Does tadalafil increase sex time? This is a common question among men considering treatment for erectile dysfunction. Tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor available in the UK under brand names such as Cialis, is primarily licensed to help achieve and maintain erections sufficient for sexual activity. Whilst it does not directly delay ejaculation or treat premature ejaculation, tadalafil can improve erectile quality and reduce performance anxiety, which may indirectly influence sexual duration. This article examines the evidence, clarifies what tadalafil does and does not do, and outlines safe, effective use in line with UK guidance.

What Is Tadalafil and How Does It Work?

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

The mechanism of action centres on the enzyme phosphodiesterase type 5, which is found in the smooth muscle cells lining blood vessels in the penis. During sexual arousal, the body releases nitric oxide, which stimulates the production of cyclic guanosine monophosphate (cGMP). This chemical messenger relaxes the smooth muscle and dilates blood vessels, allowing increased blood flow into the penile tissues to achieve and maintain an erection. PDE5 normally breaks down cGMP, limiting the duration of this effect. Tadalafil inhibits PDE5, thereby prolonging the presence of cGMP and enhancing the natural erectile response to sexual stimulation.

It is important to note that tadalafil does not cause an erection on its own—sexual arousal is still required for the medication to be effective. Tadalafil is available in different doses (2.5 mg, 5 mg, 10 mg, and 20 mg) and can be taken either as a daily low-dose regimen (2.5-5 mg) or as needed (10-20 mg, approximately 30 minutes to 2 hours before sexual activity). The drug has a notably long half-life of approximately 17.5 hours, which means its effects can last up to 36 hours, allowing greater spontaneity for users. Tadalafil should not be taken more than once in 24 hours.

Food does not significantly affect tadalafil absorption, but excessive alcohol consumption should be avoided as it may increase the risk of hypotension and dizziness. Tadalafil is contraindicated in patients taking nitrates (such as glyceryl trinitrate for angina), nitric oxide donors ("poppers"), or guanylate cyclase stimulators (such as riociguat). Caution is needed when taking alpha-blockers or medicines that strongly affect CYP3A4 enzymes (such as ketoconazole, ritonavir, or rifampicin).

Side Effects and Safety Considerations

Like all medications, tadalafil can cause side effects, although not everyone will experience them. The most commonly reported adverse effects include headache, indigestion (dyspepsia), back pain, muscle aches, flushing, and nasal congestion. These symptoms are generally mild to moderate in intensity and often resolve within a few hours as the drug is metabolised. Back pain and muscle aches, in particular, typically occur 12 to 24 hours after taking the medication and usually subside within 48 hours.

More serious but rare side effects require immediate medical attention. These include sudden vision loss (which may indicate non-arteritic anterior ischaemic optic neuropathy, or NAION), sudden hearing loss or tinnitus, and priapism—a prolonged and painful erection lasting more than four hours. Priapism is a medical emergency that requires immediate hospital treatment (A&E/999) as it can result in permanent damage to penile tissue if not treated promptly. Patients experiencing chest pain during or after sexual activity should also seek urgent medical care, as this may indicate cardiovascular complications.

Tadalafil is contraindicated in individuals taking nitrates (such as glyceryl trinitrate for angina), nitric oxide donors ("poppers"), or guanylate cyclase stimulators (such as riociguat), as these combinations can cause a dangerous drop in blood pressure. It should be used with caution in patients taking alpha-blockers (ensure stability on alpha-blocker therapy before starting tadalafil) and medicines that affect CYP3A4 enzymes. Tadalafil should also be used with caution in patients with severe cardiovascular disease, recent stroke or myocardial infarction, uncontrolled hypertension, or severe hepatic or renal impairment (daily dosing is not recommended in severe impairment).

Patients should not use tadalafil with other PDE5 inhibitors or unregulated ED products. Those with a history of NAION or retinitis pigmentosa should inform their prescriber before taking tadalafil. If you experience an allergic reaction (rash, swelling, breathing difficulty), stop taking the medication and seek urgent medical advice.

Seek immediate emergency care (A&E/999) if:

• An erection lasts longer than four hours

• You experience sudden vision or hearing loss

• You develop chest pain, dizziness, or severe palpitations during or after sexual activity

Patients are encouraged to report suspected side effects via the Yellow Card scheme at yellowcard.mhra.gov.uk.

Does Tadalafil Increase Sex Time or Duration?

A common question is whether tadalafil increases the duration of sexual intercourse or delays ejaculation. There is no official link between tadalafil and increased time to ejaculation—the drug is not licensed or indicated for the treatment of premature ejaculation (PE). Tadalafil's primary function is to facilitate the achievement and maintenance of an erection sufficient for sexual activity in men with erectile dysfunction. It does not directly affect ejaculatory control or the physiological mechanisms that govern orgasm and ejaculation.

Premature ejaculation is a separate condition with different underlying causes, including psychological factors, serotonin dysregulation, and heightened penile sensitivity. According to NICE Clinical Knowledge Summaries and European Association of Urology guidelines, the first-line pharmacological treatment for PE is typically a selective serotonin reuptake inhibitor (SSRI) such as dapoxetine (licensed for PE, though availability on the NHS may vary by area), or off-label use of other SSRIs like sertraline or paroxetine. Topical anaesthetics, including the licensed product Fortacin (lidocaine/prilocaine spray), and behavioural techniques may also be employed.

That said, some men report subjectively longer sexual encounters when using tadalafil, but this is more likely due to improved erectile quality and reduced performance anxiety rather than a direct pharmacological effect on ejaculation timing. When a man is less worried about losing his erection, he may feel more relaxed and in control, which can indirectly influence sexual duration. Additionally, the extended window of efficacy (up to 36 hours) allows for multiple attempts at intercourse, which may contribute to a perception of increased sexual stamina.

For men experiencing both erectile dysfunction and premature ejaculation, a combination approach may be appropriate. This should be discussed with a healthcare professional, who can assess the individual's needs and recommend evidence-based treatments. Self-medication or using tadalafil off-label for PE is not advised without medical guidance.

How Tadalafil Affects Sexual Performance and Confidence

Beyond its physiological effects, tadalafil can have a significant psychological impact on sexual performance and confidence. Erectile dysfunction often creates a cycle of anxiety, where fear of failure leads to increased stress, which in turn exacerbates the problem. By reliably improving erectile function, tadalafil can help break this cycle, allowing men to approach sexual activity with greater assurance and reduced performance-related anxiety.

Clinical studies and patient-reported outcomes from regulatory assessments consistently demonstrate that tadalafil improves not only erectile function scores but also overall sexual satisfaction, confidence, and quality of life. The long duration of action is particularly valued, as it reduces the need for precise timing and allows for a more spontaneous and natural sexual experience. This can alleviate the pressure some men feel when using shorter-acting medications, where the window of opportunity is more limited.

It is important to recognise that tadalafil addresses the physical component of erectile dysfunction but may not resolve underlying psychological or relational issues. For some men, ED is linked to stress, depression, relationship difficulties, or past trauma. In such cases, psychosexual counselling or cognitive behavioural therapy (CBT) may be beneficial, either alone or in combination with pharmacological treatment. NICE guidance supports a holistic approach to sexual dysfunction, considering both physical and psychological factors.

Persistent erectile dysfunction warrants a GP assessment for potential underlying causes, including cardiovascular disease, diabetes, and hormonal imbalances. ED can sometimes be an early marker of cardiovascular risk, and appropriate investigations may be recommended. Referral to specialist services may be considered if there is no response to treatment, suspected hypogonadism, complex comorbidities, or significant psychosexual factors.

Patients should also be aware that tadalafil is most effective when used as part of a healthy lifestyle. Factors such as smoking, excessive alcohol consumption, obesity, and lack of physical activity can all contribute to erectile dysfunction. The NHS recommends regular exercise, a balanced diet, smoking cessation, and moderation in alcohol intake as foundational measures for improving sexual health.

Key points for patients:

• Tadalafil improves erectile function but does not directly increase ejaculation time

• Psychological benefits include reduced anxiety and improved confidence

• Combining medication with lifestyle changes and, where appropriate, counselling can optimise outcomes

• Always use tadalafil under medical supervision and discuss any concerns with your GP

Frequently Asked Questions