Does Viagra enhance your potency?

by Roger S Kirby, FRCS, Consultant Urologist at St George's Hospital London

1998 was the year when sex dominated the headlines.  Viagra battled to displace Monica Lewinsky from the front pages of the tabloids and broadsheets alike.  The extraordinary (and often misleading) publicity associated with Viagra has had several consequences.  First, it provoked Frank Dobson to allow its prescription on the NHS (at least initially) in exceptional circumstances only, though, unhelpfully, nobody defined what exceptional circumstances were.  Second, it has encouraged some to try the drug recreationally in discos and night-clubs as an aphrodisiac.  What has been the result of this? Viagra is a breakthrough therapy for the treatment of erectile dysfunction.  It works to produce an erection of sufficient rigidity for intercourse.  Effective within one hour of dosing, the drug appears to be effective in more than 70% of men suffering from this condition.

Who benefits from Viagra

Erectile dysfunction is a highly prevalent condition.  It has been estimated that one in ten men are troubled by this disorder.  It is strongly age related, and also associated with many common disorders including hypertension and diabetes mellitus.  Many men also suffer erectile dysfunction after treatment for prostate cancer.  While it is not life threatening in its own right, it is associated with a very significant reduction in the quality of life, not only of the men affected, but also their partners.  The men lose confidence and often become depressed.  Their womenfolk feel rejected and often misinterpret the lack of sexual relations as a sign of transference of affections elsewhere.

Alternatives to Viagra

Traditionally, treatments for erectile dysfunction have involved the use of injections or intraurethral insertions of prostaglandin, vacuum devices or penile prostheses.  Many men are put off at the mere thought of these alternatives.  Viagra now offers, for the first time, a safe and effective, oral therapy for the condition.  Sadly, because of the reluctance of the Department of Health to permit doctors to decide for themselves who should and who should not receive the drug, many patients are being denied this option.  The result has been frustrated patients, confused General Practitioners and unnecessarily overloaded hospital outpatient clinics.

Recreational Use

But what of those optimists with normal erectile function who take Viagra in the hope of enhancement of their sexual performance?  This practice should certainly be discouraged.  Firstly, there are no UK data to support the claim that Viagra does in fact enhance the normal erection or alter orgasmic sensation.  Second, there have already been reports in the media of priapism (which is defined as a persistent and painful erection) developing in young men using Viagra as a recreational substance.  Priapism may result in ischaemic damage to the intracaverosal smooth muscle, which may, in turn, lead to permanent erectile dysfunction.

Side Effects

The other side-effects of Viagra should also serve to deter those with normal erectile function from experimenting with the drug.  Headaches are common after dosing and may persist for a number of hours.  Facial flushing is not uncommon and some individuals complain of heartburn.  The effect of Viagra on the retina may also result in abnormalities of vision and the perception of a blue haze.  Viagra should never be used in conjunction with compounds that serve as nitric oxide donors.  Drugs of this nature are often used as vasodilators in patients suffering from angina pectoris.  Their combination with Viagra has been reported to result in a precipitous decline of blood pressure and risk of myocardial infarction or stroke.  Not many clubbers suffer from angina(!) but the nitric oxide donor amyl nitrate is sometimes used as an orgasmic enhancer.  The combination of this with Viagra is potentially extremely hazardous.

Can Viagra help women?

What effect does Viagra have on the female?  Virtually no data are yet available to answer this question but the female vagina and clitoris certainly possess erectile tissues.  Nitric oxide induced vasodilatation of these might be enhanced by Viagra.  This could provide the explanation for early reports of women with sexual dysfunction responding favourably to the drug.  Clinical trials are already in progress.

Summary

In summary, Viagra has little to offer the normally potent male and usage by them carries certain inherent risks.  As a consequence its recreational use should certainly be discouraged.  By contrast, for men whose erectile function is waning, either as a result of prostatic or other diseases, or the passage of time, the drug now offers new hope.