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.

Will the use of this drug delay a man or woman from leaving a bad relationship, or allow a good relationship to continue? Will it deceive a partner into believing that he/she is really loved and wanted? I tend to believe that Viagra, Levitra and Cialis, and any other drug it their type that comes down the pike will not profoundly change the manner in which men and women relate to each other.

My point is simply that sex and relationships are complicated, and simple solutions are usually wishful thinking. Viagra, Levitra and Cialis will not eliminate the other problems in the relationship, but may only bring them to the fore. This may occur after a period of happiness, satisfaction and experimenting with the new erection capability.

A couple of words about what Viagra, and now Levitra and Cialis do not do: they do not make men good listeners—that drug, unfortunately, is still a very long way off. They do not make men desire their partners more, make them better lovers, increase their passion or do most things that people would like it to do. There's obviously a great danger of your having unrealistic expectations in all directions.

With the availability of Viagra, and now Levitra and Cialis, you are more likely to bring your sexual questions directly to your primary care physician. Hopefully, your concern about erections will translate into paying more attention to your overall health. It will give you the opportunity to have your physical symptoms evaluated to rule out many conditions that need to be addressed prior to prescribing Viagra, and now Levitra and Cialis for you. Your doctor will find that they are easy to prescribe, effective in most cases, and almost free of side effects. This is a wonderful advancement! Please proceed with caution and examine where it fits into your relationship.

SOME FREQUENTLY ASKED QUESTIONS

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.

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. dr_sex@telus.net, www.Doctor-Sex.org

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