Does tadalafil increase sensitivity during sexual activity? This is a common question among men considering or currently using this erectile dysfunction medication. Tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor available in the UK under brand names such as Cialis and as MHRA-approved generics, works by improving blood flow to the penis rather than altering nerve sensation. Whilst it does not directly increase tactile sensitivity, many men report enhanced sexual experiences due to improved erectile function and reduced performance anxiety. Understanding how tadalafil works, its effects on sexual function, and when to seek medical advice helps ensure safe and effective treatment of erectile dysfunction.

What Is Tadalafil and How Does It Work?

Tadalafil is a prescription medication primarily used to treat erectile dysfunction (ED) and symptoms of benign prostatic hyperplasia (BPH). It belongs to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors, which also includes sildenafil and vardenafil. In the UK, tadalafil is available under brand names such as Cialis, as well as generic formulations approved by the MHRA.

The mechanism of action centres on the body's natural erectile response. During sexual stimulation, nerve signals trigger the release of nitric oxide in the penile tissue. This chemical messenger activates an enzyme that produces cyclic guanosine monophosphate (cGMP), which relaxes smooth muscle cells in the blood vessels of the penis, allowing increased blood flow. Tadalafil works by inhibiting the PDE5 enzyme, which normally breaks down cGMP. By blocking this breakdown, tadalafil helps maintain higher levels of cGMP, thereby supporting the physiological process that leads to an erection.

It is important to understand that tadalafil does not directly cause an erection without sexual stimulation—it simply facilitates the body's natural response. The medication is available in different doses (2.5mg, 5mg, 10mg, and 20mg) and can be taken either as needed (approximately 30 minutes before sexual activity, with a standard starting dose of 10mg) or as a daily low-dose regimen (2.5-5mg). Tadalafil should not be taken more than once per day and can be taken with or without food. It has a notably long half-life of approximately 17.5 hours, with effects lasting up to around 36 hours. This extended duration of action distinguishes it from other PDE5 inhibitors. Excessive alcohol consumption whilst taking tadalafil should be avoided as it may increase the risk of postural hypotension and dizziness.

Effects of Tadalafil on Erectile Function and Sensation

A common question among patients is whether tadalafil increases penile sensitivity or alters physical sensation during sexual activity. There is no official evidence that tadalafil directly increases tactile sensitivity or changes nerve sensation in the genital area. The medication's primary effect is vascular—improving blood flow to enable and maintain erections—rather than neurological. It is also important to note that tadalafil does not increase sexual desire or libido.

What patients may perceive as "increased sensitivity" often relates to improved erectile function itself. When erectile dysfunction is present, men may experience reduced confidence, anxiety about performance, or diminished physical response. By facilitating better erections, tadalafil can restore a more natural sexual experience, which may be interpreted as enhanced sensation. The psychological relief from knowing one can achieve and maintain an erection often translates into greater enjoyment and engagement during intimacy.

Clinical trials have demonstrated that tadalafil significantly improves scores on validated assessment tools such as the International Index of Erectile Function (IIEF). Men report better erectile rigidity, increased ability to penetrate, and improved maintenance of erections sufficient for satisfactory sexual activity. These functional improvements contribute to overall sexual satisfaction but should not be confused with changes to the sensory nerve pathways themselves.

Some men do report subjective changes in their sexual experience whilst taking tadalafil, including feeling more "present" or connected during intimacy. These reports likely reflect the interplay between physical function and psychological wellbeing rather than a direct pharmacological effect on sensory nerves. If you experience new numbness, pain, or altered genital sensation whilst taking tadalafil, you should seek medical advice as these are not expected effects of the medication.

Common Side Effects and What to Expect

Like all medications, tadalafil can cause side effects, though not everyone experiences them. Understanding what to expect helps patients make informed decisions and recognise when to seek medical advice. The most frequently reported side effects are generally mild to moderate and often diminish with continued use.

Common side effects include:

• Headache – very common (may affect more than 1 in 10 people)

• Indigestion or dyspepsia – common (may affect up to 1 in 10 people)

• Back pain and muscle aches – common, typically appearing 12–24 hours after taking the medication and resolving within 48 hours

• Facial flushing – a sensation of warmth and redness in the face and neck

• Nasal congestion – due to the vasodilatory effects of the medication

These effects result from tadalafil's action on PDE5 enzymes present in other tissues beyond the penis, including blood vessels throughout the body. The back pain and muscle discomfort are thought to relate to PDE11 inhibition, though the exact mechanism remains under investigation.

Less common but more serious side effects require immediate medical attention. These include sudden vision changes or loss (which may indicate non-arteritic anterior ischaemic optic neuropathy), sudden hearing loss or tinnitus, chest pain during sexual activity, or an erection lasting more than four hours (priapism). Priapism is a medical emergency requiring urgent treatment to prevent permanent damage to penile tissue.

Patients should be aware that tadalafil can cause a small decrease in blood pressure. Whilst this is usually not problematic, it becomes significant when combined with certain medications or substances. Tadalafil must never be taken with nitrates (including recreational 'poppers') or guanylate cyclase stimulators such as riociguat—these are absolute contraindications. Caution is also needed with nicorandil, alpha-blockers (used for BPH or high blood pressure), certain antihypertensives, strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir), and grapefruit juice. If you experience chest pain, call 999 immediately; for priapism or sudden vision/hearing loss, attend A&E promptly.

You can report any suspected side effects to the MHRA through the Yellow Card Scheme at yellowcard.mhra.gov.uk or via the Yellow Card app.

When to Speak with Your GP About Tadalafil

Open communication with your GP is essential for safe and effective use of tadalafil. You should arrange an appointment to discuss erectile dysfunction treatment if you are experiencing persistent difficulties achieving or maintaining erections sufficient for satisfactory sexual activity. Your GP will take a comprehensive medical history and may perform examinations or investigations to identify underlying causes, as ED can be an early indicator of cardiovascular disease, diabetes, or other health conditions.

Before starting tadalafil, inform your doctor if you have:

• Heart problems, recent stroke, or uncontrolled blood pressure

• Severe liver or kidney impairment

• Rare inherited eye conditions such as retinitis pigmentosa

• Blood cell disorders including sickle cell anaemia or leukaemia

• Physical deformity of the penis or conditions predisposing to priapism

• Active stomach ulcers

Tadalafil should not be used where sexual activity is inadvisable due to your cardiovascular status. NICE guidance emphasises that management of erectile dysfunction should address underlying risk factors and comorbidities. Your GP may recommend lifestyle modifications such as weight loss, increased physical activity, smoking cessation, or reduced alcohol consumption alongside pharmacological treatment. They may also review your current medications, as some drugs (including certain SSRIs, antipsychotics, beta-blockers, thiazide diuretics, finasteride, and spironolactone) can contribute to erectile difficulties.

Contact your GP if you experience inadequate response to tadalafil after several attempts, as dose adjustment or alternative treatments may be appropriate. Similarly, if side effects are troublesome or persistent, your doctor can discuss management strategies or alternative PDE5 inhibitors. Seek urgent medical attention for any sudden vision or hearing changes, chest pain during sexual activity, or erections lasting more than four hours.

Regular review is important for patients on long-term tadalafil therapy. Your GP should periodically reassess your cardiovascular risk factors, consider tests such as HbA1c, lipids, and morning testosterone (if low libido is present), and ensure the medication remains appropriate for your circumstances. If you are also taking alpha-blockers for BPH or hypertension, your doctor will advise on appropriate dosing and timing to minimise the risk of hypotension. This collaborative approach ensures both safety and optimal therapeutic outcomes.

Frequently Asked Questions