It is well known that erectile dysfunction (ED) increases in prevalence and severity as men* age. Approximately 50% of 50-year-old men have some symptoms of ED, increasing to 60% of 60-year-old men, 70% of 70-year-old men, etc.

ED is also a known indicator of underlying vascular disease: peripheral vascular disease (the ED), cerebrovascular disease (a risk for stroke), and cardiovascular disease (a risk for heart attack) (1-3). Ouch!

For decades, urologists have recognized ED as the “canary in the coal mine,” indicating a need for intervention to reduce cardiovascular disease. (4). Recently, Dr. Sarah Cipriani from the University of Florence in Italy and I documented what is likely the same set of phenomena in women, specifically: impaired sexual arousal (decreased clitoral tingling and poor, reduced, or the absence of vaginal lubrication), the equivalent of ED in men, can be signs of underlying vascular disease deserving medical attention. (5). Why is this relevant to postmenopausal women?

Everyone knows, “the little blue pill,” Viagra^® (sildenafil), and Cialis^® (tadalafil), and other medications are used to treat ED in men. They take their pill and within 30-60 minutes it helps with their erections. But both these medications, taken daily, are also used for, and FDA-approved to treat a severe cardiovascular condition ─ pulmonary hypertension. As of 2020, Daily Cialis^® (tadalafil) was also being taken by about half-a-million men (6) to treat both ED and urinary flow problems due to an enlarged prostate gland ─lower urinary tract symptoms (LUTS), consisting primarily of frequent trips to the bathroom or nighttime awakenings to urinate. Again, why is this relevant to postmenopausal women?

Because so many men take Cialis^® (tadalafil), many on a daily basis, and ED is known to be associated with vascular disease, it now appears that Cialis^® can reduce heart failure, heart attack, stroke, cardiovascular death, and all-cause mortality, including in those with type 2 diabetes (7-11). Recent research also suggests that these agents may lower the risk of peptic ulcer disease, colon cancer, and even causes of cognitive decline, including Alzheimer’s disease (12-14). All these benefits for men can likely benefit women as well.

Don’t misunderstand. I am not assuming that women are just small men. Far from it. But nearly all cardiovascular disease in women parallels those changes in men. Women’s cardiovascular systems are partially protected by their reproductive hormones until they reach menopause at about age 51, and early initiation of menopausal hormone therapy within 10 years of menopause does reduce their cardiovascular disease risks. But most menopausal hormone therapy increases estrogen levels in women to the levels of a typical 50-year-old man (yes, men have estrogen, too). So, if “what’s good for the goose is good for the gander”…or in this case…” what’s good for the gander is good for the goose”, then daily low-dose Cialis^® for women – including women receiving hormone therapy – would reduce or mitigate all the cardiovascular risks noted in men to date.

The residual (cardiovascular) benefits of Cialis^® for women are immense. But the sexual benefits of the drug – improved sexual arousal and stronger orgasms – are also significant, as significant for women as they are for men. And generic Cialis^® (tadalafil) is really inexpensive. The benefits far exceed the costs.

Why should women consider taking Cialis^®? The question really is, why shouldn’t they? If you think you would benefit from reduced cardiovascular risks, improved sexual arousal and orgasm, or all of these, call (202-293-1000) to make an appointment, and we can discuss it. Remember, our motto at IntimMedicine Specialists (www.intimmedicine.com): “You talk, I’ll Listen and We’ll Plan Together.”

*people with a penis

• Montorsi P, Ravagnani PM, Galli S, et al. Association between erectile dysfunction and coronary artery disease: matching the right target with the right test in the right patient. Eur Urol 2006;50:721–731.
• Inman BA, Sauver JL, Jacobson DJ, et al. A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc 2009;84:108–113.
• Roushias S, Ossei-Gerning N. Sexual function and cardiovascular disease: what the general cardiologist needs to know. Heart 2019;105:160–168.
• Krane RJ, Goldstein I, Saenz de Tejada I. Impotence. N Engl J Med. 1989 Dec 14;321(24):1648-59.
• Cipriani S, Simon JA. Sexual Dysfunction as a Harbinger of Cardiovascular Disease in Postmenopausal Women: How Far Are We? J Sex Med. 2022 Sep;19(9):1321-1332.
• https://clincalc.com/DrugStats/Drugs/Tadalafil
• Samidurai A, Xi L, Das A, Kukreja RC. Beyond Erectile Dysfunction: cGMP-Specific Phosphodiesterase 5 Inhibitors for Other Clinical Disorders. Annu Rev Pharmacol Toxicol. 2023 Jan 20;63:585-615.
• Swiecicka A. The efficacy of PDE5 inhibitors in diabetic patients. Andrology. 2023 Feb;11(2):245-256.
• Hutchings DC, Anderson SG, Caldwell JL, Trafford AW. Phosphodiesterase-5 inhibitors and the heart: compound cardioprotection? Heart. 2018 Aug;104(15):1244-1250.
• Tzoumas N, Farrah TE, Dhaun N, Webb DJ. Established and emerging therapeutic uses of PDE type 5 inhibitors in cardiovascular disease. Br J Pharmacol. 2020 Dec;177(24):5467-5488.
• Kloner RA, Stanek E, Crowe CL, Singhal M, Pepe RS, Bradsher J, Rosen RC. Effect of phosphodiesterase type 5 inhibitors on major adverse cardiovascular events and overall mortality in a large nationwide cohort of men with erectile dysfunction and cardiovascular risk factors: A retrospective, observational study based on healthcare claims and national death index data. J Sex Med. 2023 Jan 14;20(1):38-48.
• Jalil AT, Hassan MM, Ziyad RA, Jasim I, Zabibah R, Fadhil A. PDE5 inhibitors and gastric mucosa: implications for the management of peptic ulcer disease. Naunyn Schmiedebergs Arch Pharmacol. 2023 Apr 29.
• Islam BN, Browning DD. Phosphodiesterase-5 inhibitors for colon cancer chemoprevention. Aging (Albany NY). 2018 Sep 5;10(9):2216-2217.
• Zuccarello E, Acquarone E, Calcagno E, Argyrousi EK, Deng SX, Landry DW, Arancio O, Fiorito J. Development of novel phosphodiesterase 5 inhibitors for the therapy of Alzheimer’s disease. Biochem Pharmacol. 2020 Jun;176:113818.