Tadalafil 5 mg OaD is an effective short-term treatment for psychogenic ED

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Daily (once a day [OaD]) tadalafil intake is a valuable option for men favoring spontaneous over scheduled sexual intercourse.


The study sought to assess the rate of and the clinical factors associated with spontaneous, medication-free erectile function (EF) recovery after discontinuation of tadalafil 5 mg OaD in a cohort of young men seeking first medical help for psychogenic erectile dysfunction (ED) as their primary complaint.


Data from 96 consecutive patients <50 years of age seeking first medical help for ED and prescribed tadalafil 5 mg OaD were analyzed. Patients completed the International Index of Erectile Function (IIEF) and underwent baseline penile color Doppler ultrasound. Follow-up involved clinical assessments or phone interviews. Spontaneous medication-free EF recovery was defined as IIEF EF domain score >22 after tadalafil discontinuation, prompting cessation of follow-up. Descriptive statistics compared tadalafil OaD responders and nonresponders. Cox regression hazard models explored the association between baseline characteristics and EF recovery risk post–drug discontinuation. Kaplan-Meier analyses estimated EF recovery probability over time.


The primary outcome was EF recovery after discontinuation of tadalafil 5 mg OaD.


Overall, median age was 39 (interquartile range [IQR], 32-45) years. Of all, 82 (85.4%) patients achieved EF recovery after tadalafil OaD discontinuation, while 14 (14.6%) patients were identified as nonresponders. Median tadalafil usage time (from beginning to discontinuation) was 3 (IQR, 2-11) months. The most common treatment-emergent adverse event was headache in 9 (9.4%) patients. Nonresponders were older(43 [IQR, 42-45] years vs 38 [IQR, 31-44] years; P = .03), had higher body mass index (25.5 [IQR, 23.4-29.9] kg/m2 vs 23.6 [IQR, 21.8-25.9] kg/m2;P = .04), and reported lower baseline IIEF EF domain scores (12 [IQR, 7-15] vs 15 [IQR, 10-22]; P = .02) than responders. Nonresponders and responders did not differ in terms of baseline ED severity, Charlson comorbidity index, smoking, alcohol consumption, regular physical exercise,and color Doppler ultrasound parameters. Upon Cox regression analysis, younger age (hazard ratio, 0.95; 95% confidence interval, 0.92-0.99;P = .01) was associated to EF recovery, after adjusting for baseline ED severity, body mass index, smoking, and Charlson comorbidity index ≥1.The Kaplan-Meier analysis displays the probability of EF recovery over time, indicating rates of 43%, 60%, and 72% at 3-, 6-, and 12-month follow-up intervals, respectively.

Clinical Implications

Tadalafil 5 mg OaD is an effective short-term treatment for psychogenic ED, allowing its discontinuation after achieving a normal medication-free EF.

Strengths and Limitations

The main limitations are the limited number of participants and the potential neglect of confounding factors.


Almost 1 out of 2 young men with primary psychogenic ED who were prescribed with tadalafil 5 mg OaD recovered spontaneous medication-free EF after 3 months of treatment. Overall, the younger the patient was, the higher the chance there was of spontaneous EF recovery after drug discontinuation.


This study indicates that approximately half of young patients with psychogenic ED achieved medication-free EF recovery after discontinuing tadalafil 5 mg OaD over a period of 3 months of therapy. These insights are essential for health care providers to more accurately identify the patients who are most likely to benefit from a temporary course of tadalafil 5 mg OaD, ultimately enhancing sexual spontaneity and overall patient satisfaction.
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Table 1. Sociodemographic-clinical and hormonal characteristics of the whole cohort of patients and those who were tadalafil responders vs nonresponders after discontinuation of tadalafil OaD.
Table 2. Multivariate Cox regression analysis predicting spontaneous non–drug-assisted erectile function recovery after discontinuation of tadalafil OaD.
Table 3. Kaplan-Meier estimates of spontaneous non–drug-assisted erectile function recovery after discontinuation of tadalafil OaD.
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