Viagra / Cialis (tadalafil / sildenafil)

Cialis (tadalafil) and Viagra (sildenafil) are PDE5 inhibitors, prescription medications used primarily for erectile dysfunction (and, at different dosing, sometimes for pulmonary hypertension). They don’t create an erection by themselves—rather, they support the normal erection pathway when sexual stimulation occurs. Mechanistically, sexual stimulation triggers nitric oxide (NO) release in penile tissue, which increases cGMP and relaxes smooth muscle so more blood can flow in; PDE5 inhibitors work by slowing cGMP breakdown, helping sustain that blood-flow response (1).

In PFS/PSSD/PAS discussions, PDE5 inhibitors are often framed as symptom-support tools (blood flow/erection quality) rather than a direct “root-cause” intervention for suspected mechanisms (androgen signaling, neurosteroids/GABA changes, etc.). Many people use them specifically to improve ED function without trying to push hormones or serotonergic systems (2).

Anecdotes (Community Reports):

https://www.reddit.com/r/PSSD/comments/18ykwkd/be_careful_with_sildenafil/

https://www.reddit.com/r/FinasterideSyndrome/comments/1lygooo/guys_beware_of_viagra/

How to Interpret This Page

This page summarizes community anecdotes and informal observations, not medical evidence. “Improvement” means a person reported feeling better after an intervention; it does not prove the intervention caused the change or that it will apply to others. Outcomes can be influenced by many factors (time, stopping another trigger, dose changes, other interventions, sleep/diet), and reporting bias is common. Some substances mentioned in improvement stories are also linked to flares or worsening in other reports. Use this as a starting point for research and discussion with a licensed clinician—not as medical advice.

(1) https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/20895s039s042lbl.pdf

(2) https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/496308

Community Reports: Mixed Outcomes & Variable Risk Signal

General pattern: compared with many hormone-active or strongly serotonergic substances, Cialis/Viagra are often reported as relatively well-tolerated in PFS/PSSD/PAS communities, and many people use them for ED support without noticing broader destabilization. The typical “benefit report” is simply improved erection firmness/maintenance (sometimes with secondary benefits like reduced performance anxiety).

Not harmless / tinnitus + hearing-risk note: while uncommon, PDE5 inhibitors carry a recognized warning for sudden decrease or loss of hearing, sometimes accompanied by tinnitus and dizziness/vertigo. The FDA label for Viagra specifically instructs stopping PDE5 inhibitors and seeking prompt medical attention if sudden hearing changes occur (1). Published analyses and pharmacovigilance data also report associations between PDE5 inhibitors and hearing impairment events, including tinnitus (3).
This matters for your audience because tinnitus is already a complaint some people report in PFS contexts, so even a rare tinnitus/hearing adverse effect can feel higher-stakes for someone already sensitized (4).

(3) https://pmc.ncbi.nlm.nih.gov/articles/PMC9442443/

(4) https://www.pfsnetwork.org/symptoms/tinnitus

Other practical caution signals (apply broadly):

• Do not combine with nitrates (dangerous hypotension risk). FDA Access Data

• Watch for low blood pressure symptoms, headaches, flushing, reflux, visual changes.

• Priapism (erection >4 hours) is an emergency. FDA Access Data

How to risk-qualify as a reader:

• If your main goal is ED support, PDE5 inhibitors are often a more targeted option than “stacking” supplements that affect hormones/serotonin.

• If you’re reactive, consider lowest effective dose and avoid stacking with other vasodilators/substances that spike anxiety.

• If you notice new/worsening tinnitus, muffled hearing, or sudden hearing drop, treat it as a stop-signal and seek medical care.

Evidence Basis

Established physiology/pharmacology of PDE5 inhibitors and NO–cGMP erection signaling; FDA labeling and safety warnings (including sudden hearing loss/tinnitus language); observational/pharmacovigilance literature on hearing impairment signals; anecdotal community reports.