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by David S. Hersh, EdD, FAACS |
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Previously taboo men's medical issues such as erectile dysfunction and prostate cancer are now regularly in the headlines. Men are beginning to pay attention to the physical problems that can cause loss of life-or loss of sexual function. Viagra® has come to Canada! Like everything else, it has positives and negatives. When it debuted in the U.S., it provoked comment by the media and became the source of numerous jokes. Barbara Walters mentioned that some men want to take the pill every night, and their wives are not necessarily thrilled with the added sexual attention. Others have suggested it is the start of a new sexual revolution similar to the introduction of the birth control pill. Viagra® has been demonstrated to be effective for both physical and psychological causes of erectile failure. Nevertheless, the longer the sexual dysfunction has been going on, the less likely it is that you and your partner will return to your previous level of functioning. Over time, both of you have accommodated to the lack of erection. Unfortunately, many couples, especially where communication about sex is lacking, drift toward the complete termination of sexual relations. So, now you can enhance your erection with a pill, but it will not increase either your sexual desire (libido) or the receptivity of your partner. In fact, if someone surreptitiously slipped the drug into your drink, you would probably notice nothing at all without sexual stimulation. If sexual activity is not initiated, there will be no physical response of erection. There will be no psychic sense of having taken a drug, no feeling of getting "high." There will be no mood alteration. How will this new ability to get an erection affect other factors in your relationship? I expect it will have great impact. Some men do not initiate sex because they fear they will fail to get a really firm erection. If Viagra® gives confidence and better erections to men who occasionally get nervous or have occasional erectile problems, it may mean a more satisfying sex life overall. My concern is not with the ability of a drug to help you overcome erectile dysfunction. Anything that works! My concern is that it may be perceived as a cure-all. But what real impacts will it have, and will it actually have far reaching effects beyond helping you attain erection? Will it decrease the divorce rate? (Do women really leave their husbands because they no longer have the sexual energy of a twenty-year-old?) My experience demonstrates that the number one reason why couples break up is definitely not a man's lack of ability to achieve an erection. Both men and women need to understand that the normal aging process results in changes to our sexual functioning, which can lead to anxiety and erection problems. This drug could have an adverse effect on relationships in general, by reinforcing the cultural focus that many men have on performance and "goal-oriented sex." The situation is bad enough now. Good sex does NOT equal a good relationship. Will the use of this drug delay a man or woman from leaving a bad relationship, or allow a good relationship to continue? Will it deceive a partner into believing that he/she is really loved and wanted? I tend to believe that Viagra® will not profoundly change the manner in which men and women relate to each other. My point is simply that sex and relationships are complicated, and simple solutions are usually wishful thinking. Viagra® will not eliminate the other problems in the relationship, but may only bring them to the fore. This may occur after a period of happiness, satisfaction and experimenting with the new erection capability. A couple of words about what Viagra® does not do: it does not make men good listeners-that drug, unfortunately, is still a very long way off. It does not make men desire their partners more, make them better lovers, increase their passion or do most things that people would like it to do. There's obviously a great danger of your having unrealistic expectations in all directions. With the availability of Viagra®, you are more likely to bring your sexual questions directly to your primary care physician. Hopefully, your concern about erections will translate into paying more attention to your overall health. It will give you the opportunity to have your physical symptoms evaluated to rule out many conditions that need to be addressed prior to prescribing Viagra® for you. Your doctor will find that Viagra® is easy to prescribe, effective in most cases, and almost free of side effects. This is a wonderful advancement! Please proceed with caution and examine where it fits into your relationship.
What is Viagra® and how does it work? The effect on erection of Viagra® (sildenafil citrate) was discovered accidently. It was initially tested for heart disease, but failed. When researchers asked for it back, many of the test patients refused to return it. The researchers soon realised the unexpected side effect of improving erection. Viagra® works by prolonging smooth muscle relaxation (and hence erection) and improves blood flow to the erection chambers within the penis, and to the pelvic area in general. At the end of one study, 88% of patients reported that Viagra® improved their erections, however, many of these patients did not have an erection sufficient for penetration on a number of occasions. What should I worry about? In general, you should know there is a degree of risk to the heart with any physical activity. A thorough medical history and physical examination by a physician can rule out other diseases that can be present and contributing to your erection problems, and to be sure that you can handle the physical exertion of sex. Viagra® should not be combined with other medications for treatment of erection problems; safety studies have not been done yet. Viagra® should not be taken with medications called nitrates. Some specific examples of organic nitrates include nitroglycerin, Nitro-Bid®, Nitro-Dur®, nitropaste, or basically anything with "nitro" in it, or iso-butyl nitrate or "poppers" which are sold over-the-counter as video head cleaner or room deodorizer. You should check with your pharmacist if you are at all uncertain. To take Viagra® together with a nitrate may lead to a severe drop in blood pressure and other problems, possibly even death. Cimetidine (Tagamet®), erythromycin, ketoconazole (Nizoral®), and itraconazole all interact with the drug. Please inform all physicians you are seeing that you are taking Viagra®. Side effects from the medication include headache in approximately 16%, flushing in 10%, and abnormal vision in 3% of patients. The abnormal vision is usually mild and short-lived, predominately involving blue-tinged or blurry vision. These side effects typically occur at higher doses; however, only a few patients who experience them need to stop the medication. How much to take and when to take it. For most patients, the recommended dose is 50mg. taken approximately one hour before sexual activity. The dose can be increased to but not exceed 100mg. Regardless of the strength of medication, patients should not use more than the advised dose in a 24-hour period. Important stuff you should know. Viagra® is not an aphrodisiac. It will not increase your sexual desire. It is not a sexual device or stimulant. Viagra® improves the erectile function of your penis, but still requires appropriate sexual stimulation to help bring about a useful erection for intercourse. Taking a Viagra® tablet with little additional sexual stimulation is unlikely to lead to a good erection. All the good, old inputs are necessary and might include your partner, your mood, the setting, music, aroma, and other erotic stimuli. Each of these may enhance the quality of the erection and the overall experience. Please do yourself a favour-don't just pop one pill, get a poor erection, and feel the medication and you have failed. You need to give the medication four or five tries to have a good idea whether it will help you or not. Anticipation, the anxiety of the situation, and expectations for your performance can make the first attempts less than perfect. Can a woman use Viagra®? The drug has not been approved for use by women, but some doctors are still prescribing it. Studies are underway but have not yet been completed. Anecdotally, some women who have tried Viagra® report a sensation of warmth and openness, probably resulting from increased blood flow to the pelvic area, which has given them a pleasurable response to genital stimulation and intercourse. Call your physician if you have any questions or problems. |
Copyright © 1999 David S. Hersh, EdD, FAACS
2nd edition, July, 1999.
Dr. Hersh's web site is
http://Doctor-Sex.org
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