ED Medication Is Not Scary - What You Need to Know About Viagra and Cialis
ED Medication Basics
ED medications (PDE5 inhibitors) are among the most researched and prescribed drugs in the world. Since Viagra's launch in 1998, hundreds of millions of men worldwide have used them, with well-established safety and efficacy. Three types are approved in Japan.
Sildenafil (Viagra): onset in about 1 hour, lasts 4 to 6 hours. Affected by food. Vardenafil (Levitra): onset in about 30 minutes, lasts 4 to 6 hours. Moderately affected by food. Tadalafil (Cialis): onset in 1 to 2 hours, lasts 24 to 36 hours. Minimally affected by food.
How the Medication Works
PDE5 inhibitors do not "cause" erections. They "make it easier to maintain" erections. Sexual arousal triggers nitric oxide (NO) release in the penis, which produces cGMP that dilates blood vessels and causes erection. PDE5 is an enzyme that breaks down cGMP to end the erection.
PDE5 inhibitors temporarily block this enzyme, allowing cGMP to persist longer. In other words, without sexual arousal, the medication will not produce an erection. It does not cause spontaneous erections.
Common Misconceptions and Facts
"It's Addictive" - Not True
PDE5 inhibitors have no pharmacological dependency. Stopping use causes no withdrawal symptoms, nor does it worsen natural erectile function. In fact, many cases report that successful experiences with medication resolve psychological anxiety, enabling erections without medication.
"It's Bad for the Heart" - Conditionally Safe
PDE5 inhibitors dilate blood vessels, so concurrent use with nitrates (nitroglycerin and similar drugs) is contraindicated due to the danger of a sudden drop in blood pressure. However, for men not using nitrates, cardiovascular risk is extremely low. Tadalafil is even approved as a treatment for pulmonary arterial hypertension, suggesting protective vascular effects.
"Relying on Medication When You're Young Is Shameful" - A Rational Choice
For psychogenic ED, using medication short-term as a "crutch" to build successful experiences and restore confidence is a recommended approach. This is the same as the fact that nobody says wearing glasses means "shamefully relying on lenses." Using the tools you need to solve a problem is a rational decision.
"If It Doesn't Work, It's Over" - Adjustments Are Possible
Even if the first attempt shows no effect, improvements often come from adjusting the dose, changing the timing, or reconsidering the relationship with meals. A different type may work when one doesn't suit you. Guidelines recommend trying at least 4 to 6 times before judging effectiveness.
Side Effects in Practice
The most frequently reported side effects are headache, facial flushing, nasal congestion, and indigestion. They occur because the vessel-dilating action reaches the whole body, and most are mild and temporary, subsiding once the medication wears off. Serious side effects such as priapism or sudden hearing loss are extremely rare, but if they occur, do not wait for them to resolve on their own - see a doctor immediately. For details on how often each side effect occurs, check the information leaflet given to you at the time of prescription or the package insert.
Side effects are dose-dependent, so starting with the minimum effective dose and increasing as needed is standard practice.
How to Obtain and Precautions
Use Legitimate Channels
ED medication requires a doctor's prescription. It can be prescribed at urology clinics, internal medicine, or men's health clinics. As of 2026, receiving a prescription through an online consultation and having the medication delivered to your home is also one of the options.
Some men purchase through personal import or online retailers, but counterfeit risk is extremely high. WHO has reported that among medicines bought over the internet from sites that do not disclose their physical address, more than half of the cases involved counterfeits. There are cases with no active ingredient at all, with an excessive amount, or with unrelated harmful substances mixed in, and none of this can be told from appearance alone. To protect your health, always get a prescription from a legitimate medical institution.
Rough Costs
ED medication is not covered by insurance (out of pocket). A rough guide per tablet: sildenafil (generic) 800 to 1,500 yen, tadalafil (generic) 1,000 to 1,800 yen. Initial and follow-up consultation fees are charged separately. With the arrival of generics, prices have come down considerably compared with the past.
Options Other Than Medication
ED medication is only one of the options. For psychogenic ED, counseling or cognitive behavioral therapy often brings improvement without medication. Even with organic ED, there are cases where lifestyle improvements (exercise, quitting smoking, losing weight) restore vascular function and the medication becomes unnecessary.
Whether or not to use medication is something you can decide with your doctor, choosing the approach that fits you. What matters is not leaving the problem alone but taking some kind of action.