By Martin Downs
Reviewed By Michael Smith
Rafael Palmeiro seems an unlikely Viagra pitchman. The Texas Rangers slugger is only 37 and won't admit to having erection problems, yet he recently agreed to appear in ads promoting the drug. The deal has made people wonder whether Palmeiro really represents men with erectile dysfunction, or whether Pfizer, the company that makes Viagra, wants to persuade young men to try it for fun.
It's true that erectile dysfunction is more common in older men, but many potential Viagra users are hardly senior citizens: About 40% of 40-year-old men in the U.S. have some degree of erectile dysfunction. Most Viagra users today, according to Pfizer, are in their early to mid 50s. So it makes sense that the company would want to reach more men around Palmeiro's age.
Urologist Myron Murdock, medical director of the Impotence Institute of America, says these men are likely to use Viagra because sexual performance is a high priority for them.
A younger man, Murdock says, "wants his V-12 Jaguar working just perfectly," whereas an elderly gent may be content with less dependable erections. What's more, the sexual partners of younger men "are more demanding of their performance," Murdock says.
Pfizer denies that it's promoting Viagra for recreational use. "We've consistently opposed that," says spokesman Geoff Cook. Nevertheless, Murdock says it's fine to pop the little blue pill to "optimize" your sexual performance.
We assume all young men have normal sexual functioning, "but they're really not normal," Murdock says. Hardening of the arteries, which restricts blood flow to the penis, can begin during the teen years, so that by the time a man is in his 20s, his ability to get and keep an erection has already begun to decline. Murdock says many men who seek Viagra for recreational use actually have minor erectile dysfunction.
There's also some evidence that Viagra can shorten the time it takes a man to recover after sex and be ready for another round. This is called the "refractory period." Normally it lasts 20 minutes or longer. One study, published in the journal Human Reproduction in January 2000, found that Viagra shortened the refractory period by about 10 minutes in healthy men.
What Viagra cannot do is increase your sexual appetite or make you ejaculate if you have problems reaching orgasm. Ira Sharlip, urologist in San Francisco, says you shouldn't expect your erections to reach staggering new proportions, either. "I don't believe that Viagra can increase an erection beyond 100% of normal," he says.
"Viagra is a super-safe drug," Murdock says, assuming you have a healthy heart and don't take nitrates.
Nitrates include nitroglycerin -- a drug that many men take for chest pain from heart disease -- and "poppers." Poppers are little vials of amyl or butyl nitrate. Breaking the vial releases nitrate vapor, which gives a brief high when inhaled. It's most often used to enhance sexual pleasure, and mostly by gay men. Poppers are not all that safe to use on their own, and they're especially dangerous when you're on Viagra.
Nitrates widen blood vessels, and Viagra increases that effect. Mixing the two can cause your blood pressure to drop drastically. A sudden drop in blood pressure can make you pass out, and you may die if your blood pressure stays too low for too long.
Preservatives like sodium nitrate -- found in processed food -- do not cause this problem, so you won't die from eating a hot dog while on Viagra. Even so, it's best to take it on an empty stomach. That way, the drug absorbs into your bloodstream faster. Wine may contain nitrates, but not the kind that cause problems with Viagra. It's fine to play some Marvin Gaye on the stereo and sip a glass of Chardonnay, if that's what puts you in the mood.
Although you may be tempted to order Viagra discreetly from one of the hundreds of Web sites that sell it, don't. "It's bad medicine," Murdock says. You really must bring your doctor into your sex life if you want to use Viagra.
When you buy from an online pharmacy, you just have to answer some health questions before you proceed to the checkout page. If you answer honestly -- and that might be a big "if" for those determined to get what they want -- the questionnaire may catch some possible complications. But the pharmacists who fill your order don't know your medical history, and no questionnaire can diagnose the root cause of your problem. Erectile dysfunction can have serious underlying causes, like diabetes, heart disease, liver disease, or thyroid disease.
Cook says Pfizer is opposed to Internet Viagra sales. "Our goal with any of our marketing is simply to reach men and encourage them to see a doctor," he says.
It seems that Viagra can make sex better for women, too. Like the penis, the clitoris is erectile tissue -- spongy tissue that becomes engorged with blood during sexual excitement. By increasing blood flow to the clitoris, Viagra may heighten a woman's sensation and arousal. It also seems to increase vaginal lubrication.
Murdock says many couples like to heat things up by splitting a dose of Viagra. "It's an interesting sexual situation," he says. The recommended dosage for men is up to 100 milligrams per day, and that seems to be just as safe for women. Young people may get results from a smaller dose: As little as 25 mg may be enough.
The FDA has not approved Viagra for women, but Murdock says, "It's just a matter of time." He says he and other doctors who specialize in sexual medicine prescribe it to women, which is perfectly legal. Doctors are allowed to use their best judgment. Drug companies, however, can't advertise any use that isn't FDA-approved.
The studies being done to test Viagra's safety and effectiveness in women have shown good results so far. "We're cautiously optimistic," Cook says.
Martin F. Downs is a health writer in New York City. He was formerly an editor at CBS HealthWatch. He has also written for Health.com, Salon.com, and POZ magazine and is the editor of the Alicubi Journal (alicubi.com).
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