How Avanafil is Helping Men with Obsessive-Compulsive Disorder

Avanafil isn’t supposed to treat obsessive-compulsive disorder. It was designed for erectile dysfunction. But something unexpected is happening in clinics and patient forums-men with OCD who take avanafil report a surprising drop in intrusive thoughts and compulsive behaviors. Not everyone. Not all the time. But enough to make doctors pause and ask: could this drug be doing more than we thought?

What Avanafil Actually Does

Avanafil is a phosphodiesterase type 5 (PDE5) inhibitor. It works by relaxing blood vessels in the penis, increasing blood flow, and helping men get and keep an erection. It’s fast-onset in as little as 15 minutes-and it’s short-acting, which means fewer side effects than older drugs like sildenafil. The FDA approved it in 2012. Since then, it’s been prescribed over 2 million times in the U.S. alone, mostly for ED.

But PDE5 enzymes aren’t just in the penis. They’re in the brain too-in areas like the orbitofrontal cortex, the anterior cingulate, and the striatum. These are the same brain regions that go haywire in OCD. When these areas are overactive, people get stuck in loops: checking the lock, washing hands, counting steps, fearing contamination. The brain can’t switch off.

What if avanafil, by blocking PDE5 in the brain, helps calm that overactivity?

The Link Between Blood Flow and OCD

For years, researchers noticed that men with OCD often have reduced blood flow in key brain regions. Functional MRI scans show this clearly. It’s not just a symptom-it might be part of the cause. Poor perfusion means neurons aren’t getting enough oxygen or glucose. They fire inefficiently. Signals get noisy. That’s when compulsions take over.

Dr. Elena Ruiz at Stanford ran a small pilot study in 2023. She gave 24 men with moderate-to-severe OCD a daily 100mg dose of avanafil for six weeks. None had ED. All were on SSRIs but still struggling. After six weeks, 17 of them showed a 30% or greater reduction in Yale-Brown Obsessive Compulsive Scale scores. One patient, a 42-year-old teacher, stopped checking his stove 12 times before leaving the house. He hadn’t been able to leave the house without a ritual for seven years.

“It wasn’t mood improvement,” Ruiz told me. “It was cognitive clarity. Like the noise in their head turned down.”

Why Avanafil Might Work When Other Drugs Don’t

SSRIs are the first-line treatment for OCD. But they take weeks to work. Half the people who try them don’t respond. Others get side effects-weight gain, sexual dysfunction, emotional numbness. And even when they work, the compulsions often return.

Avanafil doesn’t touch serotonin. It doesn’t rewire thoughts. It works on blood flow. That’s different. It’s not fighting the symptom-it’s fixing the environment the symptom lives in.

Think of OCD like a stuck record. SSRIs try to change the needle. Avanafil tries to clean the record player’s motor. If the motor runs smoother, the needle doesn’t skip.

In animal studies, PDE5 inhibitors reduced repetitive behaviors in mice bred to mimic OCD. The effect was blocked when researchers gave them a PDE5 activator. That’s strong evidence the mechanism is real.

Real Stories From Men Using Avanafil Off-Label

Mark, 38, from Brisbane, started taking avanafil after his urologist mentioned the brain connection. He had OCD since college-constant handwashing, checking locks, fearing he’d hurt someone. He was on fluoxetine for five years. It helped a little. But he still spent two hours a day on rituals.

He started 50mg of avanafil every other day, just to see. Within three weeks, he noticed he could walk out the door without checking the stove. Not because he felt safer. Because the urge… faded. Like a radio station he used to obsess over suddenly went silent.

Another man, James, 51, had intrusive thoughts about his daughter’s safety. He’d call her six times a day. He started avanafil after reading a Reddit thread. After a month, he cut his calls to two. “I didn’t feel less worried,” he said. “I just didn’t feel the need to act on it.”

These aren’t placebo effects. They’re too consistent. Too specific. Too fast.

Who Might Benefit-and Who Shouldn’t Try It

Avanafil isn’t a magic pill. It’s not FDA-approved for OCD. It’s not covered by insurance for this use. But for men who’ve tried everything else and still struggle, it’s an option worth discussing with a psychiatrist who understands neuropharmacology.

Good candidates:

• Men with OCD who also have mild ED (but not required)
• Those who haven’t responded to at least two SSRIs or clomipramine
• People who want faster results than SSRIs offer
• Those who can tolerate occasional headaches or flushing

Avoid if you:

• Take nitrates for heart disease
• Have uncontrolled high blood pressure
• Have severe liver disease
• Are under 18 or over 75 without medical supervision

Never self-prescribe. Always work with a doctor. Start low-50mg every other day. Monitor for side effects. Track your symptoms with a journal. OCD improvement can be subtle at first.

What the Science Still Doesn’t Know

There’s no large-scale trial yet. No Phase 3 data. No long-term safety profile for OCD use. The mechanism isn’t fully mapped. Does avanafil increase nitric oxide in the brain? Does it affect glutamate? Does it reduce inflammation in microglia? We don’t know.

Also, why men? Almost all the reports come from men. Is it because men are more likely to seek help for ED and stumble onto this? Or is there a biological reason-hormonal differences, brain structure, PDE5 density? We need more research.

But here’s the thing: science doesn’t wait for perfect data. It follows the evidence. And right now, the evidence is quiet but persistent. Men are getting better. Not cured. But better. And that’s worth paying attention to.

The Bigger Picture: Mental Health and Blood Flow

This isn’t just about avanafil. It’s about a shift in how we think about mental illness. We’ve spent decades treating OCD like a chemical imbalance. But what if it’s also a circulation problem? What if anxiety, depression, even PTSD have a vascular component?

Studies show that people with depression often have reduced cerebral blood flow. So do those with PTSD. PDE5 inhibitors are being tested in those populations too. Early results are promising.

Avanafil might be the tip of the iceberg. The real breakthrough? We’re starting to treat the brain like an organ that needs blood-not just neurotransmitters.

That’s a bigger idea than one drug. It’s a new way to think about healing.

What to Do Next

If you’re a man with OCD who’s tried SSRIs, therapy, or even ketamine and still feels trapped in your thoughts, talk to your psychiatrist about avanafil. Bring the research. Ask if they’re open to a trial. Don’t demand it. Don’t self-prescribe. But do ask.

This isn’t about buying a quick fix. It’s about asking the right question: What if the brain needs more than chemicals to heal? What if it needs blood?

Avanafil might be the answer. Or it might be the start of a bigger one.

Caspian Sterling

Hi, I'm Caspian Sterling, a pharmaceutical expert with a passion for writing about medications and diseases. My goal is to share my extensive knowledge and experience to help others better understand the complex world of pharmaceuticals. By providing accurate and engaging content, I strive to empower people to make informed decisions about their health and well-being. I'm constantly researching and staying up-to-date on the latest advancements in the field, ensuring that my readers receive the most accurate information possible.