Background: The inability to obtain and/or sustain an erection for fulfilling sexual activity is the conventional definition of erectile dysfunction. The present study was assessment of Tadalafil versus Papaverine in Pharmaco Penile Duplex Ultrasonography. Materials & Methods: 80 males with erectile dysfunction were compared using Pharmaco penile duplex ultrasonography with two protocols with one week gap. First one was ‘Tadalafil mode’ and second one was ‘Papaverine mode’. Tadalafil mode: Patients were given oral Tadalafil (20mg), 2 hours before the procedure. Papaverine mode: After 1 week, patients underwent penile doppler study following intracavernosal injection with Papaverine (60 mg). In both protocols gray scale imaging followed by duplex ultrasonography was done. The erectile response is categorised visually from E0 to E5 as proposed by Broderick GA and Arger P. Results: Age group <20 years comprised of 2, 20-30 years had 54 and 30-40 years had 16 patients. The difference was significant (P< 0.05). In tadalafil and papaverine mode, visual grading score found to be E1 in 6 and 5, E2 in 8 and 6, E3 in 10 and 9, E4 in 11 and 10 and E5 in 45 and 50 patients respectively. The difference was significant (P< 0.05).PPDU impression under Tadalafil mode and Papaverine mode found to be normal in 0 and 15, arterial insufficiency in 32 and 35, venous insufficiency in 44 and 8 and indetermined in 4 and 22 cases. Conclusion: Papaverine and tadalafil both had statistically significant outcomes that were comparable. Since tadalafil avoids the intrusiveness of papaverine, it is more effective in treating psychogenic impotence. While tadalafil administration still exhibited some practical use issues, more patients responded better to papaverine in the form of higher PSVs and improved erection response.