Black Cialis and ED: Men's Preferred Solution
The last two decades have seen an incredible development in technology and the way erectile dysfunction develops, one of the most common diseases among adults, although it can also affect young people in more than 15% of cases.
Recently we knew little about the way the disease developed, in fact we did not know how our body worked physiologically and thought that this was a natural part of ageing, that we were all going to suffer from it at some point.
However, we witnessed some people, over 70 years old, being able to have natural erections without any problem. This is where the real change and a radical interest in discovering how our bodies work and what erectile dysfunction is.
A few decades ago, there were only intracavernous injections or intraurethral pellets to treat this disorder; but everything changed when phosphodiesterase 5 inhibitors appeared on the market. We are talking, of course, about Sildenafil, a pill that Pfizer introduced to the market in 1998.
Acceptance of this drug gradually grew, as it made treatment of the dysfunction much simpler and easier. In addition, it was annoying to have to go to the urologist every time we had to give ourselves an injection, beyond the health risk that this posed.
However, in 2003 other new drugs appeared with the same basic mechanism: Tadalafil and Vardenafil, which had special characteristics that differentiated them from Sildenafil, especially in terms of duration of effect.
What is Erectile Dysfunction?
Simply put, it is the inability to maintain an erection for the time necessary to have satisfactory sexual relations. According to the latest statistics provided by the WHO, it seems to affect more than 200 million men worldwide and this number is growing rapidly due to the unhealthy lifestyle they lead.
It seems that every year the increase in cases is around 600,000, and the ages that are most affected are always between 40-69 years. However, as mentioned above, there is a small percentage (15%) of cases in which young people (under 25) are also affected.
Unfortunately, even though people now know much more about this disease and effective ways to treat it, it remains one of the most underdiagnosed disorders. This is because it places a significant emotional burden on the men who suffer from it.
Within the causes of this disease we have psychological, hormonal, neurogenic disorders, etc. However, the most important cause is cardiovascular: the alteration of the internal layers of the arteries which are responsible for maintaining blood pressure.
It is natural to expect that in later years new, more effective treatments will appear or that they will contain another method to suppress the symptoms that appear in erectile dysfunction. It is necessary to emphasize that this disease does not only suppose a physical or biological burden for men, but also an emotional one. Therefore, treatment is necessary for good biological, psychological and social health.
Physiology and the Role of Cialis
Penis erection has several underlying processes. It is a dramatic transformation that originates in the vasculature. There are both important nerve pathways and sensory stimulation that then triggers a vascular response.
For this response to exist it is necessary for nitric oxide, a small gaseous molecule that originates in the endothelial tissue (the inner layer) of our arteries, to be released, although it can also be released from some nerve endings. These are responsible for maintaining the erection.
How does he do it? Simple: blood flow. Nitric oxide increases the diameter of the vessels that reach the penis, which increases the amount of blood that is flowing through it. Then, the corpora cavernosa (filled to the brim with blood), compress the veins that are supposed to be the blood return, so the blood gets trapped in this organ.
All this response is born from a primary sensory stimulus without which it is impossible to initiate an erection: the sexual stimulus. If there is nothing that has a sensory impact on our body, it is not possible for an erection to occur.
On the other hand, after the maximum point of the corpora cavernosa is reached, it is also possible that they contract. This not only gives the penis more rigidity, but even compresses the blood much more, so that the erection is maintained longer.
Ejaculation causes a sympathetic response, which releases certain mediators and limits the release of nitric oxide, so it is the turning point and the end of the erection. This is the way the physiology of our sexual organ works, although a bit superficial.
The multiple molecules that act as mediators of all these processes are the real secret of erectile dysfunction, and of Tadalafil. The way it works is based on these previous discoveries and the link that science has made between each of the findings.
Mechanism of Action of the Tadalafil - How it Works
Phosphodiesterase is a key enzyme in erection, especially number 5. Although there are several types of phosphodiesterase, which are found in distributed throughout the body, PDE5 is one of those responsible for maintaining an erection.
Why? Simple: this enzyme oversees degrading some molecular factors that decrease the concentration of nitric oxide and ends the erection. This is the main effect of Tadalafil, and its similar, since they inhibit this enzyme.
If we block the degradation of the molecular factors there is only one possible result: the levels of nitric oxide will increase, which will improve blood flow and increase the probability of having an erection. However, it only increases a reaction that is already present.
Therefore, if there is no basic sensory stimulus for the development of an erection, then it is not possible for Cialis and like have an effect. This is the secret of this drug and what allows you not to maintain a prolonged and infinite erection whenever you are using the drug.
Still, it is necessary for you to know every single quality and characteristic behind Cialis. As we mentioned before, the secret is to know how our body works and what we can do about it. Although Tadalafil is a great option for treating the disease, you need to know how and when to use it.
Remember, something very particular about this drug is that it has small differences with the rest of the same class (Sildenafil or Vardenafil). Despite being tiny alterations in the molecular structure, they have an incredible impact on how it works that you should know about.
Qualities and Characteristics of Tadalafil
Not all phosphodiesterase inhibitors work the same way. Tadalafil has a particularity that is its high selectivity, which is 9000 times greater than other drugs in the same family. It even appears to be so selective that it only acts on PD5 and PDE11, which is found in the prostate, and has therefore been associated with improvements in benign prostatic hyperplasia.
Other drugs in the same family, such as Sildenafil, may act on other SDPs, giving rise to unwanted adverse effects. For example, many patients have claimed to experience blue vision and this is because PDE6 acts on the determination of colors on our retina, so the effect of sildenafil on this enzyme is what causes the adverse effect.
However, it seems that Tadalafil is exempt from all these errors, so it seems to be the best option for treating this type of disease.
In addition, the best quality of Tadalafil's unique selectivity is that its potency is much greater. Of course, if the whole drug goes against just one enzyme, it is expected to have a powerful effect. However, it can be 700 times greater than sildenafil or another drug from the same group.
Dose and Absorption
To begin with, you need to visit your doctor before taking any of these drugs so that he or she can tell you if you are fit to use them. Remember, although they are quite safe, it will always depend on your state of health and other associated pathologies. A person with many cardiovascular risk factors (recent heart attack, arrhythmias, recent stroke, etc.) should not take this drug.
The dose of Tadalafil, as well as the drugs in this group, should always be adjusted as necessary. Not everyone has the same tolerance or creates the same effect. Since it can last for several days, you need to start with as little as 10mg, if you are going to use it this way, or 2.5mg a day if you are going to use it as a daily dose.
Among all the drugs in this group, Tadalafil has the slowest absorption speed, so its maximum concentration will be reached within two hours after use. However, some people (with much faster natural absorption) have observed the effect of this drug in the first 15 minutes after its use. Even so, this is not common and occurs in less than 30% of cases.
The vast majority can observe the effect after two hours. If you don't notice it until then, be patient, this will only create anxiety or you will lose confidence in the treatment, which is effective. Everyone is different and everyone responds differently to the use of the drug.
Duration of Action
The half-life, one of the most important markers of all drugs in the world, is about 4-5 times longer than that of other drugs. In young people, it has been shown to be about 17.5 hours, while in older adults it can be as long as 21.5 hours.
Some scientists assume that, because they have a much longer half-life than the rest of the drugs in this group, the risk will be much higher, however, no one has been able to prove this. The safety of this drug is much higher than the rest, especially when we consider that other treatments included frequent injections into the penis.
For this reason, it is also important to note that the standard dose of Tadalafil (10mg) cannot be consumed for two days in a row. You need to wait at least 48 hours before taking this pill again. However, as you can see, the effect is longer lasting and more effective.
Some other benefits of the long half-life of Tadalafil are still under study. However, these are not negative effects but positive ones, especially on prostatic hyperplasia as mentioned above.
Compared to the other drugs in this group, such as sildenafil and Vardenafil, we should mention that Cialis has far fewer adverse effects than expected. However, they are still present, so it is important to mention them.
Likewise, it should be noted that most patients who suffered from these effects doubled the recommended dose (10mg) and took 20mg in less than 48 hours. Even so, some people are more sensitive than others to stimulation with Tadalafil, so it is important to describe the side effects.
The most common of these was headache, in up to 15% of cases, although this is related to a slight drop in blood pressure that can be expected from long exposure to nitric oxide, a typical and important vasodilator.
However, other effects observed were dyspepsia and back pain. Even so, these effects are typical of the same vasodilation we have been describing. It is important to note that less than 0.01% of cases have reacted abnormally to the drug and developed priapism, a prolonged erection in time that does not descend after ejaculation.
|100 mg||150 mg||10 mg||20 mg||All doses||All doses|
|Urinary tract infection||–||–||–||–||3||–|
Safety of Cialis
Like all PDE5 inhibitors, cialis is an excellent drug because it has a tremendous safety rating. Still, of course, it has several contraindications and there are people who cannot use it because they have other underlying pathologies or diseases that are not compatible with this drug.
For example, when a person has a heart attack or some problem with the heart rhythm (arrhythmia) most likely he cannot use Tadalafil. This is because one of the natural responses of our heart to the mild hypotension generated by this drug (remember it is a vasodilator) is tachycardia or palpitations.
Therefore, we cannot demand from a sick heart that rather needs rest, but must take other routes and alternatives. This does not mean that Cialis causes any illness in the people who take it, but that it is not suitable for everyone.
It's like someone healthy taking a medicine to lower their blood pressure. It's only going to have a negative effect that can threaten your life.
This is where it is important to talk to your family doctor before using Cialis, especially if you are older or have any other major complications. However, it is necessary to emphasize that it is essential that the cause of your erectile dysfunction be found.
Initially, PDE5 inhibitors were considered to be a treatment for angina pectoris, one of the most common cardiovascular disorders in the world, especially in people who maintain an unhealthy lifestyle. During all the studies that were conducted, it was shown that it had a vasodilatory effect and could improve blood flow.
However, this is a drug with nitrates (nitric oxide is the basis of its action), so it can be dangerous in some people. In fact, many people use nitrates as antihypertensive drugs (in patients with high blood pressure), so the combination with cialis can be dangerous.
Still, some studies claim that Tadalafil does not cause this added effect, but it is seen with sildenafil more often. The FDA even recently changed all its parameters regarding this drug and agreed that it was not a danger to people who use nitrates to treat other diseases.
Finally, it is necessary to mention the interaction with some drugs that can affect your metabolism. For example, ketoconazole, erythromycin and other antibiotics that are metabolized in the liver by the P450 pathway may disrupt the way Cialis is metabolized.
Why is it important? Because if we use both at the same time it can increase the concentration of either, and create a real problem. Can you imagine having the effect of Cialis for more than a week in your body? It's not good at all, is it? This is what happens if Tadalafil accumulates in our body because there is no way to metabolize it.
New applications of Cialis
Recent data has shown incredible effects among the use of Tadalafil for erectile dysfunction, but also for the treatment and management of other diseases and sensitive symptoms, such as those coming from the lower urinary tract, secondary to benign prostatic hyperplasia.
Let us remember something: hyperplasia of the prostate obstructs the channel through which urine passes to the outlet, which is called the urethra. Therefore, it can very easily cause obstruction of the lower urinary tract. This is something that, according to recent studies, Tadalafil seems to be able to prevent.
In fact, cialis was tested in 281 men over a 12-week period and the results were amazing. It seems that, according to international scales measuring prostate symptoms, cialis was able to decrease them by almost 60-70%.
It seems that nitric oxide can act on the tension of the small muscles that are close to the prostate and the urethra itself, at least the segment that crosses this gland. It seems that everything is mediated by various important molecular effects.
Although it is necessary to carry out many other studies that take into account other variables and various aspects of this drug, the truth is that the effectiveness is a specific factor and perhaps can be considered in the future as a good treatment for this disease, due to the risk-benefit ratio it provides.
Other drugs that are used for prostatic hyperplasia usually have several counterproductive adverse effects or are simply not as effective. If cialis is a good option, then it should be included in the market and approved as an official drug for the treatment of that disease.
Black Cialis: The Chosen One
There are several population studies that have been done that show how cialis is one of the preferred drugs for people with erectile dysfunction. Although the comparison between both drugs only puts as a main difference the time of effect, the truth is that Tadalafil is much more powerful.
Therefore, it seems that, in many cases, the latter is the winner in surveys of patients who have used Tadalafil. What usually happens is that many people only opt for conventional viagra and do not know other options, such as Cialis.
Once they use it, even though they have used Sildenafil in the past, more than 90% of the patients usually keep Tadalafil. In fact, even in men who have only used sildenafil and tried Cialis once, 70% prefer Cialis.
These data are amazing and can tell us about the incredible effect of this drug and the effectiveness it has on almost everyone.
This is undoubtedly a safe and well-tolerated option for treating all the complications that arise from erectile dysfunction. Its effectiveness has been confirmed by numerous clinical studies and by the experience of millions of patients around the world. The best quality is its long half-life and its tremendous power, so it is an excellent solution for anyone with problems to have a satisfactory erection.
Erectile Dysfunction: A Disease Designed for Men
In times past, sex was only one of the most important facets of young people's lives, however, it was not the same for older people. Even so, the latest statistics seem to state that more than 60-70% of older people (+50 years) consider sex a priority in their lives and remain active.
The most common sexual problem in the United States for men is erectile dysfunction, especially in older people, although this is not directly related to the physiological changes of aging but is due to the various complications that can develop as we reach a certain age (diseases, medications, etc.).
Although sexual function seems to decline a little for men after the age of 50, the truth is that people who have a healthy lifestyle maintain a healthy sexual organ. The most important thing about this disease is that it has an incredible psychological impact on men, who are normally used to "dominating" and feel "impotent" when they do not achieve erections.
Because men have a greater desire for sex (most of the time) and because a large part of their lives are often directed towards thoughts of a psychological sexual origin, it is necessary to make a proper diagnosis and treatment of this disease with the various drugs and measures available.
Physiology of Erection
Erection is a rather complex process that involves specific changes in the hormonal system, but also in the vascular and neural system, and that needs a major sexual stimulus (which has a psychological impact) in order to take place.
In a few words, we can describe erection in four basic stages that we will be talking about and addressing in order to explain it more easily. It is necessary to emphasize that all these routes must be integrated together in order to give rise to the erection, but also to maintain it over time.
As we have said before, the most important thing is that in the beginning there is a natural sensory stimulus that triggers the physical response. If there is no such psychological stimulation there is no way for an erection to occur. This is a frequent problem that many people do not consider.
For example, some who often live life under great stress and have problems getting erections, perhaps the biggest disorder has to do with blocking the primary stimulus: sensory perception.
If we do not perceive a psychological stimulus that increases desire and can trigger other responses in our body, there is no way for an erection to occur. This means that our organic system is in perfect condition, but our mind is not.
Some cases can be solved easily if stress is treated as the main cause, however, we do not always realize that this is the real cause of all the misfortunes that take place in our body.
|Name of study and country||Number of patients||ED prevalence||Type of diabetes||Average age, years||The average duration of diabetes, years||Medium HbA1c||Methodology and Schools|
McCulloch et al.
|541||35%||Type 1 and 2||20-59||n / a||n / a||Self-assessment, non-validated survey|
De Berardis et al.
|1.460||34%||Type 1||62 ± 10||10 ± 9||n / a||Self-assessment, non-validated survey|
Fedele et al.
|9.868||36%||Type 1 and 2||n / a||n / a||n / a||Oral survey at 178 centers|
Bacon et al.
|2.057||45.8%||Type 1 and 2||65.8||n / a||n / a||Self-assessment, non-validated survey|
Siu et al.
|500||63.6%||Type 1 and 2||58.3 ± 10||5||7.7 ± 1.5||Oral survey|
Cho et al.
|1.312||65.4%||Type 1 and 2||53.8 ± 6.6||6||7.93||IIEF5|
Giuliano et al.
|2.377||71%||Type 1 and 2||59 ± 9||n / a||7.6 ± 1.5||IIEF5 + oral survey|
Malavige et al.
|253||73.1%||Type 1||55.6 ± 10.4||7.2||7.2 ± 1.6||IIEF5|
El-Sakka et al.
|562||86.1%||Type 1||53.7 ± 10.8||11 ± 8||n / a||IIEF|
Sasaki et al.
|1.118||90%||Type 1||59 ± 8||n / a||> 8 (31%)||IIEF5|
The erection part is a rather complicated process, but we can summarize it, almost completely, with a single molecule: nitric oxide. This is the center of the erection and the true marker that the stimulation bore fruit in the sexual organ.
Although it is a somewhat complicated process, we are going to explain it as simply as possible. In principle, the stimulation that comes from the brain (through the neuronal cords) promotes the activation of the enzymes that form nitric oxide. These are not only found in the nerve endings, but also in the inner layer of the vasculature.
Therefore, many diseases affecting the cardiovascular system, especially the endothelium of the arteries, have erectile dysfunction as a secondary complication. This is the case with diabetes, high blood pressure, and other similar diseases.
After the nitric oxide is released, the best reaction it causes begins to occur: vasodilatation. This means that the arteries, especially those of the male sex organ, begin to increase in size considerably and the blood flow to the penis increases.
The corpora cavernosa are the two most important structures in an erection. They fill up quickly with blood, thanks to the increased blood flow caused by nitric oxide, and increase in volume, which makes the penis appear to be growing.
Subsequently, with the increase in volume and the contraction of the corpora cavernosa another crucial effect of the erection is achieved: the blockage of the venous return. Since the blood does not return, it only begins to accumulate at a huge rate in the penis, which increases its size and, above all, keeps it firm over time.
This is the real mechanism by which an erection is achieved, but it is only possible if nitric oxide is frequent. This is the only real way to maintain it over time and it depends on an intricate molecular system.
Although ejaculation is what every man seeks in a sexual relationship, the truth is that our bodies go far beyond pleasure. The number of hormones released in just those seconds can have an incredible effect on our entire body.
One of the most important things that happens is the release of factors that degrade nitric oxide and prevent its normal functioning on the vasodilation of the arteries of our sexual organ. This is key to continue with the same process of erection.
The last step is the return of the penis to normal. This occurs after ejaculation in a very abrupt manner and is caused by the release of the mediators we have been mentioning throughout the article. These mediators, especially some enzymes such as phosphodiesterases, can degrade nitric oxide and block its effect.
This is the focus of many treatments for erectile dysfunction: preventing the action of these enzymes and improving our body's response to low levels of nitric oxide. For this final phase, the corpus cavernosum is also expected to relax and assist in restoring venous return.
The risk factors for erectile dysfunction are numerous. However, the vast majority point to a single problem: circulation. As we said, the key to erection is in the release of nitric oxide, especially that which comes from the inner layer of the arteries, the endothelium.
Various diseases can affect this artery area which is so delicate and important, such as hypertension, dyslipidemia, diabetes, etc. There are many diseases that may be affecting a person with erectile dysfunction, and even put his life at risk.
Some of the known risk factors, beyond those mentioned, are age, coronary disease, obesity, sedentary lifestyle, trauma, benign prostatic hyperplasia, hypogonadism, peyronie, hormonal problems, smoking, depression, alcohol, drugs, etc.
It is important to emphasize that age is not considered a risk factor by itself, that is, the physiological changes of aging cannot be included in this long list of problems. However, why are we mentioning it then?
It is most likely that when you come of age you will suffer from some chronic disease, or at least that is what the statistics say. For this reason, we often have to take medication, or the underlying pathology has a special impact on our body.
Whether it is the disease or the drugs we take, the probability of suffering from erectile dysfunction increases enormously. For this reason, indirectly, age can be an important risk factor for this disease, although it is not the main cause.
It is also necessary to emphasize that erectile dysfunction is linked to important psychological disorders. Depression, for example, has a high rate of dysfunction, especially when they are older. In fact, both have an incredible link.
As we mentioned at the beginning, depression has a direct relationship with erectile dysfunction, particularly psychological symptoms in general. Not only can depression cause this pathology, but the relationship can also work in reverse.
Diagnosis of Erectile Dysfunction
First, as mentioned above, you need to have a primary care physician who can evaluate your symptoms and conditions in a general way. This cannot be done by yourself and if you have difficulty in achieving or maintaining erections, we recommend that you see your doctor.
However, in order to educate you and show you the steps to be followed by the specialist in order to reach a diagnosis, we comment them below:
Medical History and Background
Most often behind the dysfunction is a chronic disease or disorder that involves the use of medication or that on its own may alter the functioning of the inner layer of the arteries or the action of nitric oxide.
For this reason, it is crucial that your doctor does a complete examination through a guided interview of all possible symptoms you have had, that they diagnose another disease, or about some important history (especially the presence of delicate diseases in your family).
A physical examination is then required to rule out traumatic causes or any possible indicators of underlying injury. The verification of the organ's indemnity is essential to continue with the diagnosis.
If you have an illness, your doctor may be able to provide effective treatment to control it and improve your erection status. If this does not work, of course, you will go further in diagnosis and treatment.
Multiple tests are needed to rule out the most common biological causes, such as diabetes. In addition to quantifying blood glycemia (sugar) it can also be crucial to assess fat, pressure, kidney function and other factors.
If your doctor feels you need a more comprehensive or general examination that goes beyond the laboratory tests, we recommend that you have them done. It should be noted that many times the typical clinical dysfunction of the male sexual organ exceeds the limits of blood tests, so some imaging tests may be helpful.
Of course, in most cases the cause can be psychological, so it's necessary to get an appointment with a mental health professional, especially if you feel you're burdened with stress or have some symptoms that point more toward depression.
As we mentioned at the beginning, if you are not able to have an effective first sexual stimulus, you will most likely not be able to achieve an erection. It is necessary that your mind is healthy and that your thoughts are correctly focused on the perception of the stimuli. If this does not happen, you will never be able to get an erection.
Treatment of Erectile Dysfunction
Although there are many treatments available, we would like to mention the most important ones and how they differ from each other. In addition, it is necessary to emphasize that these measures have evolved incredibly since a couple of decades ago, with the entry of Viagra and Pfizer at the head.
Some of the measures that were used before today's conventional drugs were intracavernous injections of papaverine and other intraurethral drugs that were quite annoying, although they used to accomplish the task.
Currently we have a line of drugs whose main mechanism of action is the inhibition of phosphodiesterase 5, an enzyme involved in the degradation of nitric oxide, the center of the erection. By blocking it, we indirectly increase the concentration of this vasodilator and improve the function of the penis.
Although there are several representatives in this group, the first was Sildenafil, now known as Viagra. A drug that cannot be taken more than twice a day and that has an effect of about 4-6 hours.
Other representatives of this group are Vardenafil and Tadalafil, whose half-life is the longest of all (about 24 hours), and can maintain an effect for about two days, which gives you plenty of room to keep your relationships pleasant.
By: Dr. Brent Yanke