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Dr Nusbaum is a consultant for Bayer Corporation and receives research support from Pfizer Inc. She is also on the speakers bureau of Bayer Corporation and Pfizer Inc.

Correspondence to Margaret R. H. Nusbaum, DO, MPH, Department of Family Medicine, University of North Carolina at Chapel Hill, Manning Dr, Chapel Hill, NC 27599-7595. E-mail: margaret_nusbaum{at}med.unc.edu

No head-to-head studies have been conducted with the phosphodiesterase type 5 (PDE5) inhibitors to date. Results of noncomparative studies, however, suggest that tadalafil and vardenafil hydrochloride are at least as effective as sildenafil citrate in improving erections and increasing the number of successful intercourse attempts in men with erectile dysfunction (ED) at all levels of severity. By facilitating a sexual response, PDE5 inhibitors lend naturalness to sexual activity and may permit couples to return to their previous sexual lifestyle. By providing a broader window of opportunity, a longer-acting PDE5 inhibitor such as tadalafil adds to the variety of options currently available in managing ED with PDE5 inhibitors. This option offers increased flexibility by minimizing the need to plan sexual activity; allowing more time for intimacy or romance before sexual intercourse; and reducing the pressure on the patient to perform.