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In one study, a 25-mg dose was shown to cause no significant change in erectile quality, but did reduce the postejaculatory refractory time.

Some users mix it with methylenedioxymethamphetamine (MDMA, ecstasy), other stimulants, or opiates in an attempt to compensate for the common side effect of erectile dysfunction, a combination known as "sextasy", "rockin' and rollin'" or "trail mix". Golombek of Universidad Nacional de Quilmes, Argentina, for their discovery that sildenafil helps treat jet lag recovery in hamsters.

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Rare but serious side effects include prolonged erections, which can lead to damage to the penis, and sudden-onset hearing loss.Sildenafil protects cyclic guanosine monophosphate (c GMP) from degradation by c GMP-specific phosphodiesterase type 5 (PDE5) in the corpus cavernosum.Nitric oxide (NO) in the corpus cavernosum of the penis binds to guanylate cyclase receptors, which results in increased levels of c GMP, leading to smooth muscle relaxation (vasodilation) of the intimal cushions of the helicine arteries.Thus, the metabolite is responsible for about 20% of sildenafil's action.Sildenafil is excreted as metabolites predominantly in the feces (about 80% of administered oral dose) and to a lesser extent in the urine (around 13% of the administered oral dose).