VIAGRA: GOOD NEWS AND BAD

- Originally published in Physician Update

Now that Pfizer’s new product, Viagra® (sildenafil) is available to Canadian men, physicians will find themselves facing more questions about sexuality, especially erection concerns. Do you know how to answer these questions, and how to ask a few in turn?

First, you will need to answer the following questions in order to provide high-quality, sensitive medical care in the era of Viagra®:

- Can I take extra time for these patients?
- Can I comfortably use words like anal sex and masturbation?
- Do I wish to hear about a wide variety of sexual practices (some of which I personally may not approve)?

Also, you will need to possess accurate information from which to formulate your recommendations. Here is what Viagra® can and cannot do:

What Viagra® can do:

Viagra® will cause a patent erection in about seventy per cent of those who take the drug. It can help elderly couples who miss sex, diabetics and those with neurological problems, ‘late bloomers’ lacking social skills and fearful of first intercourse, and those struggling with the sexual side effects of anti-depressants, chemotherapy, and other medications and treatments. It can provide longer lasting erections more easily with less time between erections. It can help older men achieve more confident erections.

What Viagra® cannot do:

Viagra will not help those who have relationship problems, guilt, shame, anger, or anxiety problems, or who are suffering the effects of trauma, violence, or alcohol excess. It cannot alleviate lack of desire or passion nor help with communication deadlocks. It cannot help with problems of ejaculation control or of retarded ejaculation. It cannot make men good listeners nor good lovers. It will not help them desire their partners more, nor help them become more desirable. Note as well that increased capability and longer lasting erections may lead to unsafe sexual behaviour, and may mask underlying issues which may be effectively resolved with sex therapy.

Viagra® might, in fact, provide orgasm without feeling and virility without connection. It may reinforce the focus on performance and goal-oriented sex, when intimacy and communication are in order. If a couple has enjoyed no intercourse for many years, their chances of re-establishing sexual intimacy are slim. For couples who do not talk about sex, the appearance of a ‘store-bought’ erection can sometimes aggravate contentious interpersonal issues; some wives may be less than thrilled with their husband’s restored abilities.

With all these considerations, how can you determine appropriate candidates for this popular medication? Some good questions to ask are:

- Do you always have trouble with erections, or only under certain circumstances?
- Does your partner know you’re getting Viagra®?
- How does s/he feel about it?
- What other ways have you tried to resolve your erection difficulties?
- Do you (or your partner) have other sexual difficulties?
- How well do you and your partner talk about sexual issues?
- What will you do if Viagra® doesn’t solve your erection (or other sexual) problems?1

In short, you will be increasingly called upon to evaluate individuals as candidates for treatment with Viagra®. Should Viagra® not prove appropriate and efficacious, a viable and easily available option is sex therapy.

1 San Francisco Medicine; Nov/Dec 98; pg 29.