In simplest terms, erectile dysfunction occurs when you are unable to achieve or maintain an erection. It has many causes, and while disinterest in sex may be one of them, there are usually other contributors.

If you can’t produce an erection, it may be possible that you’re suffering from physical conditions like heart disease or diabetes that affect blood flow. Mental afflictions, like anxiety or depression, can also keep you from getting hard.

Erectile dysfunction can be debilitating because it can affect your ability to be intimate. Not being able to perform can damage your self-esteem and lead to strain in your romantic relationships. Erectile dysfunction can also stir up feelings of anger, disappointment, and resentment – both in you and your partner.

While ED may sound dire, there is good news: In most cases, it’s treatable. Depending on the cause, things as simple as exercise and a better diet can help. Other times, you may require the help of a medication like Cialis.

It can sometimes be difficult to determine if you’re suffering from occasional “performance anxiety” or something more serious.

According to the Cleveland Clinic, it’s completely normal if you fail to produce an erection up to 20% of the time you try.

That means if you have difficulty performing once every five times, your problem can likely be attributed to minor or temporary issues. For example, you might be tired or stressed out, or you may have had too much to drink.

On the other hand, if you can’t produce an erection 50% of the time, you are likely suffering from clinical erectile dysfunction. This is a medical condition that afflicts mens of all ages and backgrounds.

That’s right: erectile dysfunction can strike men in their 30s just as it can men in their 80s, and in both cases, it’s not normal and can usually be treated.

For 12 weeks, Mount Sinai researchers monitored nearly 2,000 men with erectile dysfunction who had begun taking tadalafil (Cialis), a once-daily medication.

Beyond improved erections, they saw an 85% boost in the men’s sexual self-confidence—measured through psychological questionnaires given throughout the study.

According to Ashutosh Tewari, MBBS, MCh, Chair of Urology at the Icahn School of Medicine at Mount Sinai (who wasn’t involved in the study), managing ED involves a mix of physical, psychological, and functional factors.

Specialist urologists play a key role in evaluating and managing ED and BPH—not merely prescribing a pill. For instance, the urology department at the Mount Sinai indicates a robust program addressing men’s health, sexual dysfunction, benign prostate conditions, and complex urologic cases.
Their approach includes:

• Thorough evaluation for underlying causes of ED (cardiovascular risk, endocrine/hormone issues, urologic anatomy)
• Discussion of lifestyle factors (weight, exercise, smoking, alcohol) that impact sexual health
• Integration of medication options (including tadalafil) alongside other therapies (counseling, devices, surgery)
• Management of BPH and urinary tract symptoms with medications (including PDE5 inhibitors) and minimally invasive options.
  Thus while telehealth and online prescribing offer convenience for tadalafil, seeing a specialist urologist (particularly if you have complicating conditions) remains important. If you live locally (in New York or near a similar tertiary centre) you may benefit from specialist consultation.

While many men can safely use tadalafil under care of a general practitioner or via telehealth, there are situations when a specialist urologist should be involved:

• If ED is newly onset and you have cardiovascular disease, diabetes, or other significant comorbidities.
• If you have complex urologic history: prior prostate surgery, prostate cancer treatment, Peyronie’s disease, penile curvature, significant BPH with urinary retention, or other anatomical issues.
• If you experience recurring or severe side effects or the drug does not work despite correct usage.
• If you have BPH with symptoms of weak stream, frequent urination at night, hesitancy, or suspicion of prostate cancer or bladder issues—then evaluation by a urologist (like at Mount Sinai) is prudent.
  In these cases, the specialist can determine whether tadalafil alone suffices, or whether other interventions (surgery, other meds) are needed.

Cialis is a brand name for the medication tadalafil. While Cialis is a medication that’s primarily used to treat erectile dysfunction (ED), it’s also prescribed to treat symptoms of benign prostatic hyperplasia (BPH) in men and pulmonary arterial hypertension (PAH) in both men and women.

Along with drugs like Viagra and Levitra, Cialis is a phosphodiesterase type 5 (PDE5) inhibitor. PDE5 is an enzyme that breaks down another molecule called cyclic guanosine monophosphate (cGMP).

When cGMP is broken down, it prevents the smoothing of muscles in the penis that are required to achieve an erection.

When prescribed for erectile dysfunction, Cialis works by relaxing the blood vessels in the body. This allows for increased blood flow to the penis, helping you to achieve and maintain an erection.

Generic Cialis contains the same active ingredient as the brand-name version — tadalafil. It works by increasing blood flow to the penis, helping men with erectile dysfunction (ED) achieve and maintain an erection.

Because it’s chemically identical to brand-name Cialis, generic tadalafil offers the same effectiveness, duration (up to 36 hours), and safety profile.

The key difference is price. Without the brand label, generic Cialis is significantly cheaper, making it a more accessible option for many men.

Whether prescribed as a daily low-dose or taken as needed, generic tadalafil provides a reliable, cost-effective solution for ED without sacrificing quality or performance.

Generic versions (tadalafil) are often available at a lower cost with the same active ingredient and results.

There’s often confusion: the brand name is Cialis, the generic form is simply tadalafil.  They are the same active compound.
Key considerations:

• Brand name (Cialis) may cost more; generic (tadalafil) is typically less expensive when available.
• Legally, generic must have same active ingredient, dosage form, safety/efficacy as the brand. Thus your doctor may feel comfortable prescribing generic Cialis.
• In some cases physicians might prefer brand name for specific patients (e.g., insurance coverage issues) but many patients shift to generic once available.

Cialis comes in two formulations:

Determining which is right for you depends on your lifestyle.

Cialis Daily is taken once a day and is available in two doses: 2.5mg and 5mg.

The lower dose of 2.5mg is generally prescribed to men who may have other health conditions that could be worsened by the medicine or who are taking other medications that could interact with higher doses of Cialis.

The primary advantage of Cialis Daily is that it allows you to have more spontaneous sexual activity, without the need to plan around the timing of the medication.

Because it provides a continuous level of the drug in your bloodstream, Cialis Daily might be the better option for you if you are relatively healthy and experience ED frequently.

The primary drawback of taking Cialis on a daily basis is that you are more likely to experience side effects because you always have the drug in your system.

Common side effects include back pain, flushing of the face, headache, indigestion, and muscle aches. More serious side effects are rare, but they can include sudden hearing loss and vision changes.

The usual recommended dose of on-demand Cialis is 10mg, but this can be adjusted based on your needs and tolerability. The maximum recommended dose is 20mg, and it’s important to not exceed this amount.

Taking more Cialis than necessary doesn’t provide better results, and it could result in worse side effects.

The primary advantage of taking Cialis as needed is that you don’t have to worry about constant side effects. While you may still experience symptoms like blurred vision or flushing, they generally go away once the medication is out of your system.

The primary drawback of on-demand Cialis is that you need to plan sexual activity around taking the pill.

While the medicine can take effect in as little as 30 minutes, it can also take an hour or longer, which prevents spontaneity.

The good news is that once Cialis kicks in, its effects can last up to 36 hours – this is how it got the name “the weekend pill”.

Cialis is one of several PDE5 inhibitors used to treat ED. Each has its own profile in terms of how fast it works, how long it lasts, and how it fits into your life. Here’s how tadalafil stacks up against other major options.

Like all medications, tadalafil comes with potential side effects and interactions. Key points:
Common/mild side effects may include headache, flushing, stuffy nose, back pain, muscle aches, indigestion, dizziness.
Serious side effects (though less common) may include:

• Prolonged erection (priapism) lasting more than 4 hours – time to seek immediate medical help.
• Sudden loss of vision in one or both eyes (possible non arteritic anterior ischemic optic neuropathy, NAION) – rare but serious.
• Sudden hearing decrease or loss.
• Significant drop in blood pressure (especially if used with nitrates or certain blood pressure drugs). For example, you should not use tadalafil with nitrates (nitroglycerin) because of risk of dangerous hypotension.
  Interactions:
• Nitrates (for chest pain) – contraindicated.
• Some antihypertensive or alpha blocker medications (for prostate/BPH) – risk of lowering blood pressure too much.
• Strong CYP3A4 inhibitors (some antifungals, HIV protease inhibitors, certain antibiotics) may raise tadalafil levels; dose adjustment may be required.
  Precautions:
• If you have cardiovascular disease, heart rhythm issues, low blood pressure, severe liver/kidney problems, you should discuss these in depth with your provider.
• Alcohol and tadalafil together can increase risk of dizziness, drop in blood pressure, fainting.
  What you should do: Use exactly as prescribed, don’t exceed the recommended dose, inform your provider of all medications (including over the counter), and monitor for any worrying symptom (vision/hearing loss, erection lasting >4 hours).

Using tadalafil is not a “magic bullet.” Success and satisfaction increase when combined with healthy lifestyle and realistic expectations. Some key points:

• Ensure modifiable risk factors for ED are addressed: cardiovascular health (blood pressure, cholesterol, smoking, exercise), glucose control if diabetic, weight management, reducing alcohol intake, good sleep.
• Understand that psychological factors (stress, anxiety, relationship issues) often contribute to ED; medication alone may not resolve all underlying issues.
• Be realistic: drug improves ability to get/keep erection when stimulated, but does not guarantee it in all situations (e.g., if underlying nerve damage or severe vascular disease).
• For BPH, using tadalafil may improve urinary symptoms – but it may not reverse prostate enlargement; surgical or other interventions may still be needed if symptoms are severe.
• Monitor your response: Talk to your doctor about how long it takes for you to respond, whether 10 mg is sufficient or you need adjustment, whether you’re comfortable with side effects or need a change.
• Understand timing: if you are using tadalafil for “as needed” ED use, plan accordingly (e.g., take it ahead of anticipated activity, but remember it remains in system for many hours).
• Keep open communication with your partner about expectations, timing, any side effects, and overall sexual health – it’s a shared issue not just individual.

It can be hard to talk about sensitive medical conditions like erectile dysfunction. Many men won’t even admit that they suffer from it, let alone seek treatment.

But the truth is, this isn’t an ailment that you have to suffer from. If you have trouble gaining or keeping an erection, you can talk to your doctor, set up a telemedicine appointment, or treat the issue yourself by buying a medicine like Cialis from an online pharmacy.

• Cialis (tadalafil) is an effective prescription medication used for ED, BPH, or both.
• It works by inhibiting PDE5 and increasing blood flow (and relaxing bladder/prostate muscles).
• The “generic vs brand” question is largely one of cost and availability; generic tadalafil is equivalent in active ingredient.
• Telehealth has improved access to prescriptions, but you still need a legitimate evaluation and monitoring.
• Cost varies, so ask about generic options, discounts, insurance issues.
• Safety is paramount: know your health status, avoid contraindicated medications (e.g., nitrates), heed side effects.
• Lifestyle factors matter – a healthy heart, good sleep, low stress, moderate alcohol, active lifestyle all support sexual health and make medication more effective.
• If you have complex health issues, or poor response to treatment, a specialist urologist (for instance at Mount Sinai) may offer advanced evaluation and options.
• Expect that medication helps with function when stimulated, but doesn’t automatically resolve all sexual or urinary problems on its own; a comprehensive approach is best.