Since its approval by the FDA on March 27, 1998, the medication Viagra has exploded onto news headlines and TV screens. Suddenly, it's everywhere, and the once seldom-discussed condition of impotence is being blared across living rooms, supermarkets and pharmacies in a way that is unprecedented for any other drug in history.
Can It Really Match the Hype?
If you're one of the 30 million men bearing the burden of impotence—or his partner—this may very well be a medication that will substantially change your life. Viagra is often all it's cracked up to be for the one in four men over 50, or indeed any man who can't achieve or sustain an erection capable of penetration. But if you don't fit this description, don't confuse it with a fountain of youth.
The Facts
There are 30 million men in the United States who are clinically impotent. That means they can't achieve or sustain an erection. For these men, loss of self-esteem, embarrassment, and relationship difficulties are not uncommon and can cause significant personal and emotional stress. The cause of their impotence may be psychological, resulting from stress, fatigue, anxiety, or depression.
As a man ages, his arteries gradually begin to harden. Production of important chemicals called neurotransmitters slow down. He may experience high blood pressure, diabetes, kidney problems. He may develop prostate cancer that may result in surgical removal of the organ. All of these conditions may translate to partial or total loss of sexual function. Historically, penile implants, injectable drugs (into the penis), and vacuum constriction devices have been the only options.
Dr. John Mulcahy of Indiana University, a nationally-known expert on erectile dysfunction (the scientific term for impotence), provides the reason behind Viagra's phenomenal success. "By the mid-to-late fifties, one of four men are impotent. By the mid-sixties it is half; by the mid-seventies it is most. And, Viagra is a pill." Research from the National Institutes of Health found that 5% of 40-year old men are impotent too. So the legions of men seeking prescriptions for Viagra may indeed be true sufferers of impotence. For them, the success rates with Viagra are impressive.
Success Rates for Psychological vs. Biological Causes of Impotence
For men whose impotence is caused by psychological factors, Viagra has been shown to work in 90% of these cases. For impotence that is traced to a biological cause, Viagra has a 60% to 70% rate of effectiveness. This is even true in cases of spinal cord injury, or in men who have had their prostates removed.
But impotence may also be caused by factors such as medication use and lifestyle. Keep in mind that smoking, obesity, and medications such as antidepressants and antihistamines may also reduce sexual functioning, and alteration of these factors is a better solution than Viagra.*
*For further information on the effects of medication on sexual functioning, see "Prescription Drugs and Sex: Not Always a Good Mix.
How Does Viagra Work?
What Viagra does is keep the smooth muscle of the penis relaxed. A relaxed penis allows good blood flow in and generation of an erection. The drug, known also by its scientific name of sildenafil, was first studied in England as a blood pressure medication. Although researchers were disappointed with the drug's effect on blood pressure, the study participants were enthusiastic; they were achieving sustainable erections for the first time in months or years. This caused the drug's manufacturer, Pfizer, to shift course and investigate it for impotence.
What To Watch for
Since Viagra does lower blood pressure somewhat, those taking nitrates such as nitroglycerin (which also reduces blood pressure) shouldn't take Viagra simultaneously. It may lead to fainting or other cardiac problems. Also, talk to your doctor if you're taking antibiotics or antifungal drugs, like ketoconazole, before taking Viagra.
Viagra offers few side effects. Some taking the drug experience headache, redness in the face and neck, or stomach upset. Also, some people notice vision changes. This may include noticing a blue tint or "halos." But extensive ophthalmic studies fail to show problems of the rods, cones, or retina in the eye. Overall, for men with a documented impotence problem, Viagra is a safe, effective solution.
The Myths
"Viagra won't make you 21 again," says Dr. Mulcahy. "If you're a normal 45-year old man, you can attain an erection and have intercourse, there's no reason to take this drug." Some of Dr. Mulcahy's patients believe it will make them "super-good." It won't. Neither will it improve your sex drive.
And don't confuse it with an aphrodisiac. "A 45-year old man who can't ejaculate seven days a week is not impotent," says Dr. Mulcahy. And it is not documented that Viagra will allow you to recover more quickly so that you can ejaculate every day or several times a day.
Dr. Mulcahy says Viagra will only make your erection last longer if you're having a problem with short-lasting erections. So, if you're not 21, don't expect to last for four hours—even if you take Viagra.
You won't get an instant erection after taking Viagra. The drug only allows an erection to result following sexual stimulation. No sexual stimulation; no erection. Nor will you be left with an erection that won't go away once ejaculation occurs—a condition known as priapism. In rare cases, priapism can occur, so the Viagra label now contains a warning.
What You Can Expect
If Viagra is for you, it is recommended that it be taken a half-hour before sex (an hour if you've had a fatty meal immediately prior). If sexually aroused, you'll probably get an erection. But don't worry if the kids won't go to sleep when you had planned: the effect is possible for about four hours after taking the drug.
There is no known upper age limit for Viagra to be effective. But elderly men, particularly those with severe vascular disease, may not see much improvement. Also, men who have had penile implants for impotence treatment may have some muscle scarring, which may render the medication ineffective. Further research is being conducted to determine the effects of Viagra on men with these conditions.
Insurance Issues
Insurance coverage varies based on the state you live in and the plan your employer has chosen. Some plans offer limited coverage for a few pills per month or supplemental coverage for "large purchasers." Medicaid is required to cover Viagra under their prescription drug rebate program.
Alternatives to Viagra
Although Viagra has just been introduced, other impotence pills in development will follow. One, known as Vasomax (phentolamine), has been approved for use in Mexico and Brazil, but Dr. Mulcahy says, "It is much less powerful."
Other medications using apomorphine (which targets the brain) are still being tested, and many pharmaceutical companies are developing medications of the same drug type as Pfizer's Viagra. And, an even faster-acting formulation than Viagra is on the drawing board. Pfizer and R.P. Scherer Corp. are considering developing a Viagra wafer that will dissolve instantly in the mouth making sex possible minutes afterwards. This product is still years away, if at all.
Before Viagra was available, the only other drug available for treating impotence was alprostadil. It is found in the injectable product called Caverject from Pharmacia & Upjohn. A topical gel formulation of alprostadil is now in development.
Beware of Copy-cat Drugs
There are a whole host of copycat medications and sexual-enhancing supplements available. Some are called NuMan, Stamina, Cobra, Viagro, Vaegra, ErogenUs. Don't expect the benefits of Viagra if you use these products. And, in case none of these oral medications are effective, other intraurethral and injectable agents are in development, too. They don't require sexual stimulation to produce an erection, offering another chance to men with severe impotence.
Resources:
U.S. Food and Drug Administration
http://www.fda.gov/cder/consumerinfo/druginfo/Viagra.htm
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
