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    Cialis, Levitra (Vardenafil) and Viagra™ (Sildenafil) work by selectively inhibiting an enzyme in the penis called Phosphodiesterase V (PDE V), a chemical that takes away the erection. By blocking PDE V temporarily, these medications empower the chemical, Nitric Oxide (NO) that occurs naturally with arousal to initiate, produce and maintain an erection. Patients need sexual stimulation and foreplay to release NO initiate an erection in order for these medications to be effective. This class of medication is a safe and effective oral treatment for men with erectile dysfunction of physical, psychological or mixed cause. However, it is important that patients should be aware of the low probability (less than 50%) that intercourse will be possible after the first dose - particularly in severe or advanced cases and especially when using Viagra or Levitra. The majority of men who stop Viagra because of apparent lack of effect will in fact respond and achieve intercourse if they continue to try again, progress from 50 mg to 100 mg, or take the pill without food on an empty stomach (3 hours after eating). Taking Viagra or Levitra on a full stomach will not only reduce their peak concentration in the body by 30 to 50% but in addition will delay their peak concentration by one hour. In other words one may have to wait after intake before initiating sexual activity. According to an April 2014 medical journal article, Viagra (sildenafil), the most popular and well-known drug prescribed for male erectile dysfunction (ED), appears to increase the risk for malignant melanoma — but not other skin cancers like cutaneous squamous cell carcinomas nor basal cell carcinomas. The four other brand name ED drugs that are phosphodiesterase 5 (PDE5) inhibitors, Cialis (tadalafil), Levitra (vardenafil), Staxyn (vardenafil), and Stendra (avanafil) are probably associated with an increased risk of melanoma skin cancer, too. Cialis is also prescribed sometimes when doctors see the signs and symptoms of benign prostatic hyperplasia (BPH). Two other phosphodiesterase 5 (PDE5) inhibitors are Revatio (sildenafil) and Adcirca (tadalafil). These drugs are prescribed for the treatment of pulmonary arterial hypertension (PAH). Essentially, the active ingredients sildenafil, tadalifil, vardenafil, and avanafil which are found in these ED, BPH, and PAH drugs act by inhibiting the phosphodiesterase 5 (PDE5). Experimental in vitro studies show that PDE5 inhibition augments tumor cell invasiveness.

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