| Nearly
five years ago, diamond-shaped blue pills called Viagra
were introduced to an eager public.
Since
then, news organizations have written 54,678 stories about
Viagra. A Yahoo Internet search for Viagra produces 1.98
million hits. Jay Leno has made 944 Viagra pill jokes.
More than 20 million men around the world use it regularly.
In the U.S., one out of every five men over 40 has tried
it. An average of nine Viagra pills are dispensed every
second.
What
more could anyone possibly need to know about Viagra pills?
Plenty. Because for all its ubiquity, Viagra pills are surprisingly
misunderstood. We all know what it does -- and what it helps
men do -- but beyond that, how much does anyone really know
about the Viagra pill experience?
"It
has the name recognition of Coke and Nike," says Harin
Padma-Nathan, clinical professor of urology at the University
of Southern California Keck School of Medicine. "But
when you ask people about it beyond the name, they really
don't understand it."
Men
-- and women -- who use it rarely talk about it openly.
But in the U.S., an estimated 34% of all men ages 40 to
70 -- about 20 million men -- suffer from some significant
level of erectile dysfunction. Most of them, about 80%,
never seek treatment.
That
may change next year, when two chemically similar rivals
to Viagra are expected to hit the market, further fueling
interest in ways to treat erectile dysfunction. And new
markets for the drug are on the horizon. Studies are showing
that the drug not only can help some women, but may also
work as a preventative, helping healthy men to stave off
impotence.
So,
from doctors who prescribe it and people who use it, here
are the answers to the Viagra questions many people wonder
about -- but rarely ask.
What
Happens When a Man First Takes a Viagra Pill?
Absolutely nothing. Pfizer Inc., the maker of Viagra, long
has said the drug isn't an aphrodisiac, but many men who
take it still expect to feel something.
They
don't. Among several men interviewed who have used the drug,
not one of them experienced any feeling or sensation after
taking the pill. The nothingness is so intense that the
most common reaction is a slight panic that the drug isn't
going to work.
"That
was my worst fear, that it wasn't going to do anything,"
says Steve Brykman of Los Angeles, who tried Viagra once
nine months ago, when he believed job and financial stresses
were interfering with his sex life. After taking the pill,
"there was nothing at all," says Mr. Brykman,
33 years old. "I just felt completely normal."
Though
you may not feel anything, things are happening in the body.
As the pill moves into the bloodstream, it starts to block
an enzyme called PDE-5. Blocking the enzyme eventually increases
blood flow to areas where PDE-5 is most heavily concentrated
-- the penis, nose and skin. Diminished blood flow to the
penis is the cause of most erectile-dysfunction problems.
So How
Do You Get the Viagra pills to Start Working?
Viagra gets the blood flowing, but your brain has to be
in the mood as well. "The biggest misperception is
that it changes your psychology and makes you want sex,"
says the editor of ViagraStories.com (http://www.Viagrastories.com/),
which claims to document the experiences of real people
who take Viagra. "But if you're sitting talking to
Grandma and you pop a Viagra, unless you have issues, nothing's
going to happen."
Viagra
takes about 30 minutes to kick in. Men who don't normally
have problems, or who have only mild dysfunction, say it
takes only a minor stimulus -- such as the brush of a hand
that wouldn't cause arousal under normal circumstances --
to trigger an erection.
For
men who have serious erectile dysfunction, getting things
going may still require extra effort, partly because of
nervousness or embarrassment about unsuccessful past attempts
at intercourse.
Because
Viagra doesn't increase desire, it's not prescribed for
men with desire disorders, such as a low sex drive. However,
if the man has lost interest in sex because he has had problems
with erections in the past, Viagra may help.
Does
Taking Viagra pills Make a Man More Virile?
It might. A surprising new area of research is whether taking
a small dose of Viagra every night works as a preventative
to stave off impotence, just as people can take an aspirin
a day to prevent heart attack.
Though
you wouldn't think you'd get much out of Viagra while you're
sleeping, it turns out that nighttime erections -- most
men get three or four every night -- are crucial to maintaining
potency. Because most men don't have several erections during
the day, the nocturnal erection, which allows blood and
oxygen to flow to the genitals, is nature's way of keeping
the penis in working order. The theory is that anything
that increases the intensity and duration of nighttime erections
is good for long-term potency.
But
don't you need a sexual stimulus for Viagra to work? You
do, and the likely trigger for nighttime erections, rapid-eye-movement
sleep, is said to be the strongest sexual stimulus a man
can experience. The brain shuts down all other activity
to the penis and the level of adrenaline, which interferes
with erections, plummets.
An Italian
study of 44 men gave half the men 50 milligrams of Viagra
before they went to sleep. The men averaged 39 years of
age and didn't have erectile dysfunction. Those who took
Viagra had significantly longer and more rigid nighttime
erections than the men taking a placebo.
Irwin Goldstein, a noted Boston urologist, says about 400
of his patients are using 25 mg of Viagra each night as
a preventative measure. "Men say, 'I'm potent. I don't
want to become impotent. Is there something I can do?' "
says Dr. Goldstein. "It's a very simple strategy for
preserving sexual health."
But
while it makes sense in theory, whether nighttime Viagra
use can prevent impotence is far from proven. Pfizer says
it's studying whether nighttime Viagra use can help improve
sexual function in patients who have had prostate surgery
but it won't present the results until early next year.
Meanwhile,
it's worth noting that the best way to prevent impotence
is to keep your veins from clogging up in the first place.
Don't smoke, eat healthy foods, lose weight and lower your
cholesterol.
Do Viagra
Pills Work for Everyone?
No. Half the people who try it don't refill the prescription.
Some doctors say the 50% dropout rate is because half the
people are unsatisfied with the pill. Pfizer says that Viagra
studies show the drug doesn't work for only about a quarter
of people who try it, and that "interpersonal issues"
probably contribute to many of the other dropouts.
"Giving
somebody a good erection doesn't necessarily give somebody
good sex," says Mike Sweeney, Pfizer's senior medical
director of urology.
In a
review of 27 Viagra trials involving 6,659 men, researchers
from the Veterans Administration found that in all the studies,
Viagra worked 66% of the time, compared with 25% for men
taking a placebo.
But
while Viagra didn't work every time, 83% of the men were
able to have sex at least once during the study period,
compared with 45% in the placebo group.
When
marketing the pill to doctors, Pfizer advises that patients
try the pill as many as eight times before giving up on
it. The reason, says Pfizer, is not that it takes the pill
that long to work, but that a couple who have been plagued
by erectile dysfunction may need a few attempts to be comfortable
having sex again.
Men
who are regular users of Viagra say the pill has been a
life-changing experience. Gary Haub, 52, of Irving, Texas,
says he began suffering from erectile dysfunction about
eight years ago. Viagra worked for him the first time he
tried it, but he says the real benefit was to restore the
intimacy between him and his wife.
"I
didn't want to hold hands or put my arm around her at the
theater," he says. "When you can't perform, you
stop doing all those things. The really wonderful part about
this is that, yes, the sex is there, but the neat thing
is we're not afraid to touch or hold hands."
Who
Is The Typical Viagra Pill User?
He's about 50 years old and has at least one cardiovascular
risk factor -- such as high blood pressure, high cholesterol
or diabetes. He's married, a little bit overweight, and
was unhappy with his sexual function for two or three years
before asking about Viagra. He uses four to six pills a
month.
What
Happens if You Take Viagra and You Don't Really Need It?
Men
who say they don't have any problems achieving or maintaining
erections say that using Viagra dramatically changes the
sexual experience, but not always in a good way.
They say taking Viagra gives them a far more rigid erection
that is so intense that it's almost uncomfortable, causing
them to lose some sensation and making it difficult to finally
achieve orgasm. One person described the feeling like puffing
your cheeks full of air and then pushing them out as hard
as you can.
Others
say the physical reaction happens so effortlessly that it
becomes intense long before the man's own level of excitement
can catch up, creating a feeling of detachment. "The
disembodied feeling is a really profound feeling,"
says the ViagraStories.com editor, a 33-year-old San Francisco
man who has used the drug three times.
Mr.
Brykman, managing editor of National Lampoon, used only
one of the six pills his doctor gave him, and also says
he felt disassociated from the experience. He says that
although physically it worked, "it didn't have anything
to do with arousal. As far as excitement levels or arousal
levels, it didn't live up to my expectations."
Those
who have used Viagra "recreationally," however,
say the drug, nonetheless, makes it much easier to sustain
an erection and achieve a second erection relatively quickly
after orgasm.
Pfizer
balks at the notion of a recreational use for Viagra, contending
that if someone can feel the effect of Viagra, then they,
by definition, have lost some sexual function. And the reality
is, sexual function starts to fade in the 20s.
"Viagra
helps to improve erectile function which isn't optimal,
" says Pfizer's Dr. Sweeney. "If you're a 20-year-old
college guy with no diseases and you have great erectile
function, it's not going to do anything for you. It can't
make it go beyond normal."
What
Happens If a Woman Takes Viagra Pills?
A 47-year-old Cincinnati woman who uses Viagra regularly
says that unlike with men, Viagra in women can cause a noticeable
sensation when you take it. "I felt like there was
a tingling in the pelvic area," she says. "I could
almost feel the increase in blood flow. It felt like there
was an increase in sensitivity."
The
woman's doctor gave her Viagra after a hysterectomy made
it nearly impossible to have an orgasm. She says Viagra
has given her about 70% of her sexual function back. The
level of orgasm "is not the same to what I had prior
-- it's not as full," she says. "But it does make
it easier."
Early
studies of Viagra and women found it didn't work, but doctors
say those studies weren't selective enough and included
women with desire disorders who, like men with such problems,
can't be helped by Viagra.
As with
men, Viagra gets the blood flowing to the genitals in women.
So for women who have difficulty achieving orgasm, vaginal
dryness or a lack of sensation, arousal or engorgement,
Viagra may help.
In a
recent Pfizer-sponsored study of 200 women who either were
postmenopausal or had undergone hysterectomies and who all
suffered from some form of sexual arousal disorder, half
were given Viagra and half were given a placebo. Researchers
found that 57% of women taking Viagra reported improved
sensation in the genital area, compared with 44% in the
placebo group.
Even
so, many researchers say sexual problems are far more complex
in women than in men, and it's unlikely Viagra will ever
work as well for women as for men.
What
Are the Most Common Side Effects, and Does Everyone Get
Them?
In addition to helping you have sex, Viagra often gives
you a headache, a stuffy nose and a flushed, beet-red face.
But nobody who uses it seems to mind that much. In studies,
only about 1% of people dropped out because of side effects
-- exactly the same as those who used a placebo.
One
bizarre side effect is visual disturbances, including a
blue-green tinge to vision, which occurs about 3% of the
time. In studies, about half of men who use Viagra experience
at least one side effect, and the incidence is higher at
higher doses. Among men taking 100 mg of Viagra in five
different trials, 23% had headaches, 17% experienced a flushed
face, and 12% had upset stomach. The side effects appear
to be similar for women. Side effects tend to disappear
with use, though one patient said he liked the headache
Viagra gave him because he knew it meant he was ready.
David
Nail, 39, of West Hollywood, Calif., began using Viagra
after a car accident left him with a spinal-cord injury.
He says sex is actually better than before his accident
and he experiences a stronger orgasm. Initially, the 50
mg of Viagra he used gave him bluish vision and a mild headache.
Now he rarely gets a headache, and the vision side effect
has stopped.
"I thought, 'If this is the side effect, then I'll
be taking this until I'm 100,'" he says. "With
Viagra, I am Superman now."
What
Types of Erectile Dysfunction Are Most Easily Treated With
Viagra?
Men whose erectile dysfunction is psychologically based
fare best. Among that group, 91% were able to have sex one
or more times during treatment. Close behind were men with
vascular disease (88%) and those suffering from depression
(86%). The remaining categories include men with hypertension
(75%), diabetes (70%), ischemic heart disease (69%) and
those who've had their prostate removed (47%).
Does
Viagra Work Differently Among People of Different Races?
In the VA review of Viagra studies, Asian men had the most
success with Viagra, completing 61% of attempts to have
sex, compared with 24% for placebo. Ninety percent reported
having sex at least once in the study period.
White
men who used Viagra succeeded 45% of the time, compared
with 15% for placebo, and 75% managed to have sex at least
once. Few blacks were included in the studies, so the data
are less meaningful, although they succeeded 53% of the
time, compared with 19% for placebo, and 78% reported at
least one successful attempt at sex.
Pfizer
says that the drug works the same in all races, and that
any apparent differences are due to health differences among
the men studied. For instance, studies of Asian men included
few men with diabetes, who have lower success rates with
Viagra.
What
Happens If I Take More Than the Recommended Dose?
The size of the dose does matter. In studies of patients
who took 50 mg of Viagra, 70% reported improved erections
after 12 weeks of use. But that number jumped to 82% with
100 mg, the maximum recommended dose.
If 100
mg is good, you might think 200 mg would be better, but
that wasn't the case. In studies, 200 mg of Viagra didn't
work any better than 100 mg.
In fact,
above 100 mg, pretty much all you get out of more Viagra
is more side effects. Abnormal vision is a problem only
11% of the time with 100 mg, but jumps to between 40% and
50% with 200 mg, for instance. One-quarter of men who use
200 mg experience facial flushing, while 15% report stomach
problems.
There's
been little study of what happens when Viagra is taken at
very high doses. But in one small study of 20 healthy men
who took between 200 mg and 800 mg of Viagra, 95% experienced
some side effect that lasted far longer than usual. Vision
problems lasted as long as eight hours among the 50% of
men who experienced them. And one subject taking 600 mg
reported an erection lasting five hours, a potentially harmful
problem.
Do the
New Erectile-Dysfunction Drugs Work as Well as Viagra?
Two new drugs, Levitra, from Bayer AG and GlaxoSmithKline
PLC, and Cialis, from Eli Lilly & Co., are expected
to be introduced next year. They work the same way as Viagra,
blocking the same enzyme. Though it's unlikely any one works
better than Viagra overall, slight chemical differences
mean that if one brand doesn't work for a patient, another
one might.
A 67-year-old Boston man with diabetes says Viagra only
worked for him about 25% of the time, and only when taking
the maximum dose of 100 mg. Even then, he says, it resulted
in only a "mediocre" erection, while making him
feel lightheaded and giving him headaches and an upset stomach.
He recently took part in a Levitra study and was shocked
by the difference. "I was very, very happy," says
the man, a retired cook.
Early
studies show Levitra requires a smaller dose and works faster
than Viagra with fewer side effects. In Europe, where Cialis
has been studied longer, the drug is dubbed the "weekend
pill," because its effects last up to 36 hours.
On its
Web site, Pfizer says Viagra remains effective for about
four hours. But doctors say it actually lasts about twice
as long. A recent study from Spain reported the drug continued
working up to 12 hours after taking it.
However,
it's impossible to know how the drugs really stack up. Nobody
has studied them against one another, and because the studies
use different participants, the results can't be compared.
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