstream for about four hours it's available in different dosing starting from 25 milligrams
all the way up to 100 milligrams and it's only offered in what we call on-demand dosing and so
what that means is you can only take it at the time prior to intercourse you can't take a daily
dose every single day it won't work like that the side effects that are unique to viagra are
that sometimes people who take viagra get what we call blue green discoloration or changes in their
color vision if that happens you have to stop the vigor right away and talk to your doctor
the other side effect that we sometimes see in viagra and not into dala fill is nose bleeds
although it is in a small percentage of people tadalafil is a more selective phosphodiesterase
inhibitor meaning it more selectively inhibits the enzymes that are responsible for erections
and it was released in 2003 so we don't have as much data on tadelphil as we do on suldenophil
similar to sildenafil it needs to be taken about 30 minutes to an hour before intercourse but
you can take it on an empty stomach also it lasts in your bloodstream for up to 36 hours
so if you want to have multiple episodes of intercourse on a weekend well this is a
great medication option for you it's also available in a low dose that you can take
every single day and some people like that because they like the spontaneity associated
with taking one pill every single day and then being able to have intercourse whenever you
want the on-demand dosing is available from five milligrams to 20 milligrams and you might notice
that that's less than the sildenafil dosing it doesn't mean that it's less effective it's just
different also the other interesting thing about the low dose daily tadalafil is that it also is
useful for men with benign prostatic hyperplasia or bph you can check out my video about bph that
i made before to learn more about that but what it does is it helps men who have symptoms
urinary symptoms associated with bph specifically having difficulty emptying your bladder straining
waking up at night to urinate maybe having some urgency gotta go gotta go or urinary frequency
so if you find yourself having urinary symptoms that are related to bph and erectile dysfunction
well you might be able to get away with just taking one medication that can help both problems
and lastly there's some data to suggest that men who have complete erectile dysfunction they
have no erections at all may benefit better from tadalafil than other medications so which one is
better for you well i'm going to share some data that i found comparing sildenafil and tadalafil
head to head i looked at a meta analysis and if you're new here i love meta-analyses meta-analyses
are studies that look at all the published data on a certain topic and they do a systematic review
which means they look at the specific data from all of the studies combine it together and that
makes for a much stronger study so you can really look at those outcomes and say well this is what
10 or 15 or 20 studies said so this must be more valid than just one study by itself this
particular meta-analysis and systematic review looked at sildenafil versus tadalafil and looked
at any study that compared them head to head and they had to use a specific validated questionnaire
to compare their erectile dysfunction outcomes they couldn't just say hey were your erections
better they had to use a questionnaire that has been looked at and validated to show a difference
a clinically meaningful difference in erectile dysfunction outcomes on medication in this
particular review they include 16 studies with over 5 000 patients so what they found was that
efficacy as i mentioned earlier was about the same in both groups but in this they also looked at
how the partner felt their erections were as well as the patient's treatment satisfaction
and adherence or sticking to the medication or using it regularly with either sildenafil or
tadalafil people in these studies who took to dallasfield tended to have better self-esteem
in their relationships and were more satisfied with their treatments and in nine studies they
looked at preference they asked them what do you prefer in nine of these studies they found
that the men and their partners both preferred to dalla fill over sildenafil so what they found was
that persistence and side effects were similar in both groups the only difference in side effects
were that sildenafil patients were more likely to have vision changes whereas hidallafil patients
were more likely to have muscle aches so what do i recommend well if you have urinary symptoms with
bph well then i recommend taking one daily dose of tadalafill every single day if you are willing to
take an on-demand medication try either one and if one doesn't work go ahead and switch
to the other one but always make sure you're doing this under the supervision of a physician
there are a number of other treatment options for erectile dysfunction besides medications
including a suppository that goes inside the urethra intracavernosal injections vacuum
erection devices and penile implants so if you're interested in learning more about those comment
below and i'll make videos about them as well i've made a couple videos about penile implants you can
check those out as well and as always remember to take care of yourself because you're worth it