Comparative Efficacy of On-demand Sildenafil, Tadalafil, and Daily Tadalafil for Treatment of Erectile Dysfunction: A 12-week Randomized Controlled Study

Background: Erectile problems are commonly associated with marital relationship problems, leading to dissatisfaction in marital life and poor quality of life (QoL). Objectives: To compare treatment satisfaction and sexual QoL (SQoL) outcomes among Sildenafil SOS, Tadalafil SOS, and Tadalafil daily regimen in men with erectile dysfunction (ED). Method: A 12-week, prospective, open-label, comparative, interventional study on 75 men diagnosed with ED as per ICD-11 criteria were randomly allocated to three study groups 25 in each: Group A (Sildenafil SOS), Group B (Tadalafil SOS) and Group C (Tadalafil daily), based on a computer-generated random number table. Dosage of the respective drugs was kept in the therapeutic range of up to 50–100 mg of Sildenafil on an SOS basis, up to 10–20 mg of Tadalafil on an SOS basis, and a 5 mg fixed dose of Tadalafil daily in Groups A, B, and C, respectively. Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and Sexual Quality of Life Questionnaire for Males (SQoL-M) scales were administered. Results: Sildenafil SOS (Group A) showed higher EDITS scores at 4, 8, and 12 weeks ( P < .01). Tadalafil regimens (Group B> Group C) demonstrated significantly greater improvements in QoL from 4 to 12 weeks ( P < .01) compared to Group A. Conclusion: Sildenafil provided higher immediate satisfaction, while Tadalafil enhanced long-term QoL, supporting individualized, preference-based ED management.