Viagra vs Cialis: How Erection Pills Really Work (and What Nobody Tells You)

In this guide

• The myth about porn and pills
• What sildenafil and tadalafil actually do
• Viagra vs Cialis: the timing difference
• Why the pill does nothing without desire
• Side effects nobody puts in the adverts
• The warning that can save your life
• Fake pills and “herbal” boosters
• Your erection is a message from your heart
• My take

Every week someone writes to me with the same question, usually phrased as a joke: “Come on, Maximo, how many blue pills do you take before a scene?” The idea is that every man on a porn set is chemically assisted, and that the secret to performing like an actor is in a little box.

I am going to be honest with you, because that is the whole point of this guide. Yes, erection medicines exist in this industry, as they exist in every bedroom in the world. Some performers use them, some never touch them, and nobody should be ashamed either way. But the way most men understand these pills is wrong, and the wrong understanding leads to two problems: men who could be helped are too embarrassed to ask, and men who should not take them buy them from a website with no doctor behind it.

So let me explain what the medical sources actually say, and then give you my opinion as a man who has to perform on camera for a living. I am not a doctor. Everything factual below comes from the NHS, the British National Formulary and published research, and the opinions are mine.

What sildenafil and tadalafil actually do

Viagra and Cialis are brand names. The medicines inside are sildenafil (Viagra) and tadalafil (Cialis). There are others in the same family, such as vardenafil and avanafil, but these two are the ones almost everyone has heard of.

They all belong to a class called PDE5 inhibitors. In simple terms, when you are aroused your body releases chemical signals that relax the smooth muscle in the penis and let blood flow in. An enzyme called PDE5 breaks those signals down. Block the enzyme, and the “let the blood in” signal lasts longer and works more strongly.

The British National Formulary, the reference British doctors use for prescribing, says an oral PDE5 inhibitor is the first-line drug treatment for erectile dysfunction, regardless of the cause, and that these drugs “act by increasing the blood flow to the penis” (BNF, NICE).

Sildenafil was approved in the United States in 1998, and since then it has become one of the most famous medicines on the planet. In the UK, generic sildenafil can be prescribed on the NHS to any man with erectile dysfunction, and a 50 mg version, Viagra Connect, can be bought in pharmacies without a prescription after a consultation with the pharmacist (NHS BNSSG prescribing guideline).

A PDE5 inhibitor does not give you an erection. It helps your body finish what your desire starts.

Viagra vs Cialis: the timing difference

The real practical difference between the two is time. An NHS prescribing guideline from Bristol, North Somerset and South Gloucestershire puts the official product information side by side (NHS BNSSG):

The NHS page on tadalafil confirms that its effects can last up to 36 hours, which is why it got the nickname “the weekend pill”. Tadalafil can also be prescribed as a low daily dose for men who prefer not to plan sex around a tablet. The BNF describes sildenafil, vardenafil and avanafil as short-acting drugs suitable for occasional use, and tadalafil as longer-acting, which can suit more spontaneous or frequent sex.

The point about food matters more than people think. If you take sildenafil after a heavy dinner, it can take much longer to work, and many men decide “it does not work for me” after one bad attempt. The NHS sildenafil page also notes that a large meal can delay it and that drinking too much alcohol makes erections harder (NHS).

The BNF adds something very few men know: a man should try six doses of a PDE5 inhibitor at the maximum dose, with sexual stimulation, before he is classed as not responding to it. One try is not a test.

Why the pill does nothing without desire

This is the part I most want men to understand. The BNF says it plainly: these drugs “do not initiate an erection; sexual stimulation is required.”

What does that mean in real life? If you are not attracted to your partner, if you are anxious, exhausted or angry, the pill does not override that. It is not a switch. It amplifies a response that has to start somewhere.

On a professional set, that is also the reason nobody can build a career on chemistry alone. You can have perfect blood flow and still have no presence, no connection with your scene partner and no energy for the camera. The work is mental first. I wrote more about this in my guide to sexual performance anxiety, because anxiety is the number one reason young men think they need pills when what they need is to slow down and breathe.

Side effects nobody puts in the adverts

These are real medicines, with real side effects. The NHS lists the common ones for sildenafil as headaches, feeling sick, flushing, indigestion, dizziness, a blocked or runny nose and changes in vision, such as a blue tinge (NHS). Tadalafil has a similar profile, and many men notice back or muscle aches with it.

The NHS also lists rare but serious side effects, including chest pain, a sudden loss of vision or hearing, and an erection that lasts more than 4 hours, called priapism. That last one is a medical emergency, not a bragging story. If it happens, you go to A&E or the emergency room.

The warning that can save your life

If you remember only one thing from this article, remember this. Sildenafil and tadalafil must not be taken with nitrates (medicines such as glyceryl trinitrate spray, used for angina) or nicorandil, and they should be used with caution with alpha-blockers such as doxazosin or tamsulosin, which are often prescribed for blood pressure or prostate problems (NHS Highland guideline).

The reason is blood pressure. Both types of medicine widen blood vessels, and together they can drop blood pressure to a dangerous level. The NHS also warns against using them with poppers (amyl nitrite), which work in a similar way. This is a combination that circulates in party culture, and it is exactly the kind of thing that nobody warns you about at 3 a.m.

That is why I do not believe in sharing pills, buying them from a friend or taking one “for fun”. A pharmacist or doctor will ask about your heart, your blood pressure and your other medicines. Those five minutes of questions are the whole value of doing it properly.

Fake pills and “herbal” boosters

Erection medicines are among the most counterfeited drugs in the world. The NHS guideline above warns doctors that these treatments are “widely counterfeited” and to make sure patients buy from legitimate sources. Fake tablets can contain the wrong dose, no active ingredient, or other substances entirely.

The other trap is the “natural” supplement. The US Food and Drug Administration keeps a public list of sexual enhancement products sold as herbal or natural that were found to contain hidden sildenafil or tadalafil, sometimes in high doses (FDA, tainted sexual enhancement products). A man who takes nitrates and buys a “herbal” pill from a petrol station may be taking exactly the combination his doctor would forbid, without knowing it.

My rule is simple: if a product promises bigger, harder and longer without a pharmacist asking you a single question, it is either useless or dangerous.

Your erection is a message from your heart

Here is the part that turns this from a sex topic into a health topic. The NHS prescribing guideline says doctors should do a cardiac risk assessment, including a blood pressure check and blood tests, before prescribing, and it states that erectile dysfunction is a marker for cardiovascular disease (NHS BNSSG).

The arteries in the penis are small. When blood vessels start to suffer from high blood pressure, high cholesterol, smoking or diabetes, the penis can be one of the first places a man notices. So if your erections have been changing, a pill can treat the symptom, but a check-up can find the cause. I explain the lifestyle side, including food and fitness, in my guides to diet for erectile health and erectile dysfunction in young men.

The same guideline also says lifestyle changes should come before or alongside the medicine. That matches what I see. The men in my industry who last for years usually sleep properly, train, drink little and do not smoke. Pills are not a substitute for that.

When to talk to a professional

The NHS says it is time to see a GP or a sexual health clinic if erection problems keep happening, rather than once in a while (NHS, erectile dysfunction). Occasional problems are normal and are often caused by stress, tiredness or alcohol.

Go and talk to someone if:

• Your erections have changed over weeks or months, not just one night.
• You also have chest pain, shortness of breath on exertion, or diabetes.
• You take medicines for your heart, blood pressure or prostate.
• You are considering medicines but have never had a blood pressure check.
• You feel anxious or depressed about sex.

A doctor has seen everything. Nothing you say will be the strangest thing they have heard that week.

My take

I have been in this industry for 14 years, and I can tell you the men who have the longest careers are not the ones with the best pharmacy. They are the ones who take care of their bodies and their heads.

Erection medicines are a real medical achievement. They have helped millions of men and their partners, and I am completely in favour of any man using them with a doctor’s or pharmacist’s advice. What I am against is the fantasy: the idea that a tablet makes you a porn star, that it replaces desire, or that a box bought on a random website is the same as a medicine.

If you are a young man reading this because you had one bad night, please read my guide on how to last longer in bed and the one on anxiety before you go anywhere near a pill. If problems keep happening, see a professional. And if you want to know what life in this industry is really like, I write about the women I admire and their real stories on House of Maximo.

To follow my work, visit maximogarciaworld.com, and for the 18+ side, fuckingpornstars.net.

Sources

1. British National Formulary (NICE). Erectile dysfunction: treatment summary.
2. NHS. Sildenafil: a medicine for erection problems.
3. NHS. Tadalafil.
4. NHS Bristol, North Somerset and South Gloucestershire. Primary care prescribing of PDE-5 inhibitors for erectile dysfunction.
5. NHS Highland. Erectile dysfunction guidelines.
6. NHS. Erectile dysfunction (impotence).
7. US Food and Drug Administration. Tainted sexual enhancement products.