Medicine against erectile dysfunction becomes “tadala” on the networks; Doctors warn of physical and psychological risks of use without clinical indication
Tadalafil, a medication recommended to treat erectile dysfunction in men over 40, has been used recreationally by young Brazilians.
On social media, the drug gained the nickname “on purpose” and appears in videos that present it as a kind of miracle solution, capable of providing good sexual performance and even acting as a pre-workout to enhance muscle gains. The problem is that these supposed benefits are not supported by scientific evidence. In fact, the practice can be very dangerous for those who have no clinical indication.
However, it is precisely those who do not have any diagnosis who use this remedy the most. A review published in 2024 in Diversity Journal analyzed more than 20 Brazilian and foreign studies from the last two decades and revealed that, although the profile of tadalafil and similar users is heterogeneous — without a single pattern of marital status, education, race or socioeconomic status —, there is a recurring feature: the acquisition of the medication without a medical prescription.
Motivations are usually related to behavioral and psychosocial factors, such as curiosity about its effects, the desire for greater self-confidence, the pressure to perform well in the relationship and the attempt to reduce anxiety or stress before sex. “None of this, however, can be resolved with medication alone”says pharmaceutical-biochemist Gustavo Alves Andrade dos Santos, researcher at USP-RP (University of São Paulo in Ribeirão Preto) and co-author of the publication.
Tadalafil, vardenafil and sildenafil (the latter, better known by the trade name Viagra) are inhibitors of phosphodiesterase type 5 (iF5) and are indicated to combat organic erectile dysfunction. They act by relaxing penile tissues and increasing arterial flow in the corpora cavernosa of the sexual organ, generating harder erections.
This means that, in men without a physiological problem, there is no real gain. These medications are not capable of maintaining an erection for a longer period of time, nor extending coitus time or making the penis larger and thicker. “The sensation of a pump (momentary muscle swelling) reported by users is probably due to transient peripheral vasodilation and represents a placebo effect”warns the SBU (Brazilian Society of Urology), in a note published in 2025.
In other words, the effect of consumption among young people tends to be just psychological. “What happens is that, believing that their sexual performance will be better due to the use of the medication, the individual tends to feel more self-confident and less pressured”explains urologist Daniel Suslik Zylbersztejn, from Einstein Hospital Israelita. “In practice, it is a kind of psychological cane.”
RISKS TO PHYSICAL AND MENTAL HEALTH
The main side effects of phosphodiesterase type 5 inhibitors arise from the mechanism of action itself: systemic vasodilation, which leads to facial flushing and nasal congestion. However, abusive use can cause tachycardia, changes in blood pressure, fainting, temporary loss of vision or hearing and, in more serious cases, heart attack, stroke and sudden death.
Another possible consequence is priapism, an abnormal, persistent erection, not accompanied by sexual desire and, often, painful. The condition affects, above all, patients with hepatic impairment, who have difficulty metabolizing the drug, causing it to remain in the body for longer.
In recreational use, the consumption of these medicines together with alcoholic beverages can lead to a paradoxical effect: although alcohol also causes a vasodilatory action in the body, it is a depressant of the central nervous system, reducing dopaminergic activity. As a result, it may compromise erection success.
And the health risks are not just physical. “There is no evidence of physiological dependence on these medications. They do not cause withdrawal syndrome or persistent biochemical changes. However, there may be psychological dependence”points out Santos. Today, it is common for young people to have difficulty in social interactions, as communication mainly happens through messages and videos. Added to this is the impact of pornography, which creates an idealization of sex and is now more accessible. This scenario leads to relationship difficulties and frustrations.
The recreational use of drugs against erectile dysfunction appears as a device to try to deal with these insecurities. “The person starts to believe that the pills will solve their anxiety, their self-image disorders and even issues related to the ability to satisfy their partner”evaluates Zylbersztejn. “But it’s important to remember that sex isn’t just about penetration. Many men forget that. Obsession with the size of the penis or the rigidity of the erection ends up preventing these individuals from taking advantage of the situation and creating good connections.”
USE WITHOUT PRESCRIPTION OR FOLLOW-UP
In a study published in 2020 in International Journal of Clinical Practiceresearchers from Peking University, in China, interviewed more than 92 thousand young men and found that, of the almost 25 thousand who took some type of medication for erectile dysfunction, 51% did so without proper professional advice.
This is aggravated by the circulation of irregular formulations of these substances, including in Brazil. On the internet, it is not difficult to find gums and supplements that are not authorized by the National Health Surveillance Agency (Anvisa) and may present a high risk of contamination. “When these medicines are placed in packaging that does not refer to a medicine, to reach the young public, trivialization is inevitable. The only way to combat this is through guidance and awareness among the population”points out Einstein’s doctor.
The fight against self-medication can be done through educational campaigns. Furthermore, considering that a large part of purchases occur without a medical prescription, the pharmacist must also play a central role in this mission, reinforcing the mandatory prescription and providing alerts at the time of sale. “An antibiotic is not used before reaching a diagnosis, nor is a GLP-1 analogue prescribed without considering clinical criteria. The same needs to happen with tadalafil, sildenafil and vardenafil. They can only be adopted under medical indication”notes Santos.
“An isolated episode of erection failure can generate insecurity, but this is normal and does not constitute a justification for the systematic use of these medications”adds the USP-RP researcher. If this type of situation is occurring to you, seek out a specialist doctor to investigate what could be behind it and what the best treatment is.
With information from Agência Einstein.