“Sildenafil”: what it is and what your next step should be

Disclaimer: This article is for informational purposes only and does not replace professional medical advice, diagnosis, or treatment. Sildenafil (commonly known by the brand name Viagra) is a prescription medication. Always consult a licensed healthcare professional regarding symptoms, medications, and personal health decisions.

Sildenafil is a medication primarily used to treat erectile dysfunction (ED) and, in different dosages and formulations, pulmonary arterial hypertension (PAH). If you’re searching for answers about erection problems, sexual performance, or sildenafil side effects, this guide walks you through the typical user journey — from first symptoms to clear next steps.

3 typical scenarios

Scenario 1: Difficulty getting or maintaining an erection

Who/what is experienced: You notice repeated trouble achieving or maintaining an erection firm enough for sexual activity. It may happen occasionally or most of the time.

What this might mean: Occasional erectile difficulties are common and can be linked to stress, fatigue, alcohol use, or relationship factors. Persistent erectile dysfunction may be associated with cardiovascular disease, diabetes, hormonal imbalance, anxiety, depression, or medication side effects. ED can sometimes be an early marker of heart or blood vessel problems.

What a doctor usually does:

• Asks about onset, frequency, and severity of symptoms
• Reviews medical history (heart disease, diabetes, high blood pressure)
• Checks current medications (including antidepressants, blood pressure drugs)
• Performs a physical exam
• May order blood tests (glucose, cholesterol, testosterone)

If ED is confirmed and no contraindications are present, a doctor may discuss phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil as part of an evidence-based erectile dysfunction treatment plan.

Scenario 2: You have heart disease and are considering sildenafil

Who/what is experienced: You have a history of angina, heart attack, arrhythmia, or you take nitrates — and you’re wondering whether sildenafil is safe.

What this might mean: Sildenafil affects blood vessels and blood pressure. In many stable cardiac patients, it can be used safely under medical supervision. However, combining sildenafil with nitrates (such as nitroglycerin) can cause a dangerous drop in blood pressure.

What a doctor usually does:

• Evaluates cardiovascular stability
• Reviews nitrate or alpha-blocker use
• Assesses exercise tolerance (can you safely engage in sexual activity?)
• Adjusts medications if necessary

Never start sildenafil without discussing your full medication list. You can also read more in our cardiovascular risk and men’s health guide.

Scenario 3: Shortness of breath due to pulmonary arterial hypertension (PAH)

Who/what is experienced: You’ve been diagnosed with PAH or experience unexplained shortness of breath, fatigue, or chest discomfort during exertion.

What this might mean: In PAH, blood pressure in the arteries of the lungs is elevated. Sildenafil (under specific brand names and dosing regimens) helps relax pulmonary blood vessels, improving exercise capacity.

What a doctor usually does:

• Orders echocardiogram and pulmonary function tests
• May perform right heart catheterization (specialist setting)
• Assesses functional class and oxygen levels
• Prescribes targeted PAH therapy if indicated

Management of PAH is complex and typically coordinated by specialists. Explore related updates in our latest medical news and research section.

Decision tree

1. If erection problems happen rarely and during high stress → then consider stress reduction, sleep optimization, and limiting alcohol before seeking medication.
2. If erectile dysfunction persists for 3+ months → then schedule a primary care or urology appointment.
3. If you have diabetes, hypertension, or high cholesterol → then request cardiovascular risk assessment along with ED evaluation.
4. If you take nitrates or have unstable heart disease → then do not use sildenafil until cleared by your cardiologist.
5. If you are diagnosed with PAH → then follow a specialist-directed treatment plan.
6. If you experience side effects after taking sildenafil → then contact your healthcare provider before the next dose.

When to seek help urgently (red flags)

• Chest pain during or after taking sildenafil — could indicate cardiac stress.
• Severe dizziness or fainting — may signal dangerous blood pressure drop.
• Priapism (erection lasting more than 4 hours) — requires emergency care to prevent permanent damage.
• Sudden vision loss or hearing loss — rare but serious adverse events.
• Allergic reaction (swelling, difficulty breathing, rash).

Approaches to treatment/management (overview)

Treatment depends on the underlying cause.

• PDE5 inhibitors (e.g., sildenafil, tadalafil) — enhance blood flow to the penis during sexual stimulation; used as prescribed by a doctor.
• Lifestyle modification — weight loss, physical activity, smoking cessation.
• Psychological counseling — helpful if anxiety, stress, or relationship factors contribute.
• Hormone therapy — considered if clinically low testosterone is confirmed.
• Vacuum erection devices or injections — second-line options in selected cases.
• PAH-specific therapy — includes sildenafil and other vasodilators under specialist supervision.

For a broader overview of options, see our comprehensive guide to ED medications and alternatives.

Prevention

While not all causes of ED or PAH are preventable, risk reduction is possible:

• Maintain healthy blood pressure and cholesterol levels.
• Exercise regularly (aerobic + strength training).
• Stop smoking.
• Limit excessive alcohol consumption.
• Manage diabetes effectively.
• Address anxiety, depression, and chronic stress.

Preventive strategies overlap with heart health recommendations, reinforcing the connection between erectile function and vascular health.

Method	Who it suits	Limitations / Risks
Sildenafil (as prescribed)	Men with diagnosed ED without contraindications	Headache, flushing, low blood pressure; unsafe with nitrates
Lifestyle changes	Most adults, especially with metabolic risk factors	Requires consistency; gradual results
Psychotherapy	ED linked to anxiety or relationship issues	Time commitment; variable response
Hormone therapy	Confirmed low testosterone	Requires monitoring; not for all patients
PAH-targeted therapy	Patients with confirmed pulmonary arterial hypertension	Specialist supervision required

Questions to ask your doctor

1. Is my erectile dysfunction likely vascular, hormonal, psychological, or mixed?
2. Is sildenafil safe considering my heart health?
3. Are there interactions with my current medications?
4. What side effects should I watch for?
5. How long does sildenafil take to work?
6. Are there alternative PDE5 inhibitors I should consider?
7. Should I have blood tests before starting treatment?
8. Can lifestyle changes improve my condition?
9. How often can I safely use this medication?
10. When should I schedule follow-up?

Sources

• U.S. Food and Drug Administration (FDA) — Sildenafil prescribing information
• American Urological Association (AUA) — Erectile Dysfunction Guidelines
• European Association of Urology (EAU) — Sexual and Reproductive Health Guidelines
• National Heart, Lung, and Blood Institute (NHLBI) — Pulmonary Hypertension
• Mayo Clinic — Erectile Dysfunction Overview