You’ve probably seen the commercial: A 50-something man repeatedly attempts to throw a football through a tire swing, with no success. His brow furrows. But what’s this? Inexplicably, his mood suddenly has changed. He tries again, and this time hits a bull’s-eye. His smiling wife joins him in the yard, and they briefly toss the football around before happily heading indoors.

If you were a bit confused about what this ad was selling, you weren’t alone. In the beginning, commercials and advertising campaigns for drugs designed to combat erectile dysfunction (ED), such as this one (for Levitra), tended to tread lightly. But like so many topics in the new millennium, ED has become fair game, and ads for Levitra, Cialis, and the old standby Viagra now fill the airwaves—and there’s no question what the product is supposed to do.

In this case, that’s a good thing. We males have long had a reputation for reticence when the specter of a visit to the doctor arises, especially when our reproductive plumbing is involved. Many of us tend to procrastinate, hoping the problem will “just go away.” Unfortunately, what goes away when ED is ignored is our quality of life. And the ramifications can be much more serious than that.

“ED can be a sign of emotional or psychological problems, but it can also be a warning sign for an underlying serious disease,” says Dr. Richard Watson, chief of Ambulatory Urology at the Hackensack University Medical Center and professor of Surgery (Urology) at the University of Medicine and Dentistry of New Jersey.

Watson, who retired as a colonel after 25 years as an Army urologist, cautions that “maybe your ED is the first sign of diabetes, or of vascular disease. Maybe your first sign is ED, and your next sign is a major myocardial infarction.”

Fortunately, ED now is highly treatable thanks to an array of new drugs that target its underlying causes. That’s good news, because conservative estimates by the National Institutes of Health place the number of men currently affected by ED at more than 30 million, and that figure is expected to more than double by 2025.

According to Dr. Ridwan Shabsigh, director of the department of urology at Columbia University’s College of Physicians and Surgeons, about half of all men over the age of 40 suffer from some form of ed. And yet Shabsigh, author of the book Back to Great Sex: Overcome ED and Reclaim Lost Intimacy (Kensington Publishing Corp., 2003), reports that relatively few seek treatment.

Vigor + Niagara = Viagra

Reluctance to seek help was more understandable in the old days, when treatments for ED mostly relied on mechanical means. These methods still are used (and have advanced considerably) but are considered the last line of defense for ED now that new medications are available.

Unless you’ve been in a cave in Afghanistan for the past few years, you’ve heard of Viagra, the first and still most widely prescribed anti-ed drug on the market. Introduced by Pfizer in 1998, the little blue pill became an instant hit, giving men with ED new hope.
 
One veteran who heard about the Viagra clinical trials and quietly signed up was Bob Dole, the former senator from Kansas, whose surgery for prostate cancer in 1991 left him with ed. No stranger to battle—he had been seriously injured as an Army captain in Italy during World War II—Dole had no intention of allowing ED to beat him.

When Pfizer learned of Dole’s participation in the trials, they hired him as spokesperson for Viagra. With Dole’s help, Viagra became an unparalleled success, leading to an increased dialogue about ED and lessening the stigma that had been associated with the condition. Now, people often thank Dole for bringing ED into the open. “And not only guys,” says Dole. “I’ve been in airports where women come up and kind of whisper, ‘Thanks for doing that.’ It’s a partner thing, not just a man thing.

“Some guys are embarrassed about it, but it’s like any other illness. If you have a problem, you’ve got to go to the doctor,” Dole says. “He’s not going to run around blabbing to everybody in the office, ‘Hey, this guy just walked in and he’s got an ED problem.’ He’s not going to violate the confidential doctor/patient relationship. If you’re still embarrassed, go in after hours or early in the morning when there’s nobody else around.”

In the summer of 2003, GlaxoSmithKline and Bayer Pharmaceuticals announced a joint venture to introduce Levitra, Viagra’s first challenger. In the fall, Eli Lilly outdid them both with Cialis. Unlike the effects of Viagra and Levitra, which last about four hours, Cialis is effective for up to 36 hours, giving it a “set it and forget it” appeal the other drugs lack. And it can begin to work in as little as 16 minutes versus up to an hour for Viagra. In February 2004, Levitra and Cialis both appeared in Super Bowl advertisements, for which their manufacturers paid more than $40 million for each 60-second spot. ED treatments now were officially big business.

But you’re probably less interested in the hoopla than in exactly how these drugs work. It helps to know how the erectile process works. Watson explains: “There are three erectile bodies, lying deep within the penis, which act … as rods. Two of them are dorsal (on the top) and are called the corpora cavernosa. They’re the ones that become rigid with erection. There’s also one on the ventral aspect—the belly side—of the penis called the corpus spongiosum. That one becomes turgid with erection, but not rigid.

“The corpora cavernosa are cylinders which have fibrous outer walls and a lot of vascular sinuses inside—areas where blood can be stored under pressure. When flaccid, these cylinders are semi-collapsed, but when it’s time for an erection, the blood comes rushing in and they fill up. Because of their fibrous coating, they can only expand so far. After that, they just become harder. There’s also a secondary function, whereby drainage from these cylinders slows down. So with the blood rushing in and the exit slowing down, the blood filling the two rods, or corpora, causes an erection. The rods swell up with inrushing blood and let the good times flow, so to speak.”

Better living through chemistry

All of the anti-ed drugs work by suppressing the effects of pde-5 for various periods of time, allowing the cyclic GMP to take over and produce its intended result. Sildenafil, the drug that became Viagra, originally was created as a cardiac medication designed to treat angina by increasing blood flow to the heart. Test subjects reported a surprising side effect: improved and longer-lasting erections. In fact, several were reluctant to give their remaining pills back after the trial was over. Pfizer immediately set to work refining and testing the drug for use in ED patients, and the rest is history.

Considering all the good these drugs can do for men with ed, could there possibly be a downside? Well, yes: None of the drugs is completely free of side effects. According to Pfizer, Viagra can cause headache, facial flushing, upset stomach, and bluish or blurred vision or sensitivity to light and shouldn’t be taken with a high-fat meal. The company says the effects usually are mild and brief. Eli Lilly reports incidences of headache, upset stomach, backaches, and muscle aches for Cialis users. Men taking Levitra might experience headaches, flushing, and stuffy or runny noses, according to Bayer/GlaxoSmithKline.

Too much of a good thing

Watson notes one potential side effect that should be treated right away: priapism. “When an erection lasts for more than an hour or so, it is important to seek medical help immediately,” he warns. Although it might be an embarrassing dilemma to explain in the emergency room, Watson says, “this complication is no joke. If not treated promptly, this condition can result in permanent damage to the penis.”

There’s also one extremely important caveat: If you’re taking nitrate drugs such as nitroglycerin, you should avoid ED drugs, which could cause a dangerous drop in blood pressure when combined with nitrates.

Mind as well as matter

Still, Watson worries about the development of a “quick fix” mentality among overworked physicians who might prescribe a drug without a comprehensive patient interview. Although most cases of ED can be traced to an organic, physical disorder, erectile dysfunction most often carries with it an emotional and psychological component as well.

“From an emotional standpoint, I think the thing we’re missing is that human sexuality and intercourse is an extraordinarily intense experience in communication between two people,” says Watson. “When erectile function starts to fail, sometimes it means the psyche, the mind, is telling the body ‘there’s a problem with communication here, and it’s so serious you’re going to have to deal with it.’”

Anxiety can be a major factor as well. Most men experience an equipment failure from time to time for reasons ranging from stress to exhaustion, and as Watson points out, it’s not exactly an ego booster.

“The next time you go back in the bedroom, you bring that memory with you along with some anxiety, and that increases the likelihood you’ll have another disappointing experience,” he says. That can result in withdrawal from intimacy, creating a whole range of new problems. In those cases, Watson prescribes an anti-ed drug on a short-term basis to build confidence.

If you’re hesitant to even mention ED to your doctor, you might be tempted to get Viagra or one of the other drugs on the Internet. After all, they’re widely available, and you can buy them anonymously. But that would be a mistake, says Watson. As mentioned, ED can be a warning sign of a serious medical problem, which can’t be diagnosed via the World Wide Web.

“If you just get a pill on the Internet, the long-range problem may be greater than the one you’re trying to solve,” Watson warns. “The important thing is to have it checked and not to be embarrassed or ashamed. Have it checked by a doctor you trust.”

The bottom line: If you have ed, take Bob Dole’s advice and go to the doctor. Make sure your doctor is someone you’re comfortable with, and give him or her as much information as possible about your symptoms and lifestyle to facilitate an accurate diagnosis. Making that appointment might not be easy, but it could save your life, as well as make it more enjoyable.