Getting Back In The Game Impotence Medications Are Helping Men — And Women — Lead Fuller Lives

Super Bowl Sunday was about many things. An exciting, hard-fought win for the Patriots. Gatherings of family and friends. Pizza, chip dips, and beer. Erectile dysfunction.That’s right, erectile dysfunction.

Judging by the commercials shown during television’s biggest advertising event, impotence drugs are the talk of the pharmaceutical world, with sales on the rise and the all-important media buzz just as hot.

And with baseball star Rafael Palmeiro pushing Viagra and NFL Hall of Famer Mike Ditka throwing a football through a hanging tire in a Levitra spot, suddenly it seems a little more acceptable to talk about impotence issues, even among friends gathered to watch football. And why not, considering the benefits that these medications promise?

“Erectile dysfunction is used as a joke on late-night TV shows, but I think most people don’t think about its association with depression and a significant decrease in quality of life and a man’s sense of worth,” said Dr. Donald Sonn, a urologist with the Urology Group of Western New England.

“What’s interesting,” he added, “is that these are not just male drugs; these are drugs that affect couples as well.”

Like any medication, these popular products carry their own set of health risks, and patients need to make their health history clear to their doctors before being carried away in the marketing-driven frenzy.

Still, used correctly, market leader Viagra and its two newer rivals, Levitra and Cialis, are allowing men to revitalize their sex lives. By any measure, that’s a crucial facet of relationships, and a task more complicated — and satisfying — than tossing a ball through a tire.

Restarting the Flow

Impotence drugs work on the simple mechanism of blood flow. Typically, when a man is sexually aroused, several things happen, beginning with the relaxing and widening of arteries in the penis, allowing more blood to flow in. At the same time, the veins that normally carry blood away from the penis are compressed, restricting the blood flow out of the penis.

For most men, the nerves or blood vessels involved in this process function properly. For men with erectile dysfunction, drugs like Viagra work by blocking an enzyme that restricts blood flow to the penis, so that a man can get and keep an erection.

However, it’s not a magic pill, doctors stress; it’s not an aphrodisiac or hormone, and it does not, by itself, bring about romantic desire. In fact, without sexual stimulation, the drug will not bring about an erection. That’s where the relationship component comes into play.

“The drawback to these medications is that the sense of expectation may be great,” Sonn said. “Patients come into the office and think these medications will make them more attractive and improve their relationships other than sexually.

“We spend a lot of time in the office making sure men don’t walk out thinking these medications will change their way of life. It will just help them with their sexual dysfunction; the rest is up to them.”

There are also safety concerns for certain patients, Sonn said. “First of all, there are men with severe cardiovascular disease who become short of breath walking up the stairs. They should really think twice before starting sexual activity.”

And the impotence drugs themselves have dangerous contraindications with nitrates or nitroglycerin tablets; together, they can quickly lower blood pressure and bring on a heart attack. The Viagra family of medications also cannot be taken along with certain popular prostate drugs, such as alpha blockers.

However, aside from these risks, he said, “for a healthy person, it’s a very safe medication.”

Growing Popularity

It’s also an increasingly popular choice for men of all ages who struggle with impotence. Viagra, produced by Pfizer, has been the market leader for several years since its inception in America, but it’s getting competition these days from Cialis — which has been popular in Europe for some time — and Levitra, the newest of the three drugs.

Cialis, which is made by Icos, is trying to separate itself from the pack because, while all three drugs act in similar ways and cost around the same — between $8 and $10 per pill — Cialis’ active chemical takes longer to break down in the bloodstream. That leads to a 36-hour window of opportunity for sexual activity — as opposed to four or five hours for Viagra and Bayer’s Levitra.

That’s important for couples who have felt that a four-hour window for sex decreases spontaneity and adds the unnecessary pressure of having to turn up the heat during a certain time frame. And it poses a huge opportunity in America for Cialis as it tries to cut into Viagra’s sales, which reached $1.7 billion worldwide in 2003.

“In one sense, you can have more spontaneity with Cialis, which has become very popular in Europe,” Sonn said. “But Viagra has been around the longest in this country and has the longest track record of safety and efficacy, helping millions of men achieve a normal sex life, which is a great achievement. Levitra is the new kid on the block, so the jury is still out on what its benefits are compared to the other medications.”

The three drugs have slightly different side effects, Sonn said — for example, Cialis can increase the risk of back pain — so doctors need to make their patients aware of those as well.

Awareness of the drugs themselves, and their benefits, is the latest challenge, which explains why the two newer products used the Super Bowl as a marketing platform. The strategy may be paying off, as the Web sites of both medications reported traffic spikes of close to 2,000{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} on Super Sunday.

And while Viagra spent $50 million on advertising in 2003, each of the three erectile-dysfunction drugs are expected to spend at least that much in 2004.
And it seems that men are watching and listening.

“We give these to young men and men of very advanced ages,” Sonn said. “Clearly, they have improved the quality of life for a lot of patients.”

No, Viagra, Levitra, and Cialis are not magic drugs. But they’re certainly giving men the confidence to put some magic back in their relationships.