After months of media hype, what's the real dope on this wonder drug? A doctor gives you the hard facts.
We've all heard news stories, rumors and even jokes about Viagra, the infamous impotence drug. HMOs are battling over whether to pay for it, and over how many pills constitutes a month's supply. Men are pounding on doctors' and pharmacists' doors nationwide, clamoring for prescriptions. Even women are sampling the pills in an attempt to improve their sex lives.
But what about the facts, medically speaking? Does it work for everyone? And how safe is this stuff, anyway? We asked Dudley Danoff, MD, a Los Angeles urologist and the author of Superpotency (Warner Books, $11), for the real lowdown on the drug that's taken the country by storm.
After years of treating male sexual dysfunction, have you ever seen anything like Viagra before?
There's no question that the magic blue pill is a phenomenon no urologist has ever seen before. Nothing has come down the urological turnpike to equal the attention, the excitement, the hope that Viagra has generated.
What do guys tell you when they come to you for a Viagra prescription?
Well, I listen to what they don't say as much as what they do say. They'll come in complaining of another thing - "It hurts when I urinate," or, "There's an abrasion on my penis." Then the moment they're ready to walk out, they say, "By the way, doctor, I have trouble with erections. I can't get it up."
What kinds of men actually need to use Viagra?
Most are at least 50, older guys who really have erectile dysfunction. They can't get an erection, or they have an erection inadequate to penetrate, or they feel it's not as firm as it once was. We also see [younger] guys who get hard-ons twice a day but want six a day. But we're very cautious in giving it to them. If my patients under 40 ask for Viagra, I'm suspicious, and I'm reluctant to give them a prescription unless they have a bona fide erectile problem.
What kinds of stories do these younger men tell you?
Most are very candid and, in a way, naive. They think Viagra is a magic bullet, which it isn't. I tell them that if they're getting erections good enough for penetration, it can be downright dangerous. The result can be an erection that can't quit or lasts more than two hours; that can be very damaging to all the veins and channels in the penis.
Can't these men get any tangible benefit from Viagra?
They're mostly psychogenic. If I were to give a blue-colored placebo to 100 guys under 50 years old, 30 of them would call in the morning and say, "That pill was like magic."
If a man gets nocturnal erections, he doesn't need Viagra. Viagra will probably work, but it is probably more psychological than because of any metabolic mechanism. The men who really need Viagra are those who are medically impotent for reasons of vascular deficiency, inadequate blood flow or neurological damage.
So how do you decide which guys to prescribe it to?
I would be reluctant to write a Viagra prescription for a guy who I didn't think had erectile dysfunction, and I would advise him that it's probably not a good idea to take it. And then I have to make a clinical judgment. I like to keep patients happy, and if a guy absolutely insists on it, and I have the feeling he's going to go and get it someplace else from someone who might give Viagra in a less responsible way, I'll say, "Let me give you a small dose. Try it - don't abuse it - and let me know how you make out."
Are there also guys who come to you because they want sex all day long?
I've run into all sorts. But most people find it's hard to have sex all day - you have to work and sleep, and you have to find a willing partner.
We're hearing that Viagra helps women achieve orgasm, too. What's the story there?
There are some women asking for it, and many doctors are giving it to them. It may increase blood flow to the clitoris, which could help them have an orgasm.
We've seen news reports about older men leaving their wives for younger women because of Viagra. Is that really happening?
You can find a case to back up anything, but let's be practical. For a guy married many years, there's no question that if you're with the same woman, the edge is off. But what guy with a sane mind is going to get a hard-on, screw somebody and then leave a long-standing relationship unless there's already something seriously wrong with that relationship in the first place? It doesn't make any sense. So, in my experience, the answer is no, that doesn't happen.
For guys who need Viagra, does the effect of potency spill over into the rest of their lives? Do they feel better about themselves in general?
A guy with an erection is like the quarterback who throws the winning touchdown, the guy who hits a grand slam. A guy with an erection is the king of the world. And a man with an inadequate erection - and I don't care who he is - unless he's very psychologically stable, he feels like he's half a man.
We all worry about that day when it won't go up. We all have performance anxiety, and that's the reality. So we all feel better if we can get an erection - that's the nature of man.
RELATED ARTICLE: A spiritual remedy
Viagra may eventually have more impact on sexual relations in America than any pharmaceutical since birth-control pills became widely available in the 1960s. Back then, the Catholic church forbade its members to use the Pill, as it does any artificial method of contraception. To sidestep any potential controversy, Viagra's manufacturers went to the Vatican to ask if the church would have any objections to it. No problem, a group of papal advisors said.
Why "yes" to Viagra, and "no" to the Pill? And what do other religions have to say about the big V?
A random, unscientific sampling reveals that some of the people you'd most expect to have a problem with a super-potency drug don't. And while most of these church reps were contacted wanted to speak off the record, they did make the message clear: Using the little blue pill to improve your sex life is fine with them - if, of course, that's your wife in bed with you.
* While the Catholic church hasn't taken a public stance on Viagra, an official at a local diocese told us, "This isn't in the same category as the Pill; the Pill has to do with human life, but Viagra doesn't. Viagra could be used within a marriage."
* A spokesman for the Church of Latter Day Saints: "Church leaders haven't taken a position on Viagra, but in general, the church doesn't have any problem with sex within marriage."
* A spokesperson for the Southern Baptist Convention: "Within marriage, we're not going to stand in the way of a husband and wife trying to consummate their relationship, whether the remedy is for a husband's impotence or a wife's headaches. As far as we're concerned, a man can use a Popsicle-stick splint if that's what it takes to get it in."
RELATED ARTICLE: Impotence drugs now and in the future
Viagra isn't perfect; it has side effects, interacts dangerously with some other drugs and doesn't work equally well for everyone. But it isn't the only erection drug around; several others are available now, and more will probably be approved in the near future. If you believe your sex life could be improved with medical help, let your experience and your doctor be your guides.
Alprostadil: A chemical formulation of the hormone prostaglandin, it works by relaxing muscle cells in the penis, opening the valves that allow the shaft to fill with blood. It's used in currently available formulations such as Caverject and Edex, which you inject with a needle, and MUSE, which you insert into your penis with a special applicator. A cream version that you simply rub onto your penis is now being developed.
Invicorp: Just submitted to the FDA for approval this year, Invicorp is a combination of a protein called VIP (vasoactive intestinal polypeptide) and a chemical called phentolamine; like alporostadil, they relax the smooth muscle cells in the penis, allowing the veins in the shaft to fill the blood. Injected by an automatic device, it's supposed to be pain-free, and manufacturers claim that it works for four out of five men in tests. it can be administered immediately before sex, but manual stimulation may also be needed.
COPYRIGHT 1998 Weider Publications
COPYRIGHT 2000 Gale Group
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