Viagra Turns 25!

Here's a little bit of the history behind the blue pill, along with other ways to enhance sexual functioning

"Um, doctor? I'm, uh, having a problem. I, um, I can't get it up." For years, it was the secret scourge of men and their partners — erectile dysfunction, also known as impotence. If you, or someone you love, struggle with the issue, take comfort in knowing you're not alone.

The landmark Massachusetts Male Aging study found that 52% of men between ages 40 and 70 experience some degree of erectile dysfunction, and current estimates are that 30 to 50 million US men are affected.

Viagra was not originally meant to be a drug to help with sexual functioning.

On March 27, 1998, Viagra (sildenafil), the little blue pill, received FDA approval, and men everywhere rushed to their doctors, rejoicing that shame and embarrassment could turn into sexual fulfillment and pleasure.

"Sexual arousal is a complicated process. It involves your brain, your hormones, your nerves, your muscles and your blood vessels. A hiccup in any of these can cause a problem," points out Matthew Ziegelmann, MD, a urologist at Mayo Clinic Men's Health in Rochester, Minnesota.

Viagra was not originally meant to be a drug to help with sexual functioning. Instead, it was developed to treat hypertension (high blood pressure) and angina pectoris (chest pain.)

While it was found to have little effect on angina, an unexpected side effect was the production of a firm, healthy erection within 30-60 minutes after taking the drug.

Seeing the opportunity to change the sexual landscape of America (and make a lot of money in the process), Pfizer Pharmaceutical Company patented sildenafil in 1996. Only two years later, it was approved for the treatment of erectile dysfunction under the name Viagra.

Erectile dysfunction or disorder (ED) is the persistent inability to achieve and maintain an erection adequate for satisfactory sexual intercourse or activity.

Viagra, and the other oral drugs for erectile dysfunction which have been developed since then, all belong to a class of medications called phosphodiesterase type 5 (PDE5) inhibitors. These block the action of an enzyme found in the corpus cavernosum, columns of spongy tissue in the shaft of the penis.

They also amplify the effects of nitric oxide, a chemical in your body that relaxes smooth muscle cells, increasing blood flow to the penis, thereby causing and helping to sustain an erection. Sexual stimulation is needed for these drugs to be effective.

Elevated risks of developing ED include:

Viagra, the first effective oral medication targeted for ED, was later joined by Levitra (vardenafil) and Cialis (tadalafil). Staxyn, (also vardenafil) and another oral medication, Stendra (Avanafil), are two more recent options.

However, each has a slightly different chemical makeup and dosage, affecting how they are used, length of effectiveness and other factors.

When choosing which drug to prescribe, your health care provider will consider your preference while looking at cost, ease of use, how long the drug's effects last and potential side effects.

In addition, you must inform your doctor of any other medications you are taking and any medical conditions you have since negative interactions might occur.

Oral medications for erectile dysfunction are contraindicated for men with a history of unstable angina (chest pain) and uncontrolled high or very low blood pressure. Using any medication containing nitrates (such as nitroglycerin, Nitrostat, Isordil, and others) means that oral ED medications should not be used.

Currently, the only nonsexual condition Viagra (sildenafil) has FDA approval for is pulmonary arterial hypertension. It is used under the trade name Revatio to improve exercise tolerance and decrease clinical worsening.

If present, the side effects of oral medications for ED tend to be mild. They can include facial flushing, headache, indigestion, stuffy or runny nose, back pain and visual changes such as a blue tinge to vision, light sensitivity or blurriness.

Rare but severe side effects can include sudden visual impairment or hearing loss. Priapism, an erection that doesn't go away on its own, is a rare condition that can be painful or cause damage to the penis. Any man who has an erection continuously for four hours or more should seek immediate medical attention.

If, for any reason, a man cannot use oral medications, there are other options. Penile injections allow the user to self-inject medication (alprostadil or papaverine) into the penis, causing the blood vessels to expand so the penis swells and stiffens to create a fully rigid erection.

Nevertheless, the procedure can be uncomfortable, and some men reject or discontinue it because of discomfort. There is also a small risk of a prolonged, potentially dangerous erection that lasts longer than four hours.

With MUSE (intraurethral alprostadil), you place a tiny alprostadil suppository into the urethra, the opening in the penis from which urine flows out. The medication is absorbed into the corpus cavernosum to create an erection. Side effects may include discomfort, bleeding from the urethra or lightheadedness.

If present, the side effects of oral medications for ED tend to be mild.

There are several variations on vacuum-assisted erection devices (penis pumps), which involve placing the penis in a plastic cylinder and creating a vacuum around it to increase blood flow. Next, a ring is placed at the base of the penis to keep the blood there, causing it to enlarge and become hard.

There is no ejaculation during orgasm because the ring compresses the urethra and prevents semen from exiting. Some men find it difficult to hold and pump the unit effectively. Bruising, skin breakdown and pain are possible side effects.

Penile prosthetic devices are surgically implanted and inflated to allow the penis to become erect. The insertion of semi-rigid rods is another type of treatment. They are used less than in the past because of the variety and effectiveness of other options. Side effects can include infection, pain and mechanical failure.

Psychotherapy or couples counseling can be helpful if it has been determined that erectile dysfunction is caused by psychological rather than solely organic factors.

Shockwave therapy, an investigational procedure offered by some medical centers and physicians even though it does not have FDA approval for the treatment of erectile dysfunction, uses targeted sound waves to purportedly encourage increased blood flow to the penis.

Lifestyle changes such as improving one's diet, exercising, getting adequate sleep and reducing stress may help to enhance sexual functioning, as can, of course, the presence of a loving, caring and supportive partner.