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Sometimes people also use mutual masturbation to mean manual sex done at the same time. The maximum recommended dosing frequency is one tablet per day. Inhibits PDE5, enhancing the effects of nitric oxide released during sexual stimulation. Read this Patient Information before you start taking sildenafil 20 mg and each time you get a refill. Conivaptanconivaptan will increase the level or effect of sildenafil by affecting hepatic intestinal enzyme CYP3A4 metabolism.