Does tadalafil increase time to ejaculation or prolong sexual activity? Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK for treating erectile dysfunction and benign prostatic hyperplasia. Whilst it significantly extends the window during which erections can be achieved—up to 36 hours—it is not licensed for premature ejaculation. Understanding what tadalafil does and does not do is essential for safe, effective use. This article examines the clinical evidence, NHS guidance, and clarifies common misconceptions about tadalafil's effects on sexual timing.

What Is Tadalafil and How Does It Work?

Tadalafil is a prescription-only medication primarily licensed for the treatment of erectile dysfunction (ED) and benign prostatic hyperplasia (BPH). It belongs to a class of drugs known as phosphodiesterase type 5 (PDE5) inhibitors, which also includes sildenafil and vardenafil. In the UK, tadalafil is available under brand names such as Cialis and as generic formulations, licensed by the Medicines and Healthcare products Regulatory Agency (MHRA).

The mechanism of action centres on the inhibition of the PDE5 enzyme, which is found in high concentrations in the smooth muscle of the corpus cavernosum of the penis. During sexual stimulation, nitric oxide is released in the erectile tissue, activating an enzyme called guanylate cyclase. This increases levels of cyclic guanosine monophosphate (cGMP), which relaxes smooth muscle and allows increased blood flow into the penis, facilitating an erection. PDE5 normally breaks down cGMP; by inhibiting this enzyme, tadalafil prolongs the vasodilatory effects of nitric oxide, thereby supporting erectile function.

Key pharmacological features of tadalafil include:

• A long half-life of approximately 17.5 hours, significantly longer than other PDE5 inhibitors

• Onset of action within 30 minutes to 2 hours

• Duration of effect up to 36 hours

• Available in doses ranging from 2.5 mg to 20 mg for ED, and 5 mg once daily for BPH

It is important to note that tadalafil does not cause spontaneous erections; sexual stimulation is required for the medication to be effective. The drug is not an aphrodisiac and does not increase sexual desire. Tadalafil is licensed specifically for erectile dysfunction and certain urological conditions, and its use should always be under medical supervision.

Clinical Evidence on Tadalafil and Timing

Clinical trials and real-world evidence have extensively evaluated tadalafil's efficacy in improving erectile function, with timing being a key consideration for both patients and clinicians. The pivotal registration trials demonstrated that tadalafil significantly improved the ability to achieve and maintain erections sufficient for satisfactory sexual activity compared with placebo, with effects measurable from 30 minutes post-dose and persisting for up to 36 hours.

In terms of timing flexibility, tadalafil offers distinct advantages over shorter-acting PDE5 inhibitors. Studies published in peer-reviewed journals show that patients taking tadalafil reported greater flexibility in sexual activity due to the extended window of efficacy. This prolonged duration means that precise timing of sexual activity relative to dosing is less critical, potentially reducing performance anxiety for some patients.

The evidence base includes:

• Randomised controlled trials involving thousands of men with ED of various aetiologies (psychogenic, organic, or mixed)

• Reported efficacy rates varying by dose and underlying cause of ED

• Consistent improvements in International Index of Erectile Function (IIEF) scores

• Subgroup analyses showing benefit across age groups and in men with comorbidities such as diabetes or post-prostatectomy ED

Cochrane systematic reviews and NICE Clinical Knowledge Summaries acknowledge tadalafil as an effective first-line pharmacological treatment for erectile dysfunction. However, the evidence specifically addresses time to achieve erection and duration of erectile capability, rather than time to ejaculation or ejaculatory latency. The distinction between these timing parameters is clinically important and often misunderstood by patients seeking information about sexual performance enhancement.

Safe Use of Tadalafil: Dosage and NHS Guidance

Tadalafil is a prescription-only medicine in the UK, and its use should be initiated and monitored by a qualified healthcare professional. The NHS and NICE provide clear guidance on appropriate prescribing, dosing, and safety considerations to optimise patient outcomes whilst minimising risks.

Standard dosing regimens include:

• On-demand use for ED: 10 mg taken prior to anticipated sexual activity (can be adjusted to 20 mg or reduced to 5 mg based on efficacy and tolerability)

• Daily use for ED: 2.5 mg or 5 mg taken once daily, regardless of timing of sexual activity, suitable for men who anticipate frequent sexual activity

• For BPH: 5 mg once daily

The on-demand dose should be taken at least 30 minutes before sexual activity, though the medication may work faster in some individuals. Tadalafil should not be taken more than once in a 24-hour period. Food intake does not significantly affect absorption, offering additional convenience compared with some other ED medications.

Important safety considerations include:

• Contraindications: Tadalafil must not be used concurrently with nitrates (e.g., glyceryl trinitrate), nicorandil, or guanylate cyclase stimulators (e.g., riociguat) due to risk of severe hypotension. It is also contraindicated in patients with recent stroke, myocardial infarction, or unstable angina.

• Caution required: In patients with anatomical penile abnormalities, bleeding disorders, active peptic ulceration, or hepatic/renal impairment (avoid in severe hepatic impairment; dose adjustment needed in severe renal impairment). Caution is also needed with alpha-blockers (risk of hypotension).

• Interactions: Potent CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) may increase tadalafil levels; CYP3A4 inducers (e.g., rifampicin) may reduce efficacy. Avoid grapefruit juice.

• Common adverse effects: Headache, dyspepsia, back pain, myalgia, flushing, and nasal congestion occur in 2–10% of users.

Patients should be advised to seek immediate medical attention if they experience an erection lasting more than 4 hours (priapism), sudden vision or hearing loss, or chest pain during sexual activity. Men with cardiovascular disease should be assessed for cardiac risk before resuming sexual activity. The NHS recommends regular review of ED treatment to assess efficacy, tolerability, and any changes in cardiovascular risk factors.

Suspected adverse reactions should be reported via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Does Tadalafil Increase Time to Ejaculation?

A common question among patients is whether tadalafil increases the time to ejaculation or helps with premature ejaculation (PE). It is important to clarify that tadalafil is not licensed for the treatment of premature ejaculation, and there is no official indication for its use in managing ejaculatory timing. The medication's primary mechanism targets erectile function, not ejaculatory control.

Premature ejaculation is defined by the International Society for Sexual Medicine as ejaculation that occurs within approximately one minute of vaginal penetration, with inability to delay ejaculation and negative personal consequences. The pathophysiology of PE differs fundamentally from ED, involving serotonergic neurotransmission and psychological factors rather than penile blood flow.

Current evidence regarding tadalafil and ejaculatory latency:

• Small-scale studies have investigated whether PDE5 inhibitors might have secondary effects on ejaculatory timing, with mixed and inconclusive results

• Some research suggests modest improvements in intravaginal ejaculatory latency time (IELT) in men taking tadalafil, but these findings are not consistent across studies

• Any observed benefit may be indirect—improved erectile confidence and reduced performance anxiety could theoretically allow better ejaculatory control

• There is no robust, large-scale evidence to support tadalafil as a treatment for PE

For men experiencing premature ejaculation, NHS resources and NICE Clinical Knowledge Summaries advise behavioural techniques, topical anaesthetics (lidocaine-prilocaine), and selective serotonin reuptake inhibitors (SSRIs). Dapoxetine is specifically licensed for PE, while other SSRIs such as paroxetine or sertraline may be used off-label. Some men experience both ED and PE concurrently; in such cases, addressing the erectile dysfunction with tadalafil may indirectly improve overall sexual satisfaction, but specific PE treatment may still be required.

Patients concerned about ejaculatory timing should discuss this openly with their GP or a specialist in sexual medicine, as combination approaches or alternative treatments may be more appropriate than tadalafil alone.

Frequently Asked Questions