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30 January 2004

Will Viagra improve your sex life?

It seems that a significant proportion of South African men feel that they need help in improving their sexual “performance”.

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It seems that a significant proportion of South African men feel that they need help in improving their sexual “performance”.

I have been staggered at the number of requests that I have had for Viagra from patients and passers by in my practice. By and large these are not people who have reported or complained of sexual dysfunction previously – they either view their problem as too minor to warrant seeking medical attention for it or the news of Viagra has prompted them to suddenly reveal a long kept secret. Either way, the hype surrounding this product begs an examination of the causes and treatments of sexual dysfunction in men.

Although there are a number of possible sexual dysfunctions and perceived dysfunctions in men, from premature ejaculation, through a perception of the erection lasting too short a time, to erectile failure – I will limit myself here to erectile failure. The reason for this is that this is what the men requesting Viagra are complaining about.

A normal erection needs three basic physiological requirements to be met:

  • The first is that the nerves to the penis must be working properly and a message from the brain triggering an erection must reach the penis.
  • The second is that the hormones in the blood must be in the right balance – this allows the spongy tissue of the penis to fill up with blood and thus achieve erection.
  • The third is that the blood vessels to the penis (both arteries and veins) must be in good working order. This means that the arteries to the penis must carry enough blood to the penis for it to fill up, and little valves in the veins must close off properly – trapping blood in the penis.
  • The nerves to the penis either work or they don’t – there are no half measures, there is no such thing as them working some of the time and not at other times. 

    Similarly, if the hormone balance is incorrect for achieving an erection then it is incorrect all the time – the hormones will not allow an erection sometimes and not at others. Finally, arteries and veins are also all or nothing mechanisms. So being able to achieve an erection some of the time, but not at other times generally means that there is nothing wrong with the three physiological requirements for an erection. For example, many men report being able to have an erection for masturbation, but not with a partner. This rules out a physiological cause for the problem – much to the disappointment of these men.

    The majority of erectile failure cases are caused by the fourth requirement for an erection not being adequately met. The fourth requirement is the psychological aspect. This psychological aspect can have deep and complex roots with a variety of causes from relationship problems to a vicious cycle of poor performance, followed by performance anxiety – leading to poor performance and so on.

    In some instances the problems are relatively simple to sort out and others require extensive therapy, counseling and other help. In some cases a disease or medicine being taken causes erectile failure. The most often quoted disease as a cause of erectile failure is long standing poorly controlled diabetes. Medicines often prescribed for heart arrhythmias and occasionally high blood pressure can also cause erectile failure.

    Where does Viagra fit into all of this?

    Firstly – a quick note on the end of the erection. One of the mechanisms which terminates an erection is the building up of an enzyme in the veins that drain the penis. Through a couple of fairly complex steps this enzyme causes the valves obstructing the blood flow out of the penis to open, the blood flows out and the penis goes flaccid.

    Viagra works by inhibiting the enzyme that causes the valves in the penis to open. In other words it helps in prolonging the erection as well as assisting the onset of erection in cases of erectile failure. The experience of the user of Viagra is apparently one of a heightened response to direct sexual stimulation of the penis.

    In cases of medical or medicinal causes of erectile failure Viagra may prove to be a blessing to these patients sex lives. It is my contention that the use of Viagra in most cases of psychological causes of erectile failure will make matters worse. Let’s take the case of someone who is caught in the vicious cycle of performance anxiety and poor performance.

    Taking Viagra may well improve their performance and consequently decrease their anxiety. However, I predict that most would (correctly) see the improved performance as being brought about by the Viagra. Any attempt to stop using the pill would probably result in a greater degree of anxiety and the vicious cycle being worse than prior to the medication. 

    In a case where relationship issues are the problem there may be, for example, an absence of foreplay. Viagra heightens the response to direct sexual stimulation of the penis – if there is none the person may still not have an erection. Imagine the feelings of inadequacy – unable to have an erection even on a “wonder drug”.Or if the sexual dysfunction in the relationship is a reflection of deep seated anger and resentment – Viagra wont make him loose his pot belly or halitosis, or stop him from farting in bed. It certainly wont make her suddenly forget all the built up anger and resentment and magically regain interest in sex.

    All in all, Viagra has its place in the treatment of sexual dysfunction, but don’t expect miracles.

    Post a question to our sexologist.

     
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