Archive for the ‘Viagra’ Category

This is a book about real people . The men and women who pass through my office share intimate details of their lives that would otherwise never see the light of day were it not for this book . Nat- urally , names and details have been changed in order to preserve privacy , and in many stories I have combined features from two or more patients . Each story is unique , yet there are themes familiar to every reader because of the commonality of human experience . Men want to feel powerful and capable and accepted , to be able to relate to their partners in a way that affirms these qualities . Women want to feel attractive to their partners and emotionally connected . When sex goes awry , particularly because of erection problems , not only do relationships come crashing down , but men and women lose their grip on these most fundamental human needs : secure identity and intimate connection . To be sure , the power of Viagra lies in its ability to correct a man ‘ s erection problems . Whether this fix rights the ship depends on the individuals involved and what they bring of themselves on board . So often , as the stories that follow show , men and women are at cross-purposes within their relationships and lack a shared language for understanding each other . As we are continually reminded by advertisements and testimonials in the media , Viagra can help correct the erection problem . But if a man is worried only about his lost machismo while his partner is concerned about a lack of emotional intimacy , then the reappearance of a firm penis is not likely to provide them with a happily-ever-after . Both will fall vic- tim to the Viagra Myth . To dispel this myth and help readers distinguish between fact and fiction , this book seeks to answer some of the questions most frequently raised by my patients and their partners , such as the following :

1. When is Viagra the ” perfect ” cure ?
2. When is Viagra not a cure but an obstacle to a relationship ?
3. How does a man determine whether his partner loves him or Viagra ?
4. What does a woman experience when she ‘ s with a man who can function sexually only with Viagra ?
5. If a man can function only with Viagra , does he continue to think of himself as impotent or does he feel inauthentic ?
6. Does Viagra make a man more virile , more attractive , and a better lover ?
7. What happens when a man doesn ‘ t tell his partner he ‘ s taking Viagra ? Will she know ? Is it the same as lying ?
8. What ‘ s the relationship between an erection and desire ?
9. Can Viagra work after prostate cancer surgery ?
10. If Viagra doesn ‘ t work for a man , will he ever be able to have sex again ?
11. Can a couple have sex without an erection ?
12. Does Viagra make sex less spontaneous and more predictable ?

I have written this book in the hope of provoking a more thoughtful and frank discussion about sexuality than currently exists . On a practical level , I hope that men and women can use these stories as starting points to improve the dialogue they have with each other in their relationships and ultimately to create a more fully satisfying life for themselves . I also hope this book will lead to the more realistic application of Viagra and other sexual therapies for the benefit of all men , women , and their relationships .

As someone who treats men with Viagra nearly every day , I can tes- tify to the remarkable effects of this medication . For many men and their partners , Viagra has unquestionably brought about significant improvements in their lives , and to a degree that was not previ- ously possible with other treatments . And yet there is clearly much
more to the story of human sexuality and relationships than the Viagra Myth would have us believe . The Viagra Myth has less to do with the effectiveness of the medication than with our cultural propensity to look for the easy fix . This myth suggests that a pill that improves blood flow to the penis can solve personal relation- ship issues , no matter how complex . I started wondering about the disconnect between the Viagra Myth and reality soon after I had started prescribing the medica- tion . John , a fifty-five-year-old man married for over twenty years , saw me three months after I had prescribed Viagra as treatment for his erectile dysfunction , with which he had suffered for over two years . ” So , John , how ‘ s the Viagra working out for you ?” I asked . ” Well , it works , Doc . But I don ‘ t take it anymore .” ” Why not ?” ” To tell you the truth , my wife and I decided to separate . All this time , I ‘ d thought that if I could have sex with her again , every- thing would work out fine . But it turns out that our problems are bigger than the sex thing . So we ‘ re splitting up .” Viagra had done wonders for John ‘ s erection problem but noth- ing toward solving his relationship problem . Then there was Chester , who at seventy-one years old had initially complained that his erections were only semifirm . Sex with his wife had become awkward and unsatisfying , and he asked specifically for a prescription for Viagra . It seemed a reasonable request , and his physical exam revealed no health risks , so I pre- scribed the medication . When Chester returned to the office sev- eral months later , he reported on various other medical issues but never mentioned how he was doing sexually , even though that had been the main concern for him at his last visit . ” Did you ever try the Viagra ?” I asked . Chester gave me a big smile , and there was a gleam in his eye . ” Oh , the Viagra ! Well , it definitely makes me harder !” he chuck- led . ” But I don ‘ t need it . The wife and I are okay with how things are going without it . I don ‘ t want to spoil her , you know !” John and Chester are just two examples of the many men for whom Viagra works in a physical sense as it is supposed to , but the medication failed to meet their expectations in other ways . Even when Viagra works , men like John and Chester often do not want to take it , and their reasons vary . Although I saw these men in my practice every day and intently followed their stories , I was still sur- prised to learn that the refill rate for Viagra prescriptions is less than 50 percent . What happened to the old crude joke that all a man needs in order to be happy is a hard penis and a place to put it ? Could our perception of Viagra and our sense of masculine sexual- ity be so out of kilter with reality ? Surprisingly the answer is yes . The Viagra Myth , which promotes the notion of the hard penis as the salvation of sexual relationships , is so pervasive that even professionals in the field bought into it . After reflecting on cases like those of John and Chester and their partners , I began to see an enormous gulf between appearances and reality when sexual relationships are in question . Many of my male patients , together with many of their part- ners , came to realize that finally achieving a great erection did not solve their relationship problems . In fact , it frequently made them worse . As with John and his wife , sometimes when the erection issue is solved , couples are forced to deal with more profound trou- bles in the relationship . As I listened to my patients , I came to see that our culture had taken Viagra and created a legend out of it that went far beyond its actual pharmacological properties . People had come to expect that taking a little blue pill could solve their personal and relationship problems , no matter how complex those difficulties were . I heard variations on this theme almost daily . Men or their partners requested prescriptions for Viagra for all sorts of problems , some- times with the barest of sexual symptoms : a lack of desire , struggles in existing relationships , fear of intimacy , or a desire to be a sexual superstud , for example . The range of issues for which men could envision successful treatment only with Viagra was astounding to me . This aura surrounding a medication that enhances blood flow to the penis is clearly a reflection of who we are and our desire for the easy , quick fix . I have called this exaggerated sense of Viagra as a wonder drug for various complex issues the Viagra Myth . Yes , the drug is enormously powerful , and it can be a lifesaver for many men , but it has also turned a bright spotlight on previ- ously hidden areas of sexuality and relationships . In particular , it forces couples to decide what is real in their relationships and what is not . I have come to see Viagra as providing a window into the psyche of men , and perhaps indirectly into the psyche of women as well , since women are not immune from unduly high expectations regarding the benefits of Viagra and its potential to provide sexual healing . The lessons I have teamed by listening to my patients and their partners form the basis of this book , and in the pages that follow I share the stories of those who have taught me so much about sex and sexuality and , by extension , about personal growth and humanity . The lessons to be learned are startling , profound , and often inspiring . What does it mean for a man to lose his sense of mas- culinity and self-esteem ? How does this loss manifest itself in the relationship between him and his partner ? How do couples survive when a man loses the ability to function sexually ? What is it like when his sexual powers return ? What is it like for a woman to have her partner restored to his ” youthful vigor ” after a prolonged period of inactivity ?

In 1998 , Viagra was first introduced to the world , and it is fair to say that the world has not been the same since . The impact of this medication has been enormous , not just in the narrow area of treat- ing erectile dysfunction ( ED ) for which it was approved , but also in the way we think of sex and sexuality , and even in the realm of relationships between men and women . Millions of men in the United States have tried Pfizer ‘ s wonder drug , sildenafil , better known as Viagra , and there are thus millions of women who have also seen its effects on their husbands , boyfriends , and lovers . Many other millions of men and women wonder about whether Viagra can offer a solution for their own sexual and emotional problems or for the problems of their part- ners . We human beings are sexual animals , after all . And unfortu- nately , our sex lives are not always the way we want them to be . So it ‘ s no surprise that when sex goes sour , relationships suffer in other ways as well . As a practicing urologist in Boston on the faculty of Harvard Medical School , I have treated many men with sexual problems and many couples who have sexual issues in their relationships . I knew about the development of Viagra before it was introduced to the public and was involved in its clinical application as soon as the Food and Drug Administration approved the new drug . I had anticipated using Viagra primarily for older patients with well- established erectile dysfunction , but it didn ‘ t take long before I real- ized that I had completely underestimated the huge extent of public interest in trying this new medication . For example , shortly after Viagra became available , an orthopedic surgeon came up to me in the surgeons ‘ lounge as I was having a cup of coffee between operations . ” Tell me ,” he said , ” what should I know about prescribing Viagra ? I have a patient who I think should try it .” Now I have great respect for my orthopedic colleagues , but I have yet to meet one who would take on the treatment of a problem outside his area of expertise in bones and cartilage . It was quite clear that this surgeon ‘ s patient was none other than himself ! Everyone wants to know about Viagra , and many are interested in trying it , whether or not they think they have an erection prob- lem . When I lecture to students at Harvard Medical School about sexuality , there are always a good number of Viagra questions , such as , ” What happens when a young , healthy man with normal sexual function takes Viagra ?” Or ” Can a woman tell during sex that her partner has taken Viagra ?” Or ” Is it true that Viagra increases a man ‘ s sex drive ?” No one ever falls asleep in those classes ! Viagra quickly tapped into a set of wishful fantasies that mir- rored our culture ‘ s hunger for certainty and the quick fix . Supported by stories that described elderly men restored to such sexual vital- ity by Viagra that they abandoned their wives in favor of younger women , a conventional wisdom arose that Viagra was a fountain of youth , a sure cure , the real deal . Baby boomers could now look for- ward to fabulous sex well into their nineties . Men shared Viagra stories with each other at cocktail parties or around the office water cooler . ” All I can say is ‘ Wow !”‘ says one man , and other men listen- ing in wonder how their lives might be different if they also took the magic blue pill . Women too have been targeted to confirm Viagra ‘ s ability to create satisfaction and serenity within a relationship where frustra- tion and friction had once been the rule . One of the most success- ful early Pfizer ads showed a series of couples happily dancing together after Viagra apparently cured the loss of rhythm in their relationship .

Former senator and presidential candidate Bob Dole appeared in Pfizer ads soon after Viagra ‘ s introduction and instantly turned into household words the terms Viagra and ED . Viagra jokes became a staple of comedy acts on late-night television ( Have you heard the one about the man who swallowed Viagra , but it stuck in his throat ? He wound up with a very stiff neck !), thus ensuring its place in our cultural lexicon . Viagra tapped into both our fantasies and our embarrassment about sexuality in a way that no other drug had ever done . When , for example , was the last time you heard a joke about a new cholesterol-lowering medication ? Skillful marketing contributed to our perception of Viagra as the pill that put the ” man ” in ” manly .” Star professional athletes- vigorous men such as baseball ‘ s Most Valuable Player Rafael Palmeiro of the Texas Rangers and NASCAR driver Mark Martin-endorse the medication in widely seen advertisements . Other kinds of athletes use Viagra as well . Hugh Hefner , the aging head of the Playboy empire who is known for his bevy of beautiful blondes , gives Viagra credit for maintaining his pleasure quotient . Rumor has it that he provides bowls of Viagra tablets at his famous parties . Magical Viagra . A wonder drug . Or so we have come to believe . But does the reality live up to the myth ? Is it really that good ? Can it truly solve erection problems ? What about relation- ship issues ? What does Viagra do for a man who has lost his sexual desire or for a man who is simply nervous about having sex with a new partner ? What ‘ s the real story ?

Tadalafil is a highly selective PDE5 inhibitor that is safe and efficacious
for the treatment of ED. Clinical evidence generally demonstrates
the favorable safety and efficacy profiles of the PDE5 inhibitors in most
patient populations, including men with stable ischemic heart disease
and those receiving therapy with antihypertensive agents (other than
a-blockers). These general properties also hold true for tadalafil, which
provides clinical benefits regardless of the cause or severity of ED and
may be safely used in men with comorbid conditions, such as diabetes
and hypertension in men following prostatectomy.
In both healthy men and those with cardiovascular disease, PDE5
inhibitors generally produce only mild vasodilation and minimal hemodynamic
effects and are not associated with increases in myocardial infarction
or death rates in controlled clinical trials. Clinical evidence with
tadalafil is consistent with this general statement, and it is important to note
that the majority of patients assessed at low cardiovascular risk may be
safely treated with tadalafil. Tadalafil is not associated with serious cardiovascular
adverse events, although, like other PDE5 inhibitors in its class,
its use is contraindicated in patients taking any form of organic nitrates.
When chest pain occurs more than 48 h after tadalafil administration,
however, nitrates may be used under close medical supervision. In addition,
tadalafil is contraindicated with the use of a blockers other than
0.4 mg of once-daily tamsulosin because of the potential for additive hypotensive
effects. There are no reports of increased risk of cardiovascular
mortality or morbidity after use of tadalafil, and the drug does not affect
exercise tolerance or time to ischemia during physical activity.
With its pharmacokinetic properties, which include a long duration of
action (up to 36 h), tadalafil represents a distinctly unique profile in the
pharmacotherapy of ED. The 36-h duration of action of tadalafil may
provide couples with increased flexibility by minimizing the need to schedule
sexual activity, thereby potentially increasing patient–partner satisfaction.
Additionally, the fact that neither the rate nor the extent of tadalafil
absorption is affected by the presence of high-fat food also translates into
increased flexibility for couples concerned about delayed onset of action
or reduced efficacy.

Although tadalafil, like other PDE5 inhibitors, is a vasodilator that may
augment the blood pressure-lowering effects of antihypertensive agents,
recent data show that tadalafil is safe in patients receiving two or more
concomitant antihypertensive agents. According to an analysis of
data from six placebo-controlled phase III studies of interactions between
tadalafil and commonly prescribed antihypertensive agents, a comparison
of patients receiving and not receiving antihypertensive therapy showed
comparable incidence rates of cardiovascular events. No statistically significant
differences were observed between tadalafil and placebo in the
mean changes in blood pressure from baseline in patients taking concomitant
antihypertensive therapy. Hypotension or postural hypotension was
not reported in any tadalafil-treated patients, compared with a report of
each in the placebo-treated patients. Additionally, syncope was reported in
one tadalafil-treated patient (0.1%) who was not receiving concomitant
antihypertensive medication and in two patients (1.9%) who received placebo
with concomitant antihypertensive agents. In clinical pharmacology
studies evaluating the combined efforts of tadalafil and various antihypertensive
agents on blood pressure, the additional blood pressure reduction
observed was generally mild, and there was no increase in hypotensive
symptoms. In addition, the studies demonstrated no difference in adverse
events in patients taking tadalafil with or without antihypertensive medications.