The New Male Sexuality (66 page)

These devices tend to be given high ratings by the men and their partners.

Disadvantages:

Implants should be considered irreversible. They can injure or destroy the natural erection system. This will likely mean you can’t decide to have an implant taken out and try another method.

Erections produced by an implant may be smaller in length and circumference and also less rigid than those produced naturally. They are certainly rigid enough for vaginal insertion and enjoyable intercourse. However, what you get may not look like what you had before.

Implant operations have the same risks as all surgery. Postoperative pain in the groin typically lasts for four to six weeks, and most patients require medication for pain control during some of that period. The risk of infection is small, but if it does occur, the implant will need to be removed temporarily.

Mechanical failure is always a possibility in hydraulic devices. In such cases, further surgery is required to replace the offending component or the whole device.

With the addition of sex therapy, these were the main interventions that existed for men with erection problems before the spring of 1998. Then came the blue pill. And that’s a story in itself.

Viagra

Humanity has been searching for an oral agent to cure erection problems since prehistoric times. By 2000
B.C.E.
the Egyptians and others were experimenting with natural substances such as belladonna, henbane, jimson-weed, and the mandrake plant, not to mention oysters and ginseng. But while there were reports of success here and there, there was no convincing evidence that any of these substances was a reliable remedy.

And now—after four thousand years—it’s here, the magic pill we wanted. We already have diet pills, birth control pills (and look what a revolution they caused), and happy pills (all sorts of antianxiety and antidepressant medicines), so why not a sex pill? No needles, no gadgets, no surgery—just
pop a pill and you’re ready to go. It’s not surprising that more than six million prescriptions were written for Viagra in the first eight months it was on the market, making it the fastest-selling drug in history.

The researchers at Pfizer, Inc., were not looking for an erection pill. Rather, they hoped that the drug then called sidenafil citrate would alleviate angina, the chest pains caused by blockage of the blood vessels leading to the heart. They were disappointed and were ready to give up on the drug until some of the men in the study reported the side effect of having erections. The rest, as they say, is history. The name Viagra was chosen later. Pfizer knew it had a winner when, after it announced it was bringing its clinical trials of the drug to an end, the study subjects wrote in droves begging to be allowed to keep a supply of the pills.

To understand how Viagra works, we need to get into a little detail about how erections are created. When a man is aroused, the brain causes the penis to release the chemical cyclic GMP, which opens the blood vessels, allowing blood to rush in and create an erection. But another chemical, PDE5, is also released, and it works to degrade cyclic GMP. In a man without erection problems there is a balance between the release and degradation of cyclic GMP, and the erection remains as long as there is effective stimulation of some kind. Viagra blocks PDE5 and thereby boosts and prolongs the effects of cyclic GMP. This allows many men to have and keep erections who ordinarily would not be able to do so.

Several men have asked why other body parts don’t stiffen when they take Viagra. Why, for instance, don’t they get stiff necks, as Jay Leno has suggested a number of times in his monologues? One reason is that a stiff neck is caused by mechanisms very different from those that cause penile erection. The other reason is that PDE5 operates only in the penis.

Viagra produces good erections in about 70 percent of the men who take it. These erections are full and firm and feel—as clients never tire of telling me—“totally natural.” The agent stays in the system for some time, although it gradually starts losing strength after four to five hours. Clients have reported erections from it seven or even ten hours later. Some have had sex in the evening after taking the pill, gone to sleep, and had sex again with a good erection in the morning.

As you might imagine, an agent this powerful must also have a downside. When Viagra was first introduced, the side effects seemed almost inconsequential, the main one being headaches, experienced by 16 percent of those participating in the clinical trials. Other side effects are flushing (10 percent of patients), indigestion (7 percent), nasal congestion (4 percent), and, in about 3 percent of patients, temporary vision problems,
mainly a blue tinge but sometimes also blurred vision. Taking more than 100 mg of Viagra at a time increases the frequency of these side effects but does
not
increase the drug’s benefits.

But a much more serious problem has come to light. In the year since Viagra’s introduction, over 130 deaths have been attributed to its use. A few of these deaths were due to an interaction between Viagra and drugs containing nitrates (either prescription medicines used to control angina and high blood pressure or street drugs known as “poppers” used to enhance orgasm). The combination of Viagra and nitrates can cause a dangerous and sometimes fatal drop in blood pressure. Most of the reported deaths, however, resulted from “cardiovascular events”; that is, heart problems. For some older men taking Viagra, the exertion of sex is too much for their damaged hearts and blood vessels.

Because of the risk, the American College of Cardiology and the American Heart Association recently issued a caution on prescribing Viagra to men in the following categories:

Those with angina

Those who on an exercise stress test show evidence of blocked arteries

Those taking multiple medications to control blood pressure

Those with congestive heart failure with borderline low blood pressure