Viagra, Levitra, Cialis and Your Relationship
by Dr. David S. Hersh, EdD, FAACS
Previously taboo men's medical issues such as
erectile dysfunction and prostate cancer are now regularly in
the headlines. Men are beginning to pay attention to the physical
problems that can cause loss of life—or loss of sexual function.
First there was Viagra, and now Levitra and Cialis
are the newest drugs to help erectile difficulties. Like everything
else, they have positives and negatives. When it debuted in the
U.S., it provoked comment by the media and became the source of
numerous jokes. On television, Barbara Walters mentioned that
some men want to take the pill every night, and their wives are
not necessarily thrilled with the added sexual attention. Others
have suggested it is the start of a new sexual revolution similar
to the introduction of the birth control pill.
Viagra, Levitra and Cialis have been
demonstrated to be effective for both physical and psychological
causes of erectile failure. Nevertheless, the longer
the sexual dysfunction has been going on, the less likely it is
that you and your partner will return to your previous level of
functioning. Over time, both of you have accommodated to the lack
of erection. Unfortunately, many couples, especially where communication
about sex is lacking, drift toward the complete termination of
sexual relations.
So, now you can enhance your erection with a
pill, but it will not increase either your sexual desire (libido)
or the receptivity of your partner. In fact, if someone surreptitiously
slipped the drug into your drink, you would probably notice nothing
at all without sexual stimulation. If sexual activity is not initiated,
there will be no physical response of erection. There will be
no psychic sense of having taken a drug, no feeling of getting
"high." There will be no mood alteration.
How will this new ability to get an erection
affect other factors in your relationship? I expect it will have
great impact. Some men do not initiate sex because they fear they
will fail to get a really firm erection. If Viagra, Levitra and
Cialis give confidence and better erections to men who occasionally
get nervous or have occasional erectile problems, it may mean
a more satisfying sex life overall.
My concern is not with the ability of a drug
to help you overcome erectile dysfunction. Anything that works!
My concern is that it may be perceived as a cure-all. But what
real impacts will it have, and will it actually have far reaching
effects beyond helping you attain erection? Will it decrease the
divorce rate? (Do women really leave their husbands because they
no longer have the sexual energy of a twenty-year-old?) My experience
demonstrates that the number one reason why couples break up is
definitely not a man's lack of ability to achieve an erection.
Both men and women need to understand that the normal aging process
results in changes to our sexual functioning, which can lead to
anxiety and erection problems.
This drug could have an adverse effect on relationships
in general, by reinforcing the cultural focus that many men have
on performance and "goal-oriented sex." The situation
is bad enough now. Good sex does NOT equal a good relationship.
SOME FREQUENTLY ASKED QUESTIONS
about erectile dysfunction drugs
What are Viagra, Levitra and Cialis and how
do they work?
The effect on erection of Viagra (sildenafil
citrate) was discovered accidentally. It was initially tested
for heart disease, but failed. When researchers asked for it back,
many of the test patients refused to return it. The researchers
soon realised the unexpected side effect of improving erection.
Viagra, Levitra and Cialis work by prolonging
smooth muscle relaxation (and hence erection) and widening, and
improves blood flow to the erection chambers within the penis,
and to the pelvic area in general.
The active ingredient works specifically on the
chain of events that occur in the penis during arousal. They belong
to a class of drugs called “PDE-5 inhibitors,” and
they block an enzyme called phosphodiesterase-5, or PDE-5.
What should I worry about?
In general, you should know there is a degree
of risk to the heart with any physical activity. A thorough medical
history and physical examination by a physician can rule out other
diseases that can be present and contributing to your erection
problems, and to be sure that you can handle the physical exertion
of sex.
Viagra, Levitra and Cialis should not be combined
with other medications for treatment of erection problems; safety
studies have not been done yet.
Viagra, Levitra and Cialis should not be taken
with medications called nitrates. Some specific examples of organic
nitrates include nitroglycerin, Nitro-Bid®, Nitro-Dur®,
nitropaste, or basically anything with "nitro" in it,
or iso-butyl nitrate or "poppers" which are sold over-the-counter
as video head cleaner or room deodorizer. You should check with
your pharmacist if you are at all uncertain. To take Viagra, Levitra
or Cialis together with a nitrate may lead to a severe drop in
blood pressure and other problems, possibly even death.
Cimetidine (Tagamet), erythromycin, ketoconazole
(Nizoral), and Itraconazole all interact with the drug. Please
inform all physicians you are seeing that you are taking Viagra,
Levitra or Cialis.
Side effects from the medication include headache
in approximately 16%, flushing in 10%, and abnormal vision in
3% of patients. The abnormal vision is usually mild and short-lived,
predominately involving blue-tinged or blurry vision. These side
effects typically occur at higher doses; however, only a few patients
who experience them need to stop the medication.
How much to take and when to take it?
Each of these medications has a specific dosage
, reaction time to the drug and longevity of drug response. Please
check with your physician about your particular prescription.
Important stuff you should know.
Viagra, Levitra and Cialis are not aphrodisiacs.
They will not increase your sexual desire. They are not a sexual
device or stimulant.
Viagra, Levitra and Cialis improve the erectile
function of your penis, but still requires appropriate sexual
stimulation to help bring about a useful erection for intercourse.
Taking a Viagra, Levitra or Cialis tablet with little additional
sexual stimulation is unlikely to lead to a good erection. All
the good, old inputs are necessary and might include your partner,
your mood, the setting, music, aroma, and other erotic stimuli.
Each of these may enhance the quality of the erection and the
overall experience.
Please do yourself a favour—don't just
pop one pill, get a poor erection, and feel the medication and
you have failed. You need to give the medication four or five
tries to have a good idea whether it will help you or not. Anticipation,
the anxiety of the situation, and expectations for your performance
can make the first attempts less than perfect.
Can a woman use Viagra, Levitra or Cialis?
The drug has not been approved for use by women,
but some doctors are still prescribing it. Studies are underway
but have not yet been completed. Anecdotally, some women who have
tried Viagra, Levitra or Cialis report a sensation of warmth and
openness, probably resulting from increased blood flow to the
pelvic area, which has given them a pleasurable response to genital
stimulation and intercourse. What
happens when a woman takes viagra
Call your physician if you have any questions or problems.
David S. Hersh, EdD, FAACS, is a Clinical and
Consulting Sexologist and Psychotherapist in private practice.
Board certified by the American College of Sexologists and the
American Board of Sexology, a Founding Fellow of the American
Academy of Clinical Sexologists (FAACS), a founder of the Sex
Therapy Consortium in San Francisco, CA, and licensed in California
by the Board of Behavioral Sciences as a Marriage and Family Therapist,
he has practiced in California since 1966 and British Columbia
since 1990. He is Associate Professor of Sexology at the Institute
for Advanced Study of Human Sexuality. He is a Registered Clinical
Counsellor with the British Columbia Association of Clinical Counsellors.
Dr. Hersh has also qualified as an expert in Human Sexuality by
the Supreme Court of British Columbia.
Dr. Hersh is listed in The International Who's
Who in Sexology (1st ed.), and he is a member of the Society for
the Scientific Study of Sexuality (SSSS), and the Sex Information
and Education Councils of the United States (SIECUS) and Canada
(SIECCAN). He has also served as Educator for Planned Parenthood
Association of BC - Nelson Branch
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