In 1998 when Viagra was approved, it was the first oral medication available for the treatment of impotence, or erectile dysfunction (ED), a condition that affects more than 18 million men in the U.S over the age 20. In March of 2016, Viagra, or as it is commonly known, the “little blue pill,” will be 18 years old, a milestone often equated with the coming of age. Well-Being thought it would be interesting to take a look back at how the release of Viagra has transformed not only the discussion of erectile dysfunction, but also how ED treatment has changed over the past 17+ years.
Well-Being spoke with Patrick P. Daily, M.D., Urologist with Mississippi Urology Clinic about changing attitudes toward ED and the options available for its treatment.
“Before the approval of Viagra, many men were reluctant to talk about problems in the bedroom,” Dr. Daily notes. “Once Viagra was available and the onslaught of commercial advertising that came with it (including spokesperson Senator Bob Dole openly discussing erectile dysfunction on national television), it helped the subject of ED become less taboo and more men started opening up to their doctors about problems they were having. You could say ED became a household word.”
“It also meant that for the first time we as physicians didn’t have to diagnose the cause of sexual dysfunction before we could prescribe treatment,” explains Daily. “Before we had to conduct a number of tests to determine if the source of the problem was vascular or neurologic. That took time and was expensive. Because they work despite the source of the malfunction, oral medications for ED have become the first line of defense for men having problems getting or keeping an erection.”
According to Dr. Daily before prescribing treatment for ED he first talks to patients about the problems they are having, goes over medical history and then discusses the various risk factors for the condition.
Risk Factors for ED
There are a number of common risk factors that can contribute to erectile dysfunction:
• Medical conditions – particularly diabetes and heart disease.
• Tobacco use – which restricts blood flow to veins and arteries.
• Overweight – particularly if someone is obese.
• Medical treatments – such as prostate surgery or radiation treatments.
• Injuries – particularly if they involved damage to the nerves or arteries controlling erections.
• Medications – such as antidepressants, antihistamines and medications that treat high blood pressure, pain and prostate conditions.
• Psychological Conditions – such as stress, anxiety or depression.
• Drug and alcohol use – especially in long-term drug use and heavy drinking.
While oral medications to treat ED are widely successful, there are some health conditions that preclude their use.
“Viagra is not recommended for patients with severe cardiovascular disease,” says Daily. “When Viagra was first introduced there was a lot of publicity about men who died after taking it. But often the problem was not the medication, but the fact that with the severity of the person’s heart disease, having sex simply was not safe. Now with the availability of other oral treatments for ED some people who might not have been able to take Viagra, can be treated.”
One large U.S. survey determined about 50 percent of men 40 to 70 years of age experience some degree of ED.
Oral medications available for treatment of erectile dysfunction work well for the majority of men and cause few side effects. Sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis) and avanafil (Stendra) are all oral medications that reverse erectile dysfunction by enhancing the effects of nitric oxide, a natural chemical the body produces that relaxes muscles in the penis, increasing blood flow and allowing an erection to occur in response to stimulation.
“When oral medications are not successful in treating ED, we still have a number of weapons in our arsenal that may be more effective,” Daily adds. “The majority of men can be treated.”
In addition to oral medications there is the intraurethral agent, in the form of a suppository, which treats male sexual disfunction by increasing blood flow to the penis. There is also injection therapy, which dilates the arteries of the penis to improve blood flow. And, there are penile implants, which are typically recommended after other treatments for ED fail.
“The most important thing to know about ED is that there are a lot of options for treatment,” Daily continues. “Most of the patients that are referred to me have already been through trying oral medications with no success. We discuss the other treatments available, given their health condition and their risk factors, and determine the next best approach to take. I recommend before beginning any kind of ED treatment, individuals check with their insurance providers to get the details of whether or not the prescription or other treatment method is covered. The cost of many medications has increased tremendously in the past few years. The average cost of Viagra in Mississippi is $48.00 a pill!”
Since “the little blue pill” first hit the scene, a lot has changed in the treatment of ED. Besides the successful treatment of millions of men who previously might have had to live without a normal sex life, another positive outcome is the normalization of conversation about sexual dysfunction, which has removed an age-old stigma and allowed men to feel more comfortable seeking the treatment they need.
Patrick P. Daily, M.D., Urologist with Mississippi Urology Clinic, received his Doctor of Medicine degree from the University of Mississippi School of Medicine, and completed his general surgery internship and residency in urology at the Medical University of South Carolina, Charleston, SC. He is certified by the American Board of Urology.