The New Male Sexuality (67 page)

Those taking other drugs that can prolong the effect of Viagra, including the common antibiotic erythromycin

Viagra can be wonderfully helpful to many men, but it has serious risks. You should get it only from a doctor who already knows your medical status or who is willing to ask the right questions and do tests to determine it.

As already noted, Viagra is effective, even at its highest allowable dose of 100 mg, for only about two-thirds of men. Because of this, penile injections and implant surgery will not disappear anytime soon. I know of several men who pinned their hopes on Viagra, and when it didn’t work for them, they became open to considering injections for the first time. Viagra is less likely to work for men who have serious physiological problems—for example, those who have had radiation for prostate cancer and those with nerve and vascular damage due to diabetes.

Viagra also has the same drawback as injections: While it works very effectively in cases of typical performance anxiety, it can be neutralized by massive anxiety. Some consider it a drawback that Viagra takes thirty or more minutes to get into gear. Injections can produce erections in as little as five minutes. Viagra’s effect can be speeded up a bit by taking it on an empty stomach.

A statement frequently heard about Viagra in the media is that “it doesn’t work without stimulation,” the implication being that the stimulation has to come from your partner. It is true that if you take Viagra and then spend the next three hours painting the house or watching the Super Bowl on the tube, you won’t get erect during that time. With an injection, you get an erection no matter what you do (although stimulation from self or partner can speed up the process). But the stimulation needed to get Viagra going need not be from your partner and need not even be physical. Watching an erotic movie or having a sexy fantasy will do it.

As a practicing sex therapist, I’m very happy we now have Viagra. It is a revolutionary tool and has already been helpful to hundreds of thousands of men. It is also changing how we think about sexuality and sex therapy. While the penis may continue to have a mind of its own, its behavior can now be made to conform to its owner’s wishes. And Viagra itself is just the beginning. There are other oral agents being developed, and some of these may work for men who don’t benefit from Viagra.

Advantages:

Take a pill and have a full, rigid, natural-feeling erection in thirty to sixty minutes. No messing with shots, pellets, or gizmos.

Disadvantages:

Works only for about 70 percent of men.

At about $8 to $9 a pill, it is expensive in the long run. Some health plans pay for Viagra, although perhaps not for as many pills as you would like, and others do not.

Cannot be taken by men who are taking any kind of drugs containing nitrates (for example, nitroglycerine), and has to be used with caution and under strict medical supervision by those with heart and blood pressure problems.

Reliance on Viagra may obscure other important underlying problems such as depression and diabetes.

QUESTIONABLE TREATMENTS

Given the huge number of men experiencing erectile difficulties, it’s not surprising that all sorts of nostrums have been offered, many of which are unproven. This doesn’t necessarily mean they don’t work for some men, only that there’s no convincing scientific evidence of their general effectiveness. If I lined up a hundred men with erection problems and had
them all drink a cup of organic camel urine daily for a week, at least ten or twenty would probably report that their erection problems had vanished. While this is not sufficient to demonstrate that camel urine is a reliable cure for erection problems, those who benefited won’t care.

I recently had a client who erection problem had been resolved by taking L-arginine (an amino acid available without prescription in health food stores). Then, after five years, the pills suddenly stopped working for him. He’s now doing fine on Viagra. In the meantime, I’d suggested L-arginine to over twenty other clients, but it never did a thing for any of them. Other therapists report similar nonresults. However, since L-arginine is not expensive and has no known side effects, you might want to give it a try. Just don’t be surprised if it doesn’t do the job.

If you’re wondering how a substance can help some people even though scientific studies can’t demonstrate its effectiveness, you need to remember the placebo effect. In serious studies there is always a control group whose members receive a therapy (such as a pill or shot) that has no therapeutic properties. Yet in all these studies some of those receiving the inert medicines get better. In the clinical trials of Viagra, about 20 percent of men in the control groups reported better erections. If camel urine, sugar pills, or some other substance works for you, more power to you. But if it doesn’t, or if it does but then stops working, try something with more scientific backing.

A number of clients have asked if acupuncture could help with their erections, and a surprisingly large number of my clients have already tried acupuncture without benefit. I know acupuncture has its uses; I have had it several times for back pain and found it to be helpful. But when I searched the literature, I found no credible evidence that acupuncture is a reliable treatment for erection problems.

Some hypnotherapists have made grandiose claims about their success with sex and other problems. I’m no stranger to this method. I’ve used hypnosis in my sex therapy, although not much anymore, and I even co-edited a book on the method. Unfortunately, the conclusion regarding hypnosis is the same as with acupuncture: There is no evidence that it is a reliable treatment for erection problems.

Here are some of the substances sometimes touted as potency aids, none of which have proven efficacy: cholestatin; deprenyl; ginkgo biloba; ginseng; melatonin; muira puama; oysters; saw palmetto; testosterone taken orally (not recommended because of the risk of inducing liver problems); trazodone (brand name Desyrel), an older antidepressant sometimes given in combination with yohimbine; vitamins B
₁₂
, C, and E.

· · ·

In considering your options, I think it’s sound policy to try the least invasive, least risky, and least expensive alternatives first. For example, since you already have this book, doing the exercises in the next chapter will cost you only some time and energy; as far as I know, they have no negative side effects. If they don’t seem to help, see a sex therapist or a physician. Even if you and your partner decide to try one of the methods discussed in this chapter, proceed with caution. Vacuum devices, yohimbine, and Viagra have few side effects. And while penile injections can have serious side effects, they are a much less invasive undertaking than surgery.

Of course, some men are in a hurry. They want the problem solved right now, even if they’ve had it for years and done nothing about it. I have no trouble understanding the impatience—I too want all my problems fixed this second. But with sex problems, as with many of life’s difficulties, some degree of patience is a virtue, and often less is more. You can always escalate if the method you start with doesn’t live up to your expectations.

WHAT IS COMING

Now that erection problems have come out of the closet, the pharmaceutical companies are busily at work. We are promised more effective injections, faster-working pills, tablets you put under your tongue, gels you smear on the penis, smaller pellets for another Muse-like system, and so on. How many of these will actually make it to market is another question entirely, but the man with an erection problem two, three, or five years from now will surely have far more choices than he does today.

Three drugs should be available sometime in 1999. One of them is a new injectable called Invicorp (made by Senetek). It contains two agents that promote arterial flow into the penis. This drug may be the answer for those men who have serious problems getting blood to stay in the penis. The two others are oral phentolamine, brand name Vasomax (made by Zonagen), and oral apomorphine, brand name Pentech (made by Tap). They work faster than Viagra and may be effective for some men for whom Viagra is not helpful. And side effects seem to be minimal, nasal congestion being the most common. By the year 2000, we may see on the market a pill still known only by its distinctly unsexy research label, IC351 (from Eli Lilly and Icos). From the clinical trials so far, it seems that IC351 works much like Viagra but with the advantage of fewer side effects.