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 | Viagra
By Michael Spilane, MD
It is no secret that sex is popular. So maybe we shouldn't be surprised that Viagra, the new pill for male erectile dysfunction, has created such a stir. In less than three months, Viagra has achieved name recognition comparable to products like Hoover and Sunbeam that have been around for ages. The stock price of Pfizer Inc. has doubled. No new pill has ever approached the instant consumer demand being experienced by Viagra. Is this all for real?
The answer is yes. Viagra seems to deliver its promise to most men who are willing to put up eight dollars per pill. That's right, per pill. But the pill is not taken on a regular daily basisit is used one hour before anticipated sexual activity. Viagra promotes penile erection. It does not increase sexual desire.
Details of the drugs physiologic actions would bore you. Simply put, Viagra works by enhancing the effects of one of the chemicals the body normally releases into the penis following sexual arousal. This allows more blood flow into the penis. The drug was initially developed as a treatment for angina pectoris (chest pain caused by insufficient blood flow to the heart). It didn't do much for angina, but some men using the medication in research studies reported improved erectile function.
The mad rush for prescriptions is proof enough that male impotence is common. And would you believe that its incidence increases with age? By age 65 almost 25% of men complain of erectile dysfunction. Although some men maintain both interest in sexual activity and performance ability into their eighth or ninth decades, the majority have lost one or both elements of sexual function by this age.
Scientifically designed studies demonstrate that Viagra does work. Almost 70% of the nearly 4,000 men in the study trials reported improved erectile performance. Side effects were minor, but did include reports of headaches (16%), flushing (10%), and indigestion (7%). Transient disturbance of vision in 3% of the men has some ophthalmologists concerned about the potential for permanent eye damage.
Viagra can result in a drop in blood pressure. This is of particular concern in patients with heart disease and in those who are older. Although the studies found no serious problems from the pressure drops, it is a side effect that is likely to have its consequences in some. Because it may precipitate more serious decreases in blood pressure, the manufacturer advises that Viagra not be taken by those who are using any variety of nitroglycerin.
Here is my advice for older men who want to try Viagra:
- Consider waiting. The studies suggest that Viagra is safe, but the proof will come only as more men use the drug. Let others be the guinea pigs. With queues winding around the corner at the pharmacies, it shouldn't be long before possible problems are discovered.
- Remember that Viagra is not an aphrodisiac. It improves erectile function but does not enhance sexual desire. Those with no erectile problem should spend their eight dollars on a pizza.
- If you use Viagra, start with the lowest strength tablet and go higher only if side effects are absent and insufficient erectile function is achieved. Viagra comes in 25-mg, 50-mg, and 100-mg strengths. Be sure to follow package directions.
- Before taking Viagra you should get a medical evaluation, including a review of all current medications. A change of medication could be all it takes to solve an impotence problem.
- Beware of rip-offs. Over-the-counter herbal products, hyped as cures for impotence and with names similar to Viagra, have already hit the shelves. Let them rot on the selves.
We have not heard the last of reputable remedies for impotence. Other preparations with speedier action than Viagra are likely to be available soon. If wide use demonstrates that Viagra and its cousins are safe as well as effective, it is good news for the many older men who have erectile dysfunction. Whether it is good news for their wives is another matter.
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