For a decade Viagra has been putting lead in our pencils. However, as Andy van Smeerdijk discovers, it's also brought the issue of erection dysfunction out of the pencilcase.
Viagra's ability to overcome limpness is no secret. But did you know the world's best known treatment for erectile dysfunction can also prevent cut flowers from drooping?
A study found that 1mg of Viagra (Sildenafil citrate) dissolved in water prevents flowers from wilting a week longer than usual. The researchers concluded it could also potentially increase the shelf life of vegetables and fruit. Picture that.
The little blue pill has many uses. Researchers have discovered that Viagra can help hamsters recover from jet-lag and while another study found that it can be used to treat and prevent high altitude pulmonary oedema, a life-threatening condition typically associated with
mountain climbing.
So how does it actually work? To put it in layman terms, Viagra acts on a chemical enzyme that relaxes arteries, which dilate and consequently enable a greater bloodflow through them.
This is particularly useful for those who suffer from erectile dysfunction (ED) as an increased bloodflow to the penis leads to a harder erection, which makes sex possible for those who have trouble 'getting it up'.
Originally developed by pharmaceutical company Pfizer as a treatment for angina, when Sildenafil's other effect was discovered, it was trialled as a treatment for ED. Dr John Dean, one of the scientists responsible for its development, says the early trials "had some rather unexpected side effects.
"The men taking it didn't want to give their tablets back! They found they were getting better erections after taking this angina medicine."
Viagra was approved for use in the US in 1998 then subsequently worldwide. Since then more than 1.8 billion tablets have been dispensed to over 35 million men in more than 120 countries, including the UAE, where it's available by prescription.
Dr Dean, a sexual physician, has prescribed Viagra to thousands of ED sufferers. "Over the past 10 years I can attest to both its safety and efficacy across a broad range of men.
"The oldest couple I can remember in my office were 92 and 86... they'd lost their husband and wife and remarried. For a year they hadn't been able to enjoy sexual intimacy and closeness. Viagra helped them to enjoy that closeness again."
Dr Dean spoke recently at the event 'Erectile Dysfunction and the 10 Year Journey' in Cairo, hosted by the Africa Gulf Society of Sexual Medicine and sponsored by Pfizer.
Prior to Viagra, ED was viewed primarily as a psychological problem whereas now it's also recognised as a medical condition, says Dr Dean. Not only has Viagra helped men have harder erections, it's made it easier for men to talk about sex, he says.
"Before Viagra, men assumed that ED was simply something that happened as you get older; today we recognise that more than half the men over 40 have some degree of erectile dysfunction."
According to Medicalnet.com, ED is the constant inability to maintain an erection for sexual intercourse or to ejaculate - or both.
Although it often has psychological causes, its physical causes include diabetes, hypertension, prostate injuries, disorders that restrict bloodflow to the penis (eg, atherosclerosis) and the side effects of certain drugs (like protean inhibitors for HIV treatment).
Treatments include psychotherapy, vacuum devices, surgery and prescription drugs, Viagra being the pioneer of the latter. Today Viagra's the most widely used oral treatment for ED with its major competitors being Cialis and Levitra. However, there are also many counterfeits available.
Dr Dean says most sexual practitioners do much more than just prescribe pills to address ED.
"What we know now is that we need to, through individual and couple education, teach more about foreplay, how to better understand each other's medical needs. Psychological therapy, medication and surgery all can play a role in this integrated approach."
And ED must not be viewed in isolation of other ailments, he warns. "ED is an important medical condition associated with many health problems. When a man has ED we don't just treat the penis, we improve their lives and health," he says.
"Among men with ED, there's a high prevalence of high cholesterol, high blood pressure, dyslipidemia, depression and anxiety, coronary heart disease, angina, diabetes... 64 per cent of about 4000 men studied with ED reported at least one or more of these conditions. So when we treat ED we can help you through the sex life but we must also address your health.
He explains there's far more to therapy than just aiding an erection. "Sex is not just a neurovascular reflex - blood vessels and nerves. It's a social interaction involving men and women and involves an emotionally charged personal experience. Increasing the penis helps that experience in many, many ways.
"Hardness is associated with more satisfaction in the sex life and also, strangely, more satisfaction with romance. It's not that hardness makes you feel more romantic... but rather if you're less worried about disappointing your partner or your wife isn't worried that you're going to be embarrassed or uncomfortable."
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Over the years, there have been various reports on the risks of taking Viagra, particularly for those with cardio-vascular problems.
All the speakers at the Pfizer conference agreed this was largely a matter of people having taken it without consulting doctors or following the precautions on its labels.
"In clinical tests, massive amounts have been taken," says Dr Dean. "In some studies, people have taken 14 times the prescribed amount and the worst thing that happened was really bad headaches. That shows how safe this drug is."
According to Pfizer's '100 Year Anniversary Backgrounder' fact sheet, a patient's cardiovascular status should be cleared by a doctor prior to taking Viagra.
Also, people taking medicines that contain nitrates (such as nitroglycerin) should not take it. Pfizer recommends people to consult their doctor to determine whether they are healthy enough to engage in sex before taking Viagra.
It advises people who experience chest pain, nausea or any other discomforts during sex to seek medical help immediately.
Viagra has side effects, one of the more common being facial flushes. "Having a warm glow is reassuring; it's nothing to be concerned about," says Dr Dean.
"Bear in mind that 90 per cent of people have no side effects." Other minor side affects include headaches and upset stomachs.
There have also been reports of a loss of vision among people using Viagra and other oral treatments, but according to the US Food and Drug Administration website this condition (non-arteritic anterior ischemic optic neuropathy, NAION) also occurs among people who don't use Viagra and there are no links established as yet.
It occurs among many people with high blood pressure, diabetes and ailments common to ED sufferers.
One of the main thrusts of the Pfizer conference was to caution consumers to only use prescription treatments like Viagra.
Professor Mohamed Tarek Anis, president of the Pan Arab Society for Sexual Medicine, says the proliferation of counterfeits in the Middle East is a major concern and he cautions consumers against using these as they could worsen the medication condition.
"You never know what the ingredients are. People should consult a doctor and take the medicine prescribed."
Not everyone, however, turns to medication to sort out their ED. Dubai-based consulting hypnotherapist Beryl Comar treats men for ED and believes the underlying cause lies in the mind.
"Fear is our worse enemy and the underpinning of so many of our problems," she says. These fears may include performance anxiety, fear of having a heart attack while having sex, fear of being hurt emotionally or physically, fear of parental disapproval and insecurity about a relationship.
Even some of the physical ailments often associated with ED are issues of the mind, she says.
"There are some physical problems, eg prostate function, but even these are often the result of faulty thinking. Diabetes (type 2) happens to 'controllers' when they feel they are losing control and is often about not seeing the joy/sweetness in life, longing for what might have been. It is often linked to deep sorrow, as is obesity."
For treatment Comar uses neuro-linguistic programming (NLP) and Emotional Freedom Technique (EFT) in combination. Typically, ED can be overcome within a few sessions, she says.
"If there is no fear of hypnosis and willingness to do the work it can be done in one session. Five is tops; most guys get over it in around three sessions."
Some risks and side effects
- Do not take Viagra if you take any medicines or recreational drugs containing nitrates or have been told by your doctor to abstain from sexual activity because of health problems.
- Viagra can cause your blood pressure to drop suddenly to an unsafe level if taken with medicines such as nitrates and alpha-blockers, or recreational drugs called 'poppers'.
- Viagra uncommonly causes erections that won't go away and vision changes, such as seeing a blue tinge to objects. Common side effects include face flushes, headache, upset stomach, runny nose, urinary tract infection and diarrhoea
- Tell your physician if you have or had heart problems, low blood pressure or have high blood pressure that is not controlled, severe vision loss or are taking a protease inhibitor (for the treatment of HIV) or alpha blockers (for prostate problems or high blood pressure).
These are several of the risks of taking Viagra. For more comprehensive information go to www.fda.gov
Source: US Food and Drug Administration website
* Beryl Comar is managing director, The Change Associates, 050-6554523
