This February, the Food and Drug Administration approved the lower dose versions (2.5mg and 5mg) of cialis for once-daily use. This option has been available in Europe for some time but has remained on the shelf in the USA until now. This extends the performance range of people who have erectile dysfunction (ED). The conventional tablet gives sexual potency for up to 36 hours and is most suitable for weekend or holiday use. If you get married and so want to be able to have sex on a daily basis, the new format gives you the confidence to be able to perform as and when you want. To encourage people to make a free decision on which version to buy, the pharmaceutical manufacturer, Ely Lily, has aligned the prices so there should be no difference in cost to the consumer.

This is quite a timely approval because, in late 2007, there was news that the once-daily version is very effective to relieve ED in men who have benign prostatic hypertrophy — a non-cancerous growth in the prostate — that impedes urination and produces symptoms similar to prostate cancer (known as lower urinary tract symptoms (LUTS)). This was a standard piece of medical research using the randomised, double-blind, placebo-controlled method. There were 280 participants. Eighty percent were sexually active and two thirds had a history of ED. Half the group took cialis at 5mg once a day for six weeks. The dosage was then increased to 20mg for a further six weeks. The other half of the group received a placebo for twelve weeks. The erectile function scores showed a significant improvement in the cialis group as against the placebo with there being no loss of improvement between men with moderate or severe LUTS. Cialis was effective at both low and high dosages.

This represents a major step forward. Since BPH is a benign condition, the balancing of advantages and disadvantages of surgery is more difficult. No matter how careful the surgeon may be, there is always a risk to sexual function when cutting away a growth. When the growth is cancerous, the benefit of removal clearly outweighs the disadvantage. The advantage is less clear when the growth simply causes increasing inconvenience in urination and sexual performance. With this new evidence that cialis improves sexual performance in even severe cases of LUTS at low dosage, the surgery can be postponed for far longer without inconveniencing the patient in the sexual field. Men will still have problems with urination, particularly at night but, presumably this will be tolerated given the risks involved in surgery.