Erectile dysfunction (ED) is a condition in which the erection of the penis is not hard enough to penetrate the vagina or does not last long enough to complete sexual intercourse, and an erection cannot be achieved or maintained sufficiently to obtain a satisfactory sex life. The underlying disease, predisposing factors, risk factors and potential causes need to be identified before treating ED, and a thorough medical examination should be conducted to determine the appropriate treatment plan. Organic ED or mixed ED is usually treated with the help of drugs, and the first choice for drug treatment is PDE5 inhibitors (commonly known as “Viagra”), which are currently commonly used in China, mainly short-acting sildenafil (Viagra, Pfizer) and long-acting tadalafil (Cialis, Eli Lilly). The birth of Viagra and Cialis In 1998, the world’s first PDE5 inhibitor sildenafil (Viagra) was approved for marketing in the United States, thus triggering the “second sexual revolution” in human history. It can safely and effectively treat mild, moderate and severe ED caused by various reasons, with an efficiency rate of up to 80%, and has prolonged the sexual life of millions of couples. Subsequently, Cialis was approved in 2002 and launched in France in 2003. Since it landed in China in December 2004, to help millions of men to resume a normal sex life. Second, the main ingredients and potency of Viagra and cialis Viagra and cialis are both PDE5 inhibitors, what is the difference between them? The main ingredient of Viagra is sildenafil citrate, originally developed and produced by Pfizer as a drug for the treatment of angina pectoris. In clinical trials, it was found that the effect of its treatment of angina pectoris was general, but the erectile function of patients who tried the drug was significantly improved by mistake, and then the drug was improved and became the first drug for the treatment of ED worldwide. In terms of efficacy, it is a short-acting drug, with a half-life of 4 to 12 hours and an onset of action of about 1 hour, and its duration of action is 4 to 5 hours, which means that it does not work after this time; while the main ingredient of cialis is tadalafil, in addition to being used to treat erectile dysfunction, current research has also found that it can be used for the treatment of pulmonary hypertension and benign prostatic hyperplasia. As a long-acting drug, the half-life of 18 to 36 hours, the onset of action time of about 2 hours, the action time of up to 36 hours, the duration of time, some patients even in two or three days time have obvious effect. Third, long-acting vs. short-acting, how to choose? Both drugs belong to PDE5 inhibitors, the mechanism of action is basically the same, both through the inhibition of PDE5 (a substance that makes the penis weak) in the appropriate sexual stimulation to relax the smooth muscle of the penile corpus cavernosum, the penis rapid blood filling and achieve a satisfactory erection. So since both can treat ED, how do patients make their choice? Viagra, based on available research and clinical experience, is believed to promote harder erections in patients compared to cialis. However, it should not be mixed with nitrates or it may cause postural hypotension. Alcohol and a high-fat diet should not be consumed while taking the drug, as this may also reduce its effectiveness. Common side effects include headache, blurred vision, dizziness, masked cardiovascular disease, lower blood pressure, glaucoma, temporary deafness, and increased sleep apnea. However, the incidence of these side effects is relatively low, with most occurring during the first few doses and gradually disappearing later. Patients with eye disease need to use caution. Unlike Viagra, Cialis is not affected by alcohol or a high-fat diet. There are relatively fewer adverse effects after taking the drug, mainly muscle aches and pains. Although the duration of effectiveness is longer, it is slightly inferior to Viagra in terms of improving the hardness of erections for some patients. Here, I would like to mention that the so-called effective time does not refer to the erection maintenance time (if the penis continues to erect for more than 6 hours, it is an abnormal erection, which is a very dangerous situation and requires immediate medical attention), but refers to the time period in which the erection of the penis can be promoted through sexual stimulation. Having said that, the choice of which drug to use depends greatly on the experience of the doctor and the particular circumstances of the patient. Clinicians tend to choose the one they are most familiar with and recommend it to their patients, which is helpful in assessing both efficacy and side effects after taking the medication. The patient’s self-selection, on the other hand, is based on his or her particular situation, mainly the frequency of sexual intercourse, opportunities, and the hardness of the erection itself. In the case of older men who have very little sexual intercourse and have poor erections themselves, they can choose short-acting Viagra, which has a faster onset and harder hardness. And for younger patients who have relatively more sex, or more weekends, they can choose to use the long-acting Viagra on Fridays to have sex naturally throughout the weekend, while enjoying good food and wine. After learning about the two different types of Viagra, I believe you should have your choice.