Kegels and tadalafil do different jobs

Published 9 September 2026.

One works on getting blood in. The other works on keeping it there. Most men who are stuck need to think about both.

What the pill does

From the Cialis label itself:

Arousal releases nitric oxide, nitric oxide raises cGMP, cGMP relaxes the smooth muscle in the corpora, and blood flows in. PDE5 breaks cGMP down and the drug blocks the breakdown. No arousal, no signal, no effect.

So it releases a brake on inflow. What it does not touch is anything mechanical. It has no effect at all on the muscles that hold pressure once the blood has arrived.

What the muscles do

Different tissue, different job. The ischiocavernosus compresses the crura at the base and drives intracavernous pressure above systolic, which is why an erection can be harder than blood pressure alone could make it. As Lavoisier and colleagues put it in Physical Therapy, those contractions come after erection, and they build and maintain rigidity.

Dorey's 2004 trial in the British Journal of General Practice taught 55 men the contraction properly and ran them for months. The trained group gained 6.7 points on the erectile function score against controls at three months.

Which half is your gap

Two rough pictures, and plenty of men are both.

If you get an erection and then lose it, partway through or on a change of position or at the point it matters, that is more often the holding half than the inflow half. A prescription may not touch it. Training is aimed straight at it.

If you struggle to get one at all, or arousal is there and nothing follows, that is the inflow half, and a prescription is the direct route.

Which is why a man can be on tadalafil, taking it correctly, and still feel that something is missing. He fixed one half.

If you are already on something

The training does not compete with your prescription and there is no reason to choose between them.

The pill needs arousal to do anything at all, and nothing about taking one removes the value of a floor that can hold what it delivers.

Where the training's record is strongest, which is ejaculatory control rather than erections, the one trial that tested a drug and pelvic floor work together came out in favour of running both. Yılmaz and colleagues randomised 65 men into three arms for twelve weeks: training alone took latency from 40 seconds to 140, dapoxetine alone 40 to 170, and the two together 42 to 205.

If you want to start a prescription

Tadalafil is contraindicated with nitrates in any form, regular or intermittent. That interaction drops blood pressure dangerously and it is the one that kills people. Also contraindicated with riociguat and similar drugs. Alpha-blockers need caution.

Common effects at as-needed doses are headache in about 11 to 15 per cent, indigestion in 8 to 10, plus back pain, muscle aches, nasal congestion and flushing. Daily low-dose is milder across the board. Rare but serious: a prolonged erection, sudden vision loss, sudden hearing loss, all reasons to stop and be seen.

Dosing is 10mg before sex, adjustable to 5 or 20, once a day at most, with an effect window up to 36 hours. Or 2.5 to 5mg daily regardless of timing. Which suits you is a conversation with a prescriber.

This article links to third-party products and services from which we may earn commissions at no extra cost to you. All clinical references are cited to peer-reviewed sources.

If you want that conversation without a waiting room, Hims runs it online and ships what gets prescribed.

Both halves

Whichever route you take on the inflow side, the holding side is trainable, and it is the half nobody hands you a prescription for. The Performance System runs twelve weeks on it, and it runs on the assumption that you may be on something.

See what's in the Performance System

The free 7-day plan is week one of it, and it costs nothing to find out whether the muscle is your gap.

Get the free 7-day plan