Impotence Support - alt.support.impotence FAQ

Author

alt.support.impotence FAQ

Jerry Sturdivant

2006-06-16, 8:21 am

[This is a weekly post and may contain dated material]

Following is a copy of FAQ:

It has a number of errors and I will be editing it until the web site is
corrected and changes to the web site is complete.

Jerry of ASI

---------------

Some of what can cause impotence:

http://www.epub.org.br/cm/n03/doencas/causas_i.htm

What is alt.support.impotence?

Alt.support.impotence is a mutual support group composed of people who
either have or are affected by Impotence (Erectile Dysfunction). For the
most part the contributors to ASI are not medical professionals, although
doctors and other medical professionals do contribute from time to time.
Basically, we are a support group composed of people who are attempting to
help each other as best we can to overcome a difficult problem. Many of the
contributors have been there for a long time, and have a large body of
experience. They're ready and willing to help.

In addition to the many regular contributors who come and go as the spirit
moves them, there are three long-term contributors who lend continuity to
the group, maintain the FAQ and try to keep things somewhat organized:

· Jerry Sturdivant, jerryst@cox.net is the original founder
and leader of the group, and has a tremendous store of knowledge on the
subject.

· Jim, (AKA avocet) avocet@hawaii.rr.com is a gay man who
contributes a unique perspective to both gay and straight issues involving
ED.

The ASIweb Charter and Posting Guidelines gives further information about
ASI, and outlines what is and what is not acceptable posting content.

Can I post anonymously to the group?

ED is a sensitive subject for most people, and until the advent of Viagra
was a disorder rarely talked about, even with a doctor. Even now it's
sometimes difficult to find a way to talk about it. Many men feel betrayed
by their own bodies, and doubt their masculinity when faced with this
problem, and their partners may feel they are no longer attractive or that
they have done something to cause the problem in their mate. Both the man
and his partner are reluctant to discuss it with their doctor, their
friends, or even each other. Alt.support.impotence provides a forum where a
person can 'Let it All Hang Out' and discuss the problem freely and openly
without fear of anybody knowing who he is or where he's from.

What is Erectile Dysfunction (ED) and how do I know if I have it?

The terms erectile dysfunction, or ED, and impotence used to be considered
to be interchangeable. However the more appropriate term is erectile
dysfunction; defined as the persistent inability to attain and maintain
erections of sufficient rigidity for penetrative sexual intercourse.
Impotence has pejorative connotations and includes this meaning. But it also
involves reduced potency which could include loss of libido, being
sub-fertile or not having an orgasm, and premature ejaculation (ejaculating
before or soon after beginning intercourse).

Premature Ejaculation (PE), in particular, is highly subjective. If you can
achieve penetration before ejaculating then you have PE from a personal
standpoint if you don't last as long as you and your partner desire.

Approximately 20 million men in the U.S. have ED to some degree, ranging
from complete inability to have an erection to occasional problems.

ED is not only, "can't get it up," but, "it won't stay up long enough."
(Like when we were 18-years old) Many are able to get an erection but
sometimes can't keep it up long enough to achieve an orgasm and/or satisfy
their partner. Age is certainly a contributing factor, and the majority of
men with ED are over 40. This is by no means always the case; we have
questions from teens upward in age.

I'm 18 and I think I might have ED, but I've never seen anyone else's erect
penis. How hard should an erect penis be?

We've been asked this question a number of times. A picture is worth a
thousand words. Here are pictures of fully erect circumcised and
uncircumcised adult penises. The same uncircumcised penis is shown with and

without the foreskin retracted. Yours may be longer, shorter, fatter or
thinner and may lie anywhere from close to your belly to horizontal or even
point slightly downward when erect. If you have a foreskin it may cover the
head when erect or not, depending on how long the foreskin is. If you're
uncircumcised you should be able to retract your foreskin fully and recover
the head easily and without pain when you're erect (if not, then see a
urologist). Your penis may curve in any direction and still be normal unless
the curve is so severe it prevents intercourse or causes pain. Everyone is
different. When fully erect, your penis should be very firm and almost
impossible to bend in the middle without pain. As the erection reaches its
peak the glans (head) will become quite rigid and its surface may become
shiny (see first picture). In general, a very large penis doesn't become as
rigid as a smaller one, but again, we're all different. Also, a penis that's
long when flaccid doesn't gain a lot in length when erect, but a smaller
flaccid penis can more than double in size when erect. In case you're
interested, the average penis is between 5 and 6 inches when erect, measured
along the top surface from pubic bone to tip. Those in the pictures are
probably a little above average.

What's a {insert part of male sexual anatomy} and where is it?

We get many questions about male sexual anatomy. What's the Corpus
Cavernosa/Epididymus/Cowper's Gland, etc.

Someone told me I might have Peyronie's Disease. What is it, and can it
cause ED?

Peyronie's disease, a condition of uncertain cause, is characterized by a
plaque, or hard lump, that forms on the penis. The plaque develops on the
upper or lower side of the penis in layers containing erectile tissue. It
begins as a localized inflammation and can develop into a hardened scar.

Cases of Peyronie's disease range from mild to severe. Symptoms may develop
slowly or appear overnight. In severe cases, the hardened plaque reduces
flexibility, causing pain and forcing the penis to bend or arc during
erection. In many cases, the pain decreases over time, but the bend in the
penis may remain a problem, making sexual intercourse difficult. The sexual
problems that result can disrupt a couple's physical and emotional
relationship and lead to lowered self-esteem in the man. In a small
percentage of patients with the milder form of the disease, inflammation may
resolve without causing significant pain or permanent bleeding.

The plaque itself is benign, or noncancerous. A plaque on the top of the
shaft (most common) causes the penis to bend upward; a plaque on the
underside causes it to bend downward. In some cases, the plaque develops on
both top and bottom, leading to indentation and shortening of the penis. At
times, pain, bending, and emotional distress prohibit sexual intercourse.

What causes ED?

The causes of ED are many and varied, and often unknown. ED can arise from
psychological problems (psychogenic ED) or can be secondary (organic ED) to
disease conditions such as diabetes or atherosclerosis, or a result of
surgery; depression, anxiety, certain drugs, smoking, or alcohol .

Causes include:

· Blood flow problems: Hardening of the arteries (atherosclerosis), high
blood pressure, diabetes, or arterial damage (bicycle riding has been cited
here)

· Drug side effects: Sedatives, antihypertensives, diuretics,
antidepressants, weight control drugs, peptic ulcer drugs, alcohol,
nicotine, caffeine, opiates (marijuana, cocaine, etc) and many more. For a
list of common drugs that may contribute to ED, see:
http://www.impotenceworld.org/medication1.htm

· Nerve impulse abnormalities: Conditions that reduce or block the nerve
supply to the penis. Diabetes, stroke, spinal cord injuries, pelvic trauma.

· Hormonal abnormalities: Diseases that disrupt the normal balance of
hormones include kidney disease (and dialysis), liver disease and
alcoholism, pituitary tumors, hypogonadism (lack of testosterone).

· Surgery: Any surgery or medical procedure involving the pelvis, and
especially the prostate or bladder

· Prostatitus: Inflammation of the prostate

· Prostate cancer: Treatments are usually the culprit whether surgery,
radiation or seed implantation

· Penile trauma or scarring: Peyronie's disease (scar tissue in the penis,
or 'bent penis').

· Psychological causes: Depression, stress, performance anxiety, guilt and
misinformation about sexuality. Premature ejaculation, in particular, is
often a psychological problem and is most often observed in young men.

Most ED has a physical cause, but there is almost always a psychological
component. Even a single failure to maintain an erection can cause worrying,
stress and apprehension. Worrying about it makes it worse, to the extent
that the ED may persist even after the physical cause disappears.

Is ED between the legs or in the brain?

Although the end result of ED is certainly seen at the level of the penis,
it can occur from changes in many different parts of the body, including the
brain and spinal cord. Irrespective of origin, the end result is generally
observed as changes in blood supply within the cavernosal tissue of the
penis.

How do I know if my ED is physical or in my head?

There are ways to try and ferret out whether a particular case of ED is
"psychogenic" or organic (physical).

Men normally have several involuntary erections each night during sleep (not
to be confused with 'wet dreams') in addition to the erection most men have
upon waking (the morning erection or 'piss' hardon). If these erections are
weak or missing there's at least a preliminary indication that something's
wrong physically.

The test for this is called Nocturnal Penile Tumescence testing (NPT) which
can be done either in a sleep lab or at home. The most popular device for
this test is called the RigiScan, which measures the frequency, longevity,
and strength of erections that occur during sleep. Measuring these sleep
erections is important because nocturnal erections can be weak, short-lived
or infrequent, indicating a physical cause despite the patient subjectively
"remembering" he has nocturnal or morning erections.

Tests to determine blood flow and venous competence of the erectile system
are also available. These include penile doppler ultrasound,
cavernosometry/cavernosography (pressure tests/x-rays of the penis during
erection), penile arteriography, and various other tests. These tests are
often of limited usefulness in the majority of ED cases, they may be useful
for men who have never experienced erections, or for men with known trauma
such as a pelvic crush injury or similar perenial trauma. Limited usefulness
means that the results of the tests will do little to change the recommended
treatment and serve only informational purposes for the patient.

To summarize, there are a variety of tests which can be performed to help
determine the exact cause of a particular case of ED, but in the
overwhelming majority of cases, once serious or life-threatening disease is
ruled out they are unnecessary from a medical standpoint.

In the future, as effective remedial treatments for such things as venous
leakage and arterial damage/insufficiency are perfected and become generally
available, these tests may become more valuable. In the present state of the
art, however, there is little that can be done to correct these situations,
and the treatment consists of simply alleviating the symptoms

Is ED like atherosclerosis?

It has been claimed by some that ED could be considered to be
atherosclerosis of the penis. Atherosclerosis is the "furring up" of
arteries and small blood vessels, resulting in reduced blood flow. Doppler
flow studies show that this can occur in the penis and in the blood vessels
that supply it.

Can stress cause ED?

One of most common psychological causes of impotence is stress or
performance anxiety. During stress, sympathetic nerve impulses constrict
smooth muscles within the penis and prevent blood from flowing in to cause
an erection. Stress also causes a decrease in nitric oxide (NO), the
substance which triggers muscle relaxation. Viagra enhances the action of NO
so that smooth muscles can relax more easily. Studies have shown that once
men overcome their anxiety simply by performing successfully, they often do
not even need any more help from medication. Men who take Viagra may want to
use it a few times and then try to have intercourse without it. In many
cases, they find that they can wean themselves off the drug.

I have ED and drink alcohol heavily. Could this be the cause?

This could certainly contribute to your ED. The simple solution is to either
stop drinking entirely or reduce your alcohol intake drastically.

Can bicycling cause ED?

At least one urologist, Irwin Goldstein, believes that bicycle seats, by
exerting pressure on the nerve supply to the penis, can, in fact, cause
reversible or irreversible damage and ED. This problem occurs most often in
men who spend a lot of time riding. Dr. Goldstein, however, probably
represents a minority view in this. Several manufacturers have designed
bicycle seats to reduce or eliminate the pressure.

The doctor said my ED is caused by venous leakage. What is it?

An erection is a complex process. To simplify as much as possible, here's
what happens: First, the deep arteries carrying blood into the penis expand,
increasing blood flow. This causes the spongy tissues that make up most of
the shaft to expand and fill with blood. When these tissues expand they
press against and close off the veins (near the surface) draining blood from
the penis, increasing blood pressure within the penis and sustaining the
erection.

Sometimes either the tissues don't expand enough or the veins are not
flexible enough to be completely squeezed shut. When this happens the blood
is allowed to drain out of the penis at the same rate as it enters,
resulting in loss of erection. This leakage of blood through the surface
veins is called venous leakage. It has nothing to do with the veins actually
leaking blood into surrounding tissues; only that they're not completely
shut off and "leak", like a leaky faucet. A cock ring can help here by
shutting off the veins externally with a tourniquet effect.

I don't have a problem now. What can I do to prevent ED in the future?

ED is associated with certain risk factors, including being overweight,
being diabetic, having abnormal blood platelets, smoking too much or
excessive alcohol intake. You can compensate for these by adjusting your
lifestyle and so reduce the likelihood of ED occurring. You should also
discuss with your primary care physician whether any of the drugs you may be
taking could have an adverse effect on sexual function.

I've finally decided to see a doctor about my problem. What should I tell
him, and what questions should I ask?

First off, it's a good idea to write down everything you want to discuss
before you see the doctor. Include a complete narrative of your particular
problem; when it began, what your symptoms are, etc. Be thorough and
completely (even painfully, as one contributor put it) honest with yourself.
If you think it's relevant, start at puberty or even before. Your doctor
depends on you for a lot of the information he needs to make a proper
diagnosis. Take two copies with you.. one for the doctor and one for you.
This approach has several added advantages.

· You have plenty of time to think it through and include everything you
want to say. In the embarrassment of the moment, you will probably leave out
something important if you rely on just talking it over with him.

· Your doctor is a lot more likely to take you seriously if you've taken
the trouble to write it all down.

· You can go over the points with the doctor one by one, and you're both on
the same "page" at all times.

Before you see the doctor, get as much information as you can about ED; what
causes it, what YOU think the cause might be in your particular case, and
the treatments that are available. This way, you can not only discuss it
intelligently with the doctor, but you can get an idea pretty quickly if
this particular doctor is well versed in the subject or not. If you know
more about the subject than the doctor does, you should find another
doctor -- IMMEDIATELY!! Remember that ED has only recently "come out of the
closet" and some doctors, GP's in particular but many urologists and
endocrinologists as well, are not well educated on the subject. If your
doctor doesn't seem willing to discuss it, or dismisses it quickly, then
find one who takes you seriously! Remember, it's YOUR sex life you're
interested in, and your doctor has no business dismissing it as unimportant.
It doesn't matter if you're eighteen or eighty, heterosexual, homosexual, or
bisexual.. you've got a right to enjoy a satisfying sex life and your doctor
is paid to help you do it!

Read the information on this web site, and join the Alt.support.impotence on
the Web discussion group. Don't be afraid to ask questions. There are a lot
of people there who know a lot about all aspects of ED and they're there to
offer advice. There are no stupid questions as long as you're sincere. If
you don't want your e-mail address or your identity known, read the FAQ
about anonymous posting. If you're still hesitant to sign up, you can e-mail
Jerry or Jim directly. They'll answer you directly if you prefer. Your
anonymity will be respected and preserved.

There are a couple documents you might want to print out and take with you
when you visit the doctor. These are the American Association of Clinical
Endocrinologists (AACE) Clinical Guidelines for the treatment of Male Sexual
Dysfunction and Hypogonadism. Hypogonadism is another term for hormonal
problems (usually too little testosterone or too much estrogen, but there
are other problems as well). You'll want this one if you feel your libido is
low or you suspect you might be suffering from low testosterone. You'll do
well to read these documents carefully and take one or both with you to the
doctor. They aren't perfect, but they're a great starting point for your
discussion, and your doc may never have seen them. You can either go to the
AACE website at

http://www.aace.com/clin/guides/sexualdysfunction.html and
http://www.aace.com/clin/guidelines/hypogonadism.pdf

If you get the Adobe version, it's already formatted for printing but
you'll need the Adobe Acrobat Reader 4.0 if you don't already have it (you
can download it free from the ASI FTP site as well, .file name ar405enq.exe.
It's about 6MB, so be prepared to wait if you're using a modem).

Seeing a doctor about a sexual problem for the first time is painful and
embarrassing for many men. But consider the alternatives. Chances are pretty
good that your problem won't go away by itself. It'll only get worse. As
men, we're reluctant to discuss our sex lives, and even more so when we feel
there's a problem. Sexual potency in men is supposedly a given, and if a man
can lay claim to being a man he's supposed to be able to perform every time
at the drop of a hat. That's what you've heard in the locker room since you
were a teenager, but you and I (and all men) know privately that that's
crap, and your doctor does, too. The doctor is there to help you, so take
advantage of it and get your sex life back on track! No man older than a
teenager can expect to get an erection and perform sexually every time he'd
like.. there are just too many things that can interfere. But we can expect
to have a normal and satisfactory sex life regardless of age, and there are
enough alternatives out there to ensure that it can happen. A visit to the
doctor and laying it all on the line is the first, and the most important,
step in achieving it. Don't delay!

My ejaculation is weak, and just dribbles out. What can I do about it?

Often, this is caused simply by getting older and losing some of the muscle
tone in the pelvis. It can also be caused by restriction (scar tissue or
some such) in the urethra, or an enlarged prostate.

Also, especially if you've had prostate surgery, either a TURP or
prostatectomy, it can be caused by a condition called "Retrograde
Ejaculation" There are two sphincters which close off the urethra; one where
it exits the bladder and one where it exits the prostate and enters the
penis. During ejaculation, the sphincter at the exit from the bladder
normally closes and the one at the exit of the prostate opens, directing the
semen out of the penis through the urethra. If this doesn't happen
correctly, for instance if the sphincter at the exit from the bladder
doesn't close completely or is damaged, then the ejaculate can go backwards
into the bladder rather than out through the penis. Prostate surgery often
damages one or both of these sphincters, especially the one at the bladder
neck, which is why many men have incontinence problems following surgery of
this type. Retrograde ejaculation isn't a serious problem unless you want to
father a child. It won't cause an infection or any other physical problem,
except for personal dissatisfaction in not being able to ejaculate normally.
I you do want to father a child, sperm can actually be recovered from the
urine and used for artificial insemination.

Lack of pelvic muscle tone can sometimes be improved by doing Kegel
exercises. This involves exercising the pubococcygeus, or PC, muscle, which
stretches from the prostate to the anus. It's used on a daily basis to shut
off the flow of urine and feces until you're ready to relieve yourself, but
it's also used in ejaculation. The same muscle in women can be used to
tighten the vagina during sex as well as in control of urine and feces. This
is the muscle that causes your penis to "jump" when it's erect and touched.
If you've had prostate surgery, exercising this muscle can help to minimize
incontinence problems, and may help to strengthen and control ejaculation as
well.

I've heard of Kegel exercises. What are they and how can they help my sex
life?

Kegel exercises were first devised by a California Gynecologist, Dr. Kegel,
to help women with stress incontinence, or urine leakage. A welcome and
unexpected side effect was strengthening of the vaginal muscles and
increased sexual satisfaction for both the woman and her partner. Recently,
research has shown that males can gain significant improvement in erectile
function as well through use of Kegel exercises. There's an appendix on
Kegels in The Testosterone Syndrome, by Dr. Eugene Shippen.

Can prostate cancer cause ED?

Prostate cancer in itself does not normally cause ED, but the treatments for
it certainly can.

What is nerve-sparing radical prostatectomy?

Radical prostatectomy is usually performed in the treatment of prostate
cancer. There is a danger that during the procedure the nerve supply to the
penis may be damaged, either reversibly or irreversibly, leading to ED. To
limit the degree of damage, the standard procedure has been modified to
maintain as much of the nerve supply as possible. Hence the term,
"nerve-sparing radical prostatectomy".

I am 6 months post-radical prostatectomy. I get no erections and nothing
helps. Will I recover?

Recovery is certainly possible, although not definite, that you may recover.
What has been found is that the nerve damage associated with the
prostatectomy can heal with time. Nerves have been shown to regenerate over
a period of 1-2 years. Many patients with ED following radical prostatectomy
respond to therapy and are able to regain full or partial erections.

What treatments are available for ED?

There are a variety of treatments available, and many more are being
developed. The choice of treatment should result from discussions between
you, your sexual partner and your doctor. Generally, the least invasive
treatment which produces the desired results and is a satisfactory solution
to both the man and his partner is the best. The various options are listed
below, in order of least to most invasive.

Cock rings (restriction bands): What are they and how do they work?

You can order them online, or get them from a drug store or a sex shop. Some
of the best are either adjustable or come in assorted sizes for best fit.
There should be an easy method of removal - either snaps or a ratchet
arrangement (in the case of adjustable) or rubber ears in the case of
elastic rings.

Solid metal rings are dangerous since there's no easy method of removal.
Rubber "O" rings from the hardware store will work and are very cheap but
are difficult to remove without cutting them off since there's no way to
grasp them for removal. Removal is easier if you apply lubricant to your
penis and the cock ring.

Since you are, in effect, applying a tourniquet to your penis the ring
should not be left in place for more than about a half hour. This means you
need to remove it as soon as you finish.

The drawbacks are that you have to take a break from sex to put it on. It's
sometimes uncomfortable, and it tends to pull your pubic hair, particularly
when removing. One way around the hair pulling is to either trim or shave
your pubic hair.

No prescription is needed, the rings are quite safe and effective as long as
you observe the half-hour rule. They can be used to prolong or enhance a
normal erection as well as keep you from losing your erection prematurely.

Pumps (Vacuum Erection Devices): What are they and how do they work?

The pump basically consists of a clear acrylic cylinder, a vacuum pump and a
cock ring. The pump can either be integral with the cylinder or separate and
attached with a plastic tube. It works by creating a vacuum around the
penis, thus drawing blood into it and causing an erection. You start by
stretching the cock ring over the open end of the cylinder. Insert your
lubricated penis, forming a seal against your body and operate the pump.
Once the erection is obtained you slip the cock ring off the cylinder onto
the base of your penis, release the vacuum and remove the cylinder.. This
maintains the erection for up to half an hour. Cost ranges from about $200
to $450 and is often covered by insurance. You can find them in adult
stores, but these are always of inferior quality. Don't waste your money.
Quality manufacturers include Osbon, Rejoyn and Pos-T-Vac. Order through
your urologist or a drug store that handles durable medical goods. The pump
is probably the most reliable of all for getting and maintaining an
erection.

Viagra

Does everyone respond to Viagra?

Viagra has revolutionized the treatment of ED. While it's not for everybody
it does the job for most ED sufferers.

The overall response rate is somewhere in the region of 60-70%, with roughly
three-quarters of responders having a full erection. This response rate will
depend on the patient population; the response rate in diabetics is
marginally less and in post-radical prostatectomy - only 50% of men are
likely to respond.

How does Viagra work?

Viagra works by inhibiting an enzyme called phosphodiesterase (PDE), in
particular, one member of this class of enzymes called PDE5. This enzyme is
found within the penis and this accounts for the relatively selective action
of Viagra on ED. By inhibiting PDE5, Viagra increases the level of cyclic
guanosine monophosphate (cGMP). Elevated cGMP levels result in relaxation of
the cavernosal smooth muscle, which in turn results in engorgement of the
tissue and erection. In patients with ED, cGMP levels may be low and would
therefore be raised by Viagra.

Another explanation: Sildenafil is a phosphodiesterase inhibitor (PDE).
Basically this means it stops the breakdown of cyclic-GMP (a neurochemical
in the penis). The subtype of PDE in the penis is PDE5. The drug
cross-reacts with PDE6 (which occurs in the retina) and can cause some
visual disturbances (the "Blue Haze"). The drug is 10 times more effective
on PDE5 (penis) than PDE6 (eye) so these visual disturbances are not all
that common, though they can occur and we know the reason. No long term
retinal problems were identified in the initial study--only some temporary
visual changes.

For more information, call the American foundation for Urologic disease at
800-473-0616. Also check the web at www.iiem.org.

Here is a good report on what Viagra does:

It is not an aphrodisiac. Your sex drive will not be affected. According to
Pfizer, you will not get a spontaneous erection after you take the pill;
stimulus will still be needed. (Note that some men report that they do get a
spontaneous erection in spite of what Pfizer says.) That stimulus may be
mental, visual or physical, in your case, perhaps your partner's touch. It
all depends on the individual. Results vary but the effects of the drug
typically last four hours or more. It takes anywhere from 15 minutes to an
hour for the drug to become effective after you take it.

You will have to keep taking Viagra. It is not a one-time treatment. The
normal dose is 50 mg. You may find that 25 or even 12.5 mg works for you.
However, you may need a 100mg dose.

The drug is most effective if taken on an empty stomach. It should not be
taken with any nitrate-containing drugs such as nitroglycerine.

Side effects vary according to the individual and dose. Most common are
headaches, nasal congestion, facial flushing, visual disturbances (bluish
tint) and a sense of having a hangover the next day. Not everyone gets side
effects and very few men have reported having to stop using the drug because
of them. Most of the time, the dosage can be adjusted to minimize the side
effects, or a drug such as aspirin or an antihistamine can be taken to
relieve the discomfort.

Pills are expensive...about $10 US. Some men have gotten the pills mail
order. Most insurers in the US are not covering the drug or are limiting
coverage to about one pill a week. If you have to pay for it yourself, and
do not need the highest dose, it would behoove you to get 100 mg tabs and
split them as the price is relatively independent of the dose size.

Is my insurance likely to cover Viagra?

Some do, but most don't. Most insurance companies that cover Viagra will
only allow a certain number of pills per month. If this is the case, there's
no reason you can't get a prescription for as many as you need and just pay
the difference.

What is sildenafil? Is it the same thing as Viagra?

Pfizer only has one drug for the treatment of ED. Sildenafil is the generic
name of the active ingredient in Viagra tablets. Viagra is a trade name that
can be protected by Pfizer.

Does Viagra affect libido?

There is no evidence to date that Viagra affects libido. However, having
said that, a person with ED tends to avoid and suppress his desire for sex.
Viagra may give him the confidence to allow natural urges to come to the
fore and, in effect, give his libido a boost..

Will Viagra affect ejaculation?

Viagra is not known to affect ejaculation per se. However, it may reduce the
refractory period, which is the time it takes to get another erection after
ejaculating. Some men have reported, however, that it takes longer to
ejaculate when using Viagra, and a few cannot orgasm at all even though they
don't lose the erection.

Does Viagra or any other drug cause reversal of ED?

There is no evidence that Viagra does in fact cause reversal of the
underlying disease process in ED. However, a number of men are finding that
after several doses of Viagra normal activity seems to be restored. This may
be because their confidence in getting an erection has been restored and the
anxiety that was contributing to the problem is absent. It may also be part
of the "Use it or Lose it" syndrome. In other words, it's easier to get a
good erection if you have them regularly. This has to do with the next
question.

After several doses of Viagra my erections occur without it. Does this mean
that I have recovered?

There is no evidence that Viagra actually has a direct effect on the
underlying disease associated with ED. However, what may be happening
according to one urologist, Irwin Goldstein, is that as your erections begin
to reappear, you get better tissue oxygenation within the penile tissue
resulting in some level of collagen breakdown. This collagen breakdown then
restores tissue elasticity within the penile musculature and enables the
normal erectile process to reoccur.

Viagra was originally developed for angina. Does this mean my blood
pressure will change?

Your blood pressure may change on Viagra, although the changes in blood
pressure observed in clinical studies are considered not to be clinically
important. If you are on anti-hypertensive medication you should discuss
this with your primary care physician. Viagra should not be used in
conjunction with any drugs that contain nitrates, such as nitroglycerine,
glyceryl trinitrate, isosorbide or amyl nitrate (poppers).

Does Viagra have any side effects, and if so what are they?

No drug is without side-effects. However, Pfizer have worked out the
effective dose range that can be used to minimize side-effects. If the drug
is used within this dose range - usually 25-100mg - side effects are likely
to be minimal. Incidentally, not every individual will, in fact, experience
side-effects.

Most of the side effects you might experience are covered in the product
information sheet, but a few additional ones have been reported from users.
They can include headache, heartburn, nasal congestion, backache, slight
dizziness, diarrhea, a next-day "hung over" feeling and some slight visual
disturbance (blue haze). Some users have experienced delayed or no
ejaculation, especially after long-term use. Viagra will cause a drop in
blood pressure, which is why it shouldn't be used with any medication
containing nitrates, such as nitroglycerine.

What can I take to help eliminate side effects?

In general, just take whatever you would normally take to alleviate the
symptom if it occurred on its own. For instance, for headache, take Tylenol
or Ibuprofen. For stomach upset or heartburn take an antacid. For a stuffy
nose take a decongestant. If you regularly experience the same side effects,
try taking the remedy at the same time as you take the Viagra. For the
"Viagra Hangover", maybe a Bloody Mary or two. There's not much you can do
for the 'blue haze' except wait until the drug wears off.

It may be worth noting that Tagamet, the antacid, has been reported to
increase Viagra's levels in the bloodstream. Pfizer's studies, however,
showed that this only happens at about four times the usual Tagamet dosage,
and at this level Tagamet can not only contribute to ED, but also to hair
loss. It's doubtful you'll see any change in the effectiveness of Viagra
with a normal dose of Tagamet.

There is a general consensus that the side effects lessen with continued
use.

The main thing to remember about side effects is this: Increasing dosage
beyond what is required to get a serviceable erection increases the side
effects without improving your erection. In other words, to minimize side
effects (and save money) use the smallest dose that does the job.

What does half-life mean and what does it have to do with Viagra?

The half-life of a medication is the time at which the level in the
bloodstream is half of the maximum level. For Viagra, the half life is
supposedly about 2-4 hours. This means if you take a 100mg dose, after four
hours its effectiveness has dropped to what it would have been if you'd
taken 50mg.

After taking Viagra, why do I have erections the next morning?

Although the half-life, that is the time for the plasma level of the drug to
drop by 50%, of Viagra is about 2-4 hours, erections are quite commonly
experienced for some considerable periods after that. This is probably
because Viagra may be taken up into tissues and slowly released for up to 24
hours after a single dose.

I have been advised that for best results I should take Viagra on an empty
stomach. What is an empty stomach?

An empty stomach essentially means that you have not eaten food up to 2-3
hours prior to taking Viagra. The longer you can wait after a meal before
taking Viagra the better. Additionally, experience has shown that foods high
in fat diminish the effect. Some people have had good results by taking the
pill about half an hour before a meal. This gives the medicine time to get
into the bloodstream before it can be affected by the food.

The best time to take Viagra is in the morning before breakfast. This way
you can be sure your stomach is empty, plus you're relaxed and testosterone
levels are highest in the morning.

Why is Viagra so expensive?

Viagra has taken Pfizer some 10-12 years to develop at a cost of
approximately $250-300 million. For Pfizer to maintain a research and
development investment, they must try to recover this cost. This has to be
done over a limited time as the patent office only gives about 20 years
patent protection, which represents 5-6 years after a drug has been
marketed. These factors are reflected in the pricing of Viagra.

My insurance won't pay for Viagra. How can I minimize the cost?

Viagra comes in three strengths: 25, 50 and 100mg. For some reason known
only to Pfizer the three dosages all cost about the same; between $7 and $11
per pill depending on where you get it.

Find the lowest price

The most obvious cost saving device is to find the lowest price. Shop around
among your local pharmacies; you'll find the price varies a lot. You can
telephone and ask the price; there's no secret about it. In general, you'll
probably find the lowest price at discount pharmacies like Wal-Mart or
Target. There are some reputable online pharmacies who offer very attractive
prices. Drugstore.com , Planetrx and the AARP Pharmacy are among these.
Steer away from the online "Viagra without a prescription" sites. They're
bad news.

Split the pills

Regardless of the dosage you need, get a prescription for the 100mg pills.
You can use a sharp knife or an inexpensive pill splitter (available from
the pharmacy) to split the pill into halves or quarters. The medicine is
evenly distributed throughout the pill, so there's no problem of getting
more in one split part than another. Also, exact dosage is no problem if the
pill doesn't split evenly; approximate is fine. If you're worried about
this, just crush the pill into powder, divide the powder and put it in empty
gelatin capsules you can get from GNC.

If you're worried about your doctor prescribing the 100mg pills when you
only need 50's, don't. The doctor understands economy as well as you do.
Just explain what you're going to do and he'll likely be happy to comply.

Is there any way I can make Viagra work faster?

You can dissolve the pill in a little water (a bathroom paper cup is about
right) and drink it. If you're using a whole pill, break or crush it first
for faster dissolving. Don't worry about the blue coating - it doesn't
contain any medicine. Experience has shown that this cuts the time for the
Viagra to take effect down to about 15-30 minutes. Some people find that
using hot water works even faster. The resulting drink is bitter but
tolerable, and you can always follow it a with a little fresh water to wash
away the taste.

I took my first dose of Viagra and nothing happened. What's wrong?

First off, you may be one of the 20-30% of men for whom Viagra just doesn't
work. If that's the case don't despair; there are other alternatives.

Keep in mind that Viagra doesn't give you an automatic erection. It simply
enables you to get a normal erection with a normal amount of sexual
stimulation; visual, mental or manual. This means that if you take a pill
and then the occasion for sex doesn't arise as expected, nothing will happen
except you've just wasted a few bucks.

It's very important to take Viagra on an empty stomach. This means waiting 2
hours at a minimum after eating before taking the pill. Food high in fats
have the worst effect, but alcohol in moderation seems to be OK. Best time
is in the morning before breakfast when your stomach is empty, you're
relaxed and your natural testosterone levels are the highest. Some men have
found that they can take the pill about half an hour before eating. This
gives the medicine time to get into your bloodstream before the food
arrives. Since the Viagra will work for at least a couple hours this gives
you time for a leisurely meal followed by some satisfying sex.

You may be taking too low a dose. Most men find that 50mg is about right,
but others get the required effect on more or less. Try upping the dosage,
but keep in mind that the maximum recommended dosage is 100mg in a 24 hour
period. Also keep in mind that increasing the dosage will increase any side
effects you experience. Using a higher dosage than you need will increase
side effects without improving your erection. To avoid disappointment with
your partner it's probably better to experiment solo, with masturbation
before going for a home run.

What are some of the contributors experiences with Viagra?

Here is a mixture of individual's reports: (Try this at home. Your
experiences may vary.)

TIME DELAY: I've had my best results after waiting a couple of days between
pills. I don't know why but it seems to work better even though the
literature says you can take it daily.

FACE FLUSHING: I delay dick stimulation until I feel flush in my face which
can take as long as 45 minutes after taking the pill.

PURPLE DICK: About 5-10 minutes after the face flush, my dick takes on a
red/purple hue. Not sure if it's blood or medicine but after this is when
stimulation works best for me. I don't know why ... maybe prior stimulation
pushes medicine out of the dick.

LITTLE IS BETTER: Again, I'm not sure why ... but for me ... slower and
gentler stimulation proves best. Maybe time is needed for the old nerve
cells to get reactivated, but soft squeezing of the head, body and finally
the base now gets me close to a "woody".

EATING: The consensus is, don't eat for at least two hours before taking
Viagra. It slows the effect of the pill. For you morning folks, the fat in
milk slows it.

PILL ACTION: Instructions say take the pill an hour before sex. The effect
should last about four hours. (Called a 'Four-hour half-life') Some have
found that if they crush the pill, then take it the effect is quicker and
more dramatic. Presumably because they get the effect all at once. The word
is, Viagra's maker (Pfizer) is going to make a wafer, so it will act faster.

FASTER PILL ACTION: Some of us have found that if you chew the pill, or
dissolve it in a small amount of water and take it (tastes very bitter), the
results take effect in 15 to 30 minutes.

Can women take Viagra?

Clinical trials on the effects of Viagra on female sexual dysfunction are
underway, with promising but mixed results so far. Especially for women of
child bearing age, taking Viagra before it's got a clean bill of health
through extensive testing could be a risky business. There's no proof that
the medicine won't affect a fetus and cause any number of birth defects.
Theoretically Viagra should enable more engorgement of the clitoris and
labia and increased vaginal lubrication, resulting in more satisfying sex.
Better to be safe and wait until the verdict is in.

I don't have ED. Will Viagra or other drugs for ED enhance my sexual powers?

There is no evidence that Viagra will affect normal sexual function. If you
can get a hard erection and keep it until you ejaculate, it's very doubtful
Viagra will do anything positive for you. However, there have been a few
reports of priapism with the recreational use of Viagra. Priapism is a
persistent and painful erection, and is something you definitely don't want
to experience. It can cause damage to your penis.

Muse suppositories. What are they and how do they work?

Muse is a tiny suppository which is inserted about an inch deep into your
urethra using a disposable applicator. The medication, Prostaglandin (the
same medication as in Caverject), is absorbed through the urethra and into
the corpa cavernosa, the erectile tissues of the penis causing smooth muscle
relaxation and a resulting erection. It works in just a few minutes. It's
quite expensive, and may or may not be covered by insurance.

Although there was much interest and optimism in the response rate to MUSE
when it was introduced in 1995, more recent data presented at the American
Urological Association (AUA ) are less encouraging, with response rates only
marginally better than with placebo. Pain was also apparent at the delivery
site in approximately 30% of patients.The consensus on the group is that it
only helps about 3% of users and "hurts like hell", causing an ache in both
penis and testicles. The dropout rate in users is quite high, but until the
advent of Viagra, Muse was the treatment of choice for men who did not want
penile injections or any of the less invasive treatments.

I've heard about penile injections for ED. What's this all about?

There are several drugs which can be injected directly into the erectile
tissues of the penis to cause an erection.

Before you run screaming at the idea of sticking a needle in your dick, be
assured that the injections are made with a very fine needle (the type
normally used for insulin) and are less painful than a flu shot. The
following questions discuss the various drugs and how they're used.

What is Caverject?

Caverject is the trade name for an injectable solution of prostaglandin E1
(PGE1) or alprostadil, which is manufactured by Pharmacia-Upjohn. There are
other variants of this including Edex, a similar product from
Schwarz-Pharma.

Caverject makes the shot kit. (Do a Internet search for 'Caverject') It is
portable and does not require refrigeration until you mix the ingredients.
It's expensive, compared to the PGE1 or PPP. A popular complaint is that the
needle is very large. Many here will tell you to purchase the small needles
that diabetics use for insulin injections. Mix your powder and liquid using
the large needle supplied with the kit, then change to the small needle for
the injection. The reason the company supplies large needles may be the
worry you might break off the needle in your dick and sue them.

What are Bimix and Trimix injectables?

Bimix and Trimix are injectables for intracavernosal administration. They
refer to any combination of either two or three chemicals. Bimix is often a
mixture of papaverine and phentolamine, while Trimix would add PGE1. Other
cocktails are used, mainly in Europe.

These mixtures are not commercially available but must be mixed by a
compounding pharmacy. They are generally much cheaper than Caverject or
Edex, and tend to minimize aching in the penis or testicles which is a
problem in some men with Prostaglandin (PGE-1) alone. A compounding pharmacy
is one which will create custom medications on a doctor's prescription; it
usually doesn't include the corner drugstore or large chain pharmacies.

If you need to find a compounding pharmacy close to where you live, you can
go to the International Academy of Compounding Pharmacists at
http://www.iacprx.org/ . You can fill in a form on the site and they'll mail
you a list of pharmacies in your area.

My urologist says he's going to try me on injections my next visit. What
should I expect?

Either the doctor or a nurse will inject your penis with a test dose of the
chosen medication and observe the reaction. Since different men react in
varying degrees to the same dose, this is to establish what's the correct
dosage for you. The doctor or nurse will also show you how to administer the
shots yourself. Depending on your penis's reaction to the test dosage the
doctor will write you a prescription showing a higher, a lower or the same
dosage for home use.

When you inject at home you may get a different reaction than you did in the
doctor's office. That's because the environment is different; you may be
more or less relaxed or apprehensive. You can adjust the dosage upwards or
downwards in small increments until you find the right dosage for you. The
danger of too large a dose is that you may get an erection that refuses to
go down. This is called Priapism and if it goes on for more than three hours
you should contact your doctor immediately. Priapism can be serious.

Do the shots hurt?

Less than in your arm. The small needles, combined with the soft tissue,
makes it go in easy. It's just a little unnerving the first time. And the
first time is usually done by a Dr. in their office.

How do I give myself an injection?

A diagram usually comes with the medicine. One says to lay your dick to one
side, against your body, and shoot into it. Another has you hold it out. The
idea is to inject into the corpora cavernosa; the tubes on each side of your
dick. Going into the side at about the 9 o'clock to 11 o'clock, or, 1
o'clock to 3 o'clock position. This way you miss the urethra. Anywhere from
the base of your dick (next to your body) to about ¾ of the length. Don't
shoot in the head (ouch!)

What about the possibility of scarring?

The understanding is that there's a possibility that Prostaglandin (PGE1)
can cause scarring, (fibrosis) with long-term use. Several men in the group,
however, have used injections for years with no adverse effects. There seems
to be less risk with Trimix. Penile fibrosis can lead to Peyronie's disease
or "bent penis".

Will the shots give me a 100% erection by themselves?

They can, but in practice the shot alone should give you about an 80%
erection. Stimulation should bring it the rest of the way up. If the shot
alone gives you a 100% erection, you may have an erection for a longer time
than you want. Many have received a shot in the doctor's office and had
little to nothing happen. Yet when they inject at home, in a situation where
they began having sex, it worked.

I get erections but they don't last long enough. Will the shots help?

They should. You will find that the erection can last longer than the sex.
In other words, after climax, you may retain your erection.

Does it matter which side I inject?

No. The corpora are connected.

How long is too long a time for an erection?

If your erection lasts for 3 hours or more, it's time to call the doctor. An
erection that won't go down is called Priapism, and can be extremely painful
and harmful to penile tissues. The doctor will prescribe an antihistamine
and possibly caffeine. In extreme cases they may have to drain the blood
from your penis.

What is the medicine in the shots?

Most doctors start you out with PGE1 . This is Prostaglandin E1 (AKA
Alprostadil) and is the ingredient in Caverject and Edex. If this doesn't
work the doctor may prescribe Tri-mix, which is a mixture of Prostaglandin,
Papaverine and Phentolamine. A typical mix, in one bottle, is:
Prostaglandin, .05ml; phentolamine, .55ml; Papaverine, 2.5ml; Saline, 1.2ml.

Can I use my injectables intravenously to get better effect?

In a word, NO. It would be inadvisable to do this and may be positively
dangerous. Certainly with Trimix, side-effects are minimized by the fact
that you are applying the drug intracavernously and are, in fact, localizing
the effects of the drug to the corporal tissue. To give the drug
intravenously would be likely to cause serious systemic side-effects.

What can cause the plunger on the syringe to sometimes push hard?

If you draw slightly more into the syringe than your normal dosage, then
expel the excess back into the vial, you'll probably find the problem will
go away. The flexible plunger is a tight fit in the syringe bore, and if its
edge hangs on the surface when depressed, it will distort and bind. Drawing

extra liquid in, then expelling it, lubricates the surface of the cylinder.

Is there something to relieve the pain associated with Caverject?

One person reports he used lidocaine (not marcaine, or lidocaine with
epinephrine, which might defeat the purpose and would be dangerous) after
Radical Prostatectomy when he was experiencing significant pain. Half the
diluent in the Caverject kit syringe was replaced with 1% Lidocaine,
resulting in a 0.5% solution. "The Lidocaine has no effect on the surface
nerves and the solution was not noticeably different in action, other than
less pain. This procedure was recommended on Upjohn's web site over two
years ago." Consult with your doctor before trying this!

I have noticed that injection therapy gives me a harder erection and Viagra
a more natural one. Is this a common finding?

Viagra is essentially just restoring normal function and hence you get a
natural erection. On the other hand, substances you inject, e.g. Caverject,
are having a direct effect on the cavernosal smooth muscle. Also, as they
are locally applied, you quite often appear to get a harder erection either
subjectively, i.e. as you see it yourself, or objectively when you use a
device like RigiScan to measure it.

What about Priapism (an erection that won't go down)? I've heard it can be
a problem with injections.

This can be a problem, especially of you take too large a dose. It's
unlikely to happen if you follow the injection guidelines your doctor gave
you and increase or decrease dosage in small steps until you find the right
dosage for you. Your doctor should definitely have given you specific
instructions about what to do in case this happens. If not, then be sure to
ask about it! This will normally involve a prescription which you should
have filled and on hand, and instructions about either calling the doctor or
going to the emergency room if the prescription doesn't work.

In general, you should be concerned about any erection that lasts for more
than about 3 hours (but follow your doctor's advice about this). We're
talking about a hard, steady erection here; not one that comes and goes. The
problem is that with a very hard erection, there is virtually no blood flow
through the penis, since the veins that carry blood away are shut off tight.
Blood flows in but can't leave. All the oxygen in the blood captured in the
penis is used up and the blood stagnates and thickens, making it even harder
for it to be removed by any veins that are still open. If this goes on too
long it can cause permanent damage to the erectile tissues.

In extreme cases you might have to go to a hospital or doctor's office for
treatment. The treatment may involve injection of antihistamines, caffeine
or adrenaline directly into your penis, or "bleeding" your penis to remove
stagnant blood.

There are a few things you can do before resorting to the emergency room if
you think your erection is lasting too long. Here's a copy of a message
Jerry posted. He's been through an extended bout of priapism caused by
penile injections:

Your doctor should give you some pills that counteract the shots. It's
usually three pills, to be taken after three hours of erections. Each pill
taken a half-hour after the last. The pills are each equal to about 4-5 cups
of coffee. In other words, coffee (caffeine) works against erections.

Another emergency method is to stand (not lie in bed) and squeeze,
attempting to force blood out of the penis. Keep the pressure on for 15-20
minutes. Obviously your hands will tire. Squeeze 50 seconds, rest 10
seconds. The standing and squeezing also causes some adrenaline and this,
too, counters erections. Adrenaline is the medicine they inject in your
penis if the doctors have to get your erections down. Apparently exercising
creates some adrenaline and will help get it down.

Here's another suggestion from a poster:

One way to check to make sure you have adequate blood flow is to use ice
cubes to cool it (your penis) way down. If it gets warm again on its own,
you know there is adequate blood flowing through it to avoid damage. (This
is what my doc told me.)

What are penile implants and how do they work?

Implants are prosthetic devices inserted in the penis to take the place of
the erectile tissues of the penis. They come in several different types and
prices. Most are made by American Medical Systems. Implants should be
considered as a last resort since inserting them destroys the erectile
tissues of the penis. There's no going back. For a good description, go to:

http://www.drmobley.com/daveL44.htm

Here's a summary of what's available, 'borrowed' from
http://www.msdinst.com/implant.htm:

Malleable Prosthesis

Prostheses come in several styles, malleable (bendable) and inflatable. Each
malleable prosthesis consists of two cylindrical plastic rods from 6-10
inches long and up to 1 inch thick, with tapered ends. These rods fit the
body because the penis is actually twice as long as it appears. At least
half of it extends behind the skin where it cannot be seen, and is fixed to
the bones of the pelvis. Malleable implants always remain the same length,
width and degree of hardness, but they are cleverly made so that when the
penis containing the prosthesis is bent upwards, it produces a hard,
normal-looking erection. When bent downward so that it hangs comfortably in
front of the scrotum, it looks like a normal flaccid organ.

Inflatable Prosthesis

2 and 3 piece inflatables

All inflatable prostheses have three components: a cylinder, a reservoir and
a pump. In some models the pump and the reservoir are combined into a
resi-pump. Instead of two plastic malleable rods, the inflatable prosthesis
has two hollow expandable, balloon-like cylinders, about 2 1/3 inches wide,
that become longer, fatter and harder as fluid (sterile salt water) is
pumped into them from the reservoir.

Inflatable prostheses range from 8 - 14 inches in length. The reservoir is a
hollow plastic ball, capable of holding 2 1/2 - 3 1/2 ounces of liquid. The
pump is a hollow ball the size of a large grape. When the ball is squeezed
manually, fluid is forced from the reservoir into the cylinders, which
become hard and distended, producing an erection. The erection will not go
down until the deflate bar of the pump is gently pressed. The component
parts of this device are connected by plastic tubing. The reservoir is
placed inside and behind the lower abdominal muscles; the pump goes into the
scrotum behind the testicles; and the cylinders go inside the
spongy-tissue-containing tubes in the penis. Everything is concealed.
Nothing shows.

Edited October 13, 2002

sherrybove@gmail.com

2006-06-21, 4:22 pm

FYI
Heart attacks linked to jobs loss

Losing your job late in your career doubles the chance of suffering a
heart attack or stroke, a study says.
Once risk factors such as diabetes, smoking, obesity and high blood
pressure were taken into account, the risk of the involuntary job loss
group having a heart attack after losing their job was 2.5% and a
stroke 2.4%.

I've found this information from
http://epsdrugstore.com/6-21eps-Heart_attacks.htm
let me know if helpful

Jerry Sturdivant wrote:
> [This is a weekly post and may contain dated material]
>
> Following is a copy of FAQ:
>
> It has a number of errors and I will be editing it until the web site is
> corrected and changes to the web site is complete.
>
> Jerry of ASI
>
> ---------------
>
> Some of what can cause impotence:
>
> http://www.epub.org.br/cm/n03/doencas/causas_i.htm
>
>
> What is alt.support.impotence?
>
> Alt.support.impotence is a mutual support group composed of people who
> either have or are affected by Impotence (Erectile Dysfunction). For the
> most part the contributors to ASI are not medical professionals, although
> doctors and other medical professionals do contribute from time to time.
> Basically, we are a support group composed of people who are attempting to
> help each other as best we can to overcome a difficult problem. Many of t=
he
> contributors have been there for a long time, and have a large body of
> experience. They're ready and willing to help.
>
> In addition to the many regular contributors who come and go as the spirit
> moves them, there are three long-term contributors who lend continuity to
> the group, maintain the FAQ and try to keep things somewhat organized:
>
> =B7 Jerry Sturdivant, jerryst@cox.net is the original founder
> and leader of the group, and has a tremendous store of knowledge on the
> subject.
>
> =B7 Jim, (AKA avocet) avocet@hawaii.rr.com is a gay man who
> contributes a unique perspective to both gay and straight issues involving
> ED.
>
> The ASIweb Charter and Posting Guidelines gives further information about
> ASI, and outlines what is and what is not acceptable posting content.
>
>
>
> Can I post anonymously to the group?
>
> ED is a sensitive subject for most people, and until the advent of Viagra
> was a disorder rarely talked about, even with a doctor. Even now it's
> sometimes difficult to find a way to talk about it. Many men feel betrayed
> by their own bodies, and doubt their masculinity when faced with this
> problem, and their partners may feel they are no longer attractive or that
> they have done something to cause the problem in their mate. Both the man
> and his partner are reluctant to discuss it with their doctor, their
> friends, or even each other. Alt.support.impotence provides a forum where=
a
> person can 'Let it All Hang Out' and discuss the problem freely and openly
> without fear of anybody knowing who he is or where he's from.
>
>
>
> What is Erectile Dysfunction (ED) and how do I know if I have it?
>
> The terms erectile dysfunction, or ED, and impotence used to be considered
> to be interchangeable. However the more appropriate term is erectile
> dysfunction; defined as the persistent inability to attain and maintain
> erections of sufficient rigidity for penetrative sexual intercourse.
> Impotence has pejorative connotations and includes this meaning. But it a=
lso
> involves reduced potency which could include loss of libido, being
> sub-fertile or not having an orgasm, and premature ejaculation (ejaculati=
ng
> before or soon after beginning intercourse).
>
> Premature Ejaculation (PE), in particular, is highly subjective. If you c=
an
> achieve penetration before ejaculating then you have PE from a personal
> standpoint if you don't last as long as you and your partner desire.
>
> Approximately 20 million men in the U.S. have ED to some degree, ranging
> from complete inability to have an erection to occasional problems.
>
> ED is not only, "can't get it up," but, "it won't stay up long enough."
> (Like when we were 18-years old) Many are able to get an erection but
> sometimes can't keep it up long enough to achieve an orgasm and/or satisfy
> their partner. Age is certainly a contributing factor, and the majority of
> men with ED are over 40. This is by no means always the case; we have
> questions from teens upward in age.
>
>
>
> I'm 18 and I think I might have ED, but I've never seen anyone else's ere=
ct
> penis. How hard should an erect penis be?
>
> We've been asked this question a number of times. A picture is worth a
> thousand words. Here are pictures of fully erect circumcised and
> uncircumcised adult penises. The same uncircumcised penis is shown with a=
nd
>
>
> without the foreskin retracted. Yours may be longer, shorter, fatter or
> thinner and may lie anywhere from close to your belly to horizontal or ev=
en
> point slightly downward when erect. If you have a foreskin it may cover t=
he
> head when erect or not, depending on how long the foreskin is. If you're
> uncircumcised you should be able to retract your foreskin fully and recov=
er
> the head easily and without pain when you're erect (if not, then see a
> urologist). Your penis may curve in any direction and still be normal unl=
ess
> the curve is so severe it prevents intercourse or causes pain. Everyone is
> different. When fully erect, your penis should be very firm and almost
> impossible to bend in the middle without pain. As the erection reaches its
> peak the glans (head) will become quite rigid and its surface may become
> shiny (see first picture). In general, a very large penis doesn't become =
as
> rigid as a smaller one, but again, we're all different. Also, a penis tha=
t's
> long when flaccid doesn't gain a lot in length when erect, but a smaller
> flaccid penis can more than double in size when erect. In case you're
> interested, the average penis is between 5 and 6 inches when erect, measu=
red
> along the top surface from pubic bone to tip. Those in the pictures are
> probably a little above average.
>
>
>
> What's a {insert part of male sexual anatomy} and where is it?
>
> We get many questions about male sexual anatomy. What's the Corpus
> Cavernosa/Epididymus/Cowper's Gland, etc.
>
>
>
> Someone told me I might have Peyronie's Disease. What is it, and can it
> cause ED?
>
> Peyronie's disease, a condition of uncertain cause, is characterized by a
> plaque, or hard lump, that forms on the penis. The plaque develops on the
> upper or lower side of the penis in layers containing erectile tissue. It
> begins as a localized inflammation and can develop into a hardened scar.
>
>
>
> Cases of Peyronie's disease range from mild to severe. Symptoms may devel=
op
> slowly or appear overnight. In severe cases, the hardened plaque reduces
> flexibility, causing pain and forcing the penis to bend or arc during
> erection. In many cases, the pain decreases over time, but the bend in the
> penis may remain a problem, making sexual intercourse difficult. The sexu=
al
> problems that result can disrupt a couple's physical and emotional
> relationship and lead to lowered self-esteem in the man. In a small
> percentage of patients with the milder form of the disease, inflammation =
may
> resolve without causing significant pain or permanent bleeding.
>
> The plaque itself is benign, or noncancerous. A plaque on the top of the
> shaft (most common) causes the penis to bend upward; a plaque on the
> underside causes it to bend downward. In some cases, the plaque develops =
on
> both top and bottom, leading to indentation and shortening of the penis. =
At
> times, pain, bending, and emotional distress prohibit sexual intercourse.
>
>
>
> What causes ED?
>
> The causes of ED are many and varied, and often unknown. ED can arise from
> psychological problems (psychogenic ED) or can be secondary (organic ED) =
to
> disease conditions such as diabetes or atherosclerosis, or a result of
> surgery; depression, anxiety, certain drugs, smoking, or alcohol .
>
> Causes include:
>
> =B7 Blood flow problems: Hardening of the arteries (atherosclerosis), hi=
gh
> blood pressure, diabetes, or arterial damage (bicycle riding has been cit=
ed
> here)
>
> =B7 Drug side effects: Sedatives, antihypertensives, diuretics,
> antidepressants, weight control drugs, peptic ulcer drugs, alcohol,
> nicotine, caffeine, opiates (marijuana, cocaine, etc) and many more. For a
> list of common drugs that may contribute to ED, see:
> http://www.impotenceworld.org/medication1.htm
>
> =B7 Nerve impulse abnormalities: Conditions that reduce or block the ner=
ve
> supply to the penis. Diabetes, stroke, spinal cord injuries, pelvic traum=
a=2E
>
> =B7 Hormonal abnormalities: Diseases that disrupt the normal balance of
> hormones include kidney disease (and dialysis), liver disease and
> alcoholism, pituitary tumors, hypogonadism (lack of testosterone).
>
> =B7 Surgery: Any surgery or medical procedure involving the pelvis, and
> especially the prostate or bladder
>
> =B7 Prostatitus: Inflammation of the prostate
>
> =B7 Prostate cancer: Treatments are usually the culprit whether surgery,
> radiation or seed implantation
>
> =B7 Penile trauma or scarring: Peyronie's disease (scar tissue in the pe=
nis,
> or 'bent penis').
>
> =B7 Psychological causes: Depression, stress, performance anxiety, guilt=
and
> misinformation about sexuality. Premature ejaculation, in particular, is
> often a psychological problem and is most often observed in young men.
>
> Most ED has a physical cause, but there is almost always a psychological
> component. Even a single failure to maintain an erection can cause worryi=
ng,
> stress and apprehension. Worrying about it makes it worse, to the extent
> that the ED may persist even after the physical cause disappears.
>
>
>
> Is ED between the legs or in the brain?
>
> Although the end result of ED is certainly seen at the level of the penis,
> it can occur from changes in many different parts of the body, including =
the
> brain and spinal cord. Irrespective of origin, the end result is generally
> observed as changes in blood supply within the cavernosal tissue of the
> penis.
>
> How do I know if my ED is physical or in my head?
>
> There are ways to try and ferret out whether a particular case of ED is
> "psychogenic" or organic (physical).
>
> Men normally have several involuntary erections each night during sleep (=
not
> to be confused with 'wet dreams') in addition to the erection most men ha=
ve
> upon waking (the morning erection or 'piss' hardon). If these erections a=
re
> weak or missing there's at least a preliminary indication that something's
> wrong physically.
>
> The test for this is called Nocturnal Penile Tumescence testing (NPT) whi=
ch
> can be done either in a sleep lab or at home. The most popular device for
> this test is called the RigiScan, which measures the frequency, longevity,
> and strength of erections that occur during sleep. Measuring these sleep
> erections is important because nocturnal erections can be weak, short-liv=
ed
> or infrequent, indicating a physical cause despite the patient subjective=
ly
> "remembering" he has nocturnal or morning erections.
>
> Tests to determine blood flow and venous competence of the erectile system
> are also available. These include penile doppler ultrasound,
> cavernosometry/cavernosography (pressure tests/x-rays of the penis during
> erection), penile arteriography, and various other tests. These tests are
> often of limited usefulness in the majority of ED cases, they may be usef=
ul
> for men who have never experienced erections, or for men with known trauma
> such as a pelvic crush injury or similar perenial trauma. Limited usefuln=
ess
> means that the results of the tests will do little to change the recommen=
ded
> treatment and serve only informational purposes for the patient.
>
> To summarize, there are a variety of tests which can be performed to help
> determine the exact cause of a particular case of ED, but in the
> overwhelming majority of cases, once serious or life-threatening disease =
is
> ruled out they are unnecessary from a medical standpoint.
>
> In the future, as effective remedial treatments for such things as venous
> leakage and arterial damage/insufficiency are perfected and become genera=
lly
> available, these tests may become more valuable. In the present state of =
the
> art, however, there is little that can be done to correct these situation=
s,
> and the treatment consists of simply alleviating the symptoms
>
> Is ED like atherosclerosis?
>
> It has been claimed by some that ED could be considered to be
> atherosclerosis of the penis. Atherosclerosis is the "furring up" of
> arteries and small blood vessels, resulting in reduced blood flow. Doppler
> flow studies show that this can occur in the penis and in the blood vesse=
ls
> that supply it.
>
> Can stress cause ED?
>
> One of most common psychological causes of impotence is stress or
> performance anxiety. During stress, sympathetic nerve impulses constrict
> smooth muscles within the penis and prevent blood from flowing in to cause
> an erection. Stress also causes a decrease in nitric oxide (NO), the
> substance which triggers muscle relaxation. Viagra enhances the action of=
NO
> so that smooth muscles can relax more easily. Studies have shown that once
> men overcome their anxiety simply by performing successfully, they often =
do
> not even need any more help from medication. Men who take Viagra may want=
to
> use it a few times and then try to have intercourse without it. In many
> cases, they find that they can wean themselves off the drug.
>
> I have ED and drink alcohol heavily. Could this be the cause?
>
> This could certainly contribute to your ED. The simple solution is to eit=
her
> stop drinking entirely or reduce your alcohol intake drastically.
>
> Can bicycling cause ED?
>
> At least one urologist, Irwin Goldstein, believes that bicycle seats, by
> exerting pressure on the nerve supply to the penis, can, in fact, cause
> reversible or irreversible damage and ED. This problem occurs most often =
in
> men who spend a lot of time riding. Dr. Goldstein, however, probably
> represents a minority view in this. Several manufacturers have designed
> bicycle seats to reduce or eliminate the pressure.
>
> The doctor said my ED is caused by venous leakage. What is it?
>
> An erection is a complex process. To simplify as much as possible, here's
> what happens: First, the deep arteries carrying blood into the penis expa=
nd,
> increasing blood flow. This causes the spongy tissues that make up most of
> the shaft to expand and fill with blood. When these tissues expand they
> press against and close off the veins (near the surface) draining blood f=
rom
> the penis, increasing blood pressure within the penis and sustaining the
> erection.
>
> Sometimes either the tissues don't expand enough or the veins are not
> flexible enough to be completely squeezed shut. When this happens the blo=
od
> is allowed to drain out of the penis at the same rate as it enters,
> resulting in loss of erection. This leakage of blood through the surface
> veins is called venous leakage. It has nothing to do with the veins actua=
lly
> leaking blood into surrounding tissues; only that they're not completely
> shut off and "leak", like a leaky faucet. A cock ring can help here by
> shutting off the veins externally with a tourniquet effect.
>
> I don't have a problem now. What can I do to prevent ED in the future?
>
> ED is associated with certain risk factors, including being overweight,
> being diabetic, having abnormal blood platelets, smoking too much or
> excessive alcohol intake. You can compensate for these by adjusting your
> lifestyle and so reduce the likelihood of ED occurring. You should also
> discuss with your primary care physician whether any of the drugs you may=
be
> taking could have an adverse effect on sexual function.
>
> I've finally decided to see a doctor about my problem. What should I tell
> him, and what questions should I ask?
>
> First off, it's a good idea to write down everything you want to discuss
> before you see the doctor. Include a complete narrative of your particular
> problem; when it began, what your symptoms are, etc. Be thorough and
> completely (even painfully, as one contributor put it) honest with yourse=
lf.
> If you think it's relevant, start at puberty or even before. Your doctor
> depends on you for a lot of the information he needs to make a proper
> diagnosis. Take two copies with you.. one for the doctor and one for you.
> This approach has several added advantages.
>
> =B7 You have plenty of time to think it through and include everything you
> want to say. In the embarrassment of the moment, you will probably leave =
out
> something important if you rely on just talking it over with him.
>
> =B7 Your doctor is a lot more likely to take you seriously if you've tak=
en
> the trouble to write it all down.
>
> =B7 You can go over the points with the doctor one by one, and you're bot=
h on
> the same "page" at all times.
>
> Before you see the doctor, get as much information as you can about ED; w=
hat
> causes it, what YOU think the cause might be in your particular case, and
> the treatments that are available. This way, you can not only discuss it
> intelligently with the doctor, but you can get an idea pretty quickly if
> this particular doctor is well versed in the subject or not. If you know
> more about the subject than the doctor does, you should find another
> doctor -- IMMEDIATELY!! Remember that ED has only recently "come out of t=
he
> closet" and some doctors, GP's in particular but many urologists and
> endocrinologists as well, are not well educated on the subject. If your
> doctor doesn't seem willing to discuss it, or dismisses it quickly, then
> find one who takes you seriously! Remember, it's YOUR sex life you're
> interested in, and your doctor has no business dismissing it as unimporta=
nt.
> It doesn't matter if you're eighteen or eighty, heterosexual, homosexual,=
or
> bisexual.. you've got a right to enjoy a satisfying sex life and your doc=
tor
> is paid to help you do it!
>
> Read the information on this web site, and join the Alt.support.impotence=
on
> the Web discussion group. Don't be afraid to ask questions. There are a l=
ot
> of people there who know a lot about all aspects of ED and they're there =
to
> offer advice. There are no stupid questions as long as you're sincere. If
> you don't want your e-mail address or your identity known, read the FAQ
> about anonymous posting. If you're still hesitant to sign up, you can e-m=
ail
> Jerry or Jim directly. They'll answer you directly if you prefer. Your
> anonymity will be respected and preserved.
>
> There are a couple documents you might want to print out and take with you
> when you visit the doctor. These are the American Association of Clinical
> Endocrinologists (AACE) Clinical Guidelines for the treatment of Male Sex=
ual
> Dysfunction and Hypogonadism. Hypogonadism is another term for hormonal
> problems (usually too little testosterone or too much estrogen, but there
> are other problems as well). You'll want this one if you feel your libido=
is
> low or you suspect you might be suffering from low testosterone. You'll do
> well to read these documents carefully and take one or both with you to t=
he
> doctor. They aren't perfect, but they're a great starting point for your
> discussion, and your doc may never have seen them. You can either go to t=
he
> AACE website at
>
> http://www.aace.com/clin/guides/sexualdysfunction.html and
> http://www.aace.com/clin/guidelines/hypogonadism.pdf
>
>
> If you get the Adobe version, it's already formatted for printing but
> you'll need the Adobe Acrobat Reader 4.0 if you don't already have it (you
> can download it free from the ASI FTP site as well, .file name ar405enq.e=
xe.
> It's about 6MB, so be prepared to wait if you're using a modem).
>
> Seeing a doctor about a sexual problem for the first time is painful and
> embarrassing for many men. But consider the alternatives. Chances are pre=
tty
> good that your problem won't go away by itself. It'll only get worse. As
> men, we're reluctant to discuss our sex lives, and even more so when we f=
eel
> there's a problem. Sexual potency in men is supposedly a given, and if a =
man
> can lay claim to being a man he's supposed to be able to perform every ti=
me
> at the drop of a hat. That's what you've heard in the locker room since y=
ou
> were a teenager, but you and I (and all men) know privately that that's
> crap, and your doctor does, too. The doctor is there to help you, so take
> advantage of it and get your sex life back on track! No man older than a
> teenager can expect to get an erection and perform sexually every time he=
'd
> like.. there are just too many things that can interfere. But we can expe=
ct
> to have a normal and satisfactory sex life regardless of age, and there a=
re
> enough alternatives out there to ensure that it can happen. A visit to the
> doctor and laying it all on the line is the first, and the most important,
> step in achieving it. Don't delay!
>
> My ejaculation is weak, and just dribbles out. What can I do about it?
>
> Often, this is caused simply by getting older and losing some of the musc=
le
> tone in the pelvis. It can also be caused by restriction (scar tissue or
> some such) in the urethra, or an enlarged prostate.
>
> Also, especially if you've had prostate surgery, either a TURP or
> prostatectomy, it can be caused by a condition called "Retrograde
> Ejaculation" There are two sphincters which close off the urethra; one wh=
ere
> it exits the bladder and one where it exits the prostate and enters the
> penis. During ejaculation, the sphincter at the exit from the bladder
> normally closes and the one at the exit of the prostate opens, directing =
the
> semen out of the penis through the urethra. If this doesn't happen
> correctly, for instance if the sphincter at the exit from the bladder
> doesn't close completely or is damaged, then the ejaculate can go backwar=
ds
> into the bladder rather than out through the penis. Prostate surgery often
> damages one or both of these sphincters, especially the one at the bladder
> neck, which is why many men have incontinence problems following surgery =
of
> this type. Retrograde ejaculation isn't a serious problem unless you want=
to
> father a child. It won't cause an infection or any other physical problem,
> except for personal dissatisfaction in not being able to ejaculate normal=
ly.
> I you do want to father a child, sperm can actually be recovered from the
> urine and used for artificial insemination.
>
> Lack of pelvic muscle tone can sometimes be improved by doing Kegel
> exercises. This involves exercising the pubococcygeus, or PC, muscle, whi=
ch
> stretches from the prostate to the anus. It's used on a daily basis to sh=
ut
> off the flow of urine and feces until you're ready to relieve yourself, b=
ut
> it's also used in ejaculation. The same muscle in women can be used to
> tighten the vagina during sex as well as in control of urine and feces. T=
his
> is the muscle that causes your penis to "jump" when it's erect and touche=
d=2E
> If you've had prostate surgery, exercising this muscle can help to minimi=
ze
> incontinence problems, and may help to strengthen and control ejaculation=
as
> well.
>
> I've heard of Kegel exercises. What are they and how can they help my sex
> life?
>
> Kegel exercises were first devised by a California Gynecologist, Dr. Kege=
l,
> to help women with stress incontinence, or urine leakage. A welcome and
> unexpected side effect was strengthening of the vaginal muscles and
> increased sexual satisfaction for both the woman and her partner. Recentl=
y,
> research has shown that males can gain significant improvement in erectile
> function as well through use of Kegel exercises. There's an appendix on
> Kegels in The Testosterone Syndrome, by Dr. Eugene Shippen.
>
> Can prostate cancer cause ED?
>
> Prostate cancer in itself does not normally cause ED, but the treatments =
for
> it certainly can.
>
>
>
> What is nerve-sparing radical prostatectomy?
>
> Radical prostatectomy is usually performed in the treatment of prostate
> cancer. There is a danger that during the procedure the nerve supply to t=
he
> penis may be damaged, either reversibly or irreversibly, leading to ED. To
> limit the degree of damage, the standard procedure has been modified to
> maintain as much of the nerve supply as possible. Hence the term,
> "nerve-sparing radical prostatectomy".
>
> I am 6 months post-radical prostatectomy. I get no erections and nothing
> helps. Will I recover?
>
> Recovery is certainly possible, although not definite, that you may recov=
er.
> What has been found is that the nerve damage associated with the
> prostatectomy can heal with time. Nerves have been shown to regenerate ov=
er
> a period of 1-2 years. Many patients with ED following radical prostatect=
omy
> respond to therapy and are able to regain full or partial erections.
>
> What treatments are available for ED?
>
> There are a variety of treatments available, and many more are being
> developed. The choice of treatment should result from discussions between
> you, your sexual partner and your doctor. Generally, the least invasive
> treatment which produces the desired results and is a satisfactory soluti=
on
> to both the man and his partner is the best. The various options are list=
ed
> below, in order of least to most invasive.
>
> Cock rings (restriction bands): What are they and how do they work?
>
> You can order them online, or get them from a drug store or a sex shop. S=
ome
> of the best are either adjustable or come in assorted sizes for best fit.
> There should be an easy method of removal - either snaps or a ratchet
> arrangement (in the case of adjustable) or rubber ears in the case of
> elastic rings.
>
> Solid metal rings are dangerous since there's no easy method of removal.
> Rubber "O" rings from the hardware store will work and are very cheap but
> are difficult to remove without cutting them off since there's no way to
> grasp them for removal. Removal is easier if you apply lubricant to your
> penis and the cock ring.
>
> Since you are, in effect, applying a tourniquet to your penis the ring
> should not be left in place for more than about a half hour. This means y=
ou
> need to remove it as soon as you finish.
>
> The drawbacks are that you have to take a break from sex to put it on. It=
's
> sometimes uncomfortable, and it tends to pull your pubic hair, particular=
ly
> when removing. One way around the hair pulling is to either trim or shave
> your pubic hair.
>
> No prescription is needed, the rings are quite safe and effective as long=
as
> you observe the half-hour rule. They can be used to prolong or enhance a
> normal erection as well as keep you from losing your erection prematurely.
>
>
>
> Pumps (Vacuum Erection Devices): What are they and how do they work?
>
> The pump basically consists of a clear acrylic cylinder, a vacuum pump an=
d a
> cock ring. The pump can either be integral with the cylinder or separate =
and
> attached with a plastic tube. It works by creating a vacuum around the
> penis, thus drawing blood into it and causing an erection. You start by
> stretching the cock ring over the open end of the cylinder. Insert your
> lubricated penis, forming a seal against your body and operate the pump.
> Once the erection is obtained you slip the cock ring off the cylinder onto
> the base of your penis, release the vacuum and remove the cylinder.. This
> maintains the erection for up to half an hour. Cost ranges from about $200
> to $450 and is often covered by insurance. You can find them in adult
> stores, but these are always of inferior quality. Don't waste your money.
> Quality manufacturers include Osbon, Rejoyn and Pos-T-Vac. Order through
> your urologist or a drug store that handles durable medical goods. The pu=
mp
> is probably the most reliable of all for getting and maintaining an
> erection.
>
> Viagra
>
> Does everyone respond to Viagra?
>
> Viagra has revolutionized the treatment of ED. While it's not for everybo=
dy
> it does the job for most ED sufferers.
>
> The overall response rate is somewhere in the region of 60-70%, with roug=
hly
> three-quarters of responders having a full erection. This response rate w=
ill
> depend on the patient population; the response rate in diabetics is
> marginally less and in post-radical prostatectomy - only 50% of men are
> likely to respond.
>
> How does Viagra work?
>
> Viagra works by inhibiting an enzyme called phosphodiesterase (PDE), in
> particular, one member of this class of enzymes called PDE5. This enzyme =
is
> found within the penis and this accounts for the relatively selective act=
ion
> of Viagra on ED. By inhibiting PDE5, Viagra increases the level of cyclic
> guanosine monophosphate (cGMP). Elevated cGMP levels result in relaxation=
of
> the cavernosal smooth muscle, which in turn results in engorgement of the
> tissue and erection. In patients with ED, cGMP levels may be low and would
> therefore be raised by Viagra.
>
> Another explanation: Sildenafil is a phosphodiesterase inhibitor (PDE).
> Basically this means it stops the breakdown of cyclic-GMP (a neurochemical
> in the penis). The subtype of PDE in the penis is PDE5. The drug
> cross-reacts with PDE6 (which occurs in the retina) and can cause some
> visual disturbances (the "Blue Haze"). The drug is 10 times more effective
> on PDE5 (penis) than PDE6 (eye) so these visual disturbances are not all
> that common, though they can occur and we know the reason. No long term
> retinal problems were identified in the initial study--only some temporary
> visual changes.
>
> For more information, call the American foundation for Urologic disease at
> 800-473-0616. Also check the web at www.iiem.org.
>
> Here is a good report on what Viagra does:
>
> It is not an aphrodisiac. Your sex drive will not be affected. According =
to
> Pfizer, you will not get a spontaneous erection after you take the pill;
> stimulus will still be needed. (Note that some men report that they do ge=
t a
> spontaneous erection in spite of what Pfizer says.) That stimulus may be
> mental, visual or physical, in your case, perhaps your partner's touch. It
> all depends on the individual. Results vary but the effects of the drug
> typically last four hours or more. It takes anywhere from 15 minutes to an
> hour for the drug to become effective after you take it.
>
> You will have to keep taking Viagra. It is not a one-time treatment. The
> normal dose is 50 mg. You may find that 25 or even 12.5 mg works for you.
> However, you may need a 100mg dose.
>
> The drug is most effective if taken on an empty stomach. It should not be
> taken with any nitrate-containing drugs such as nitroglycerine.
>
> Side effects vary according to the individual and dose. Most common are
> headaches, nasal congestion, facial flushing, visual disturbances (bluish
> tint) and a sense of having a hangover the next day. Not everyone gets si=
de
> effects and very few men have reported having to stop using the drug beca=
use
> of them. Most of the time, the dosage can be adjusted to minimize the side
> effects, or a drug such as aspirin or an antihistamine can be taken to
> relieve the discomfort.
>
> Pills are expensive...about $10 US. Some men have gotten the pills mail
> order. Most insurers in the US are not covering the drug or are limiting
> coverage to about one pill a week. If you have to pay for it yourself, and
> do not need the highest dose, it would behoove you to get 100 mg tabs and
> split them as the price is relatively independent of the dose size.
>
> Is my insurance likely to cover Viagra?
>
> Some do, but most don't. Most insurance companies that cover Viagra will
> only allow a certain number of pills per month. If this is the case, ther=
e's
> no reason you can't get a prescription for as many as you need and just p=
ay
> the difference.
>
>
>
> What is sildenafil? Is it the same thing as Viagra?
>
> Pfizer only has one drug for the treatment of ED. Sildenafil is the gener=
ic
> name of the active ingredient in Viagra tablets. Viagra is a trade name t=
hat
> can be protected by Pfizer.
>
> Does Viagra affect libido?
>
> There is no evidence to date that Viagra affects libido. However, having
> said that, a person with ED tends to avoid and suppress his desire for se=
x=2E
> Viagra may give him the confidence to allow natural urges to come to the
> fore and, in effect, give his libido a boost..
>
> Will Viagra affect ejaculation?
>
> Viagra is not known to affect ejaculation per se. However, it may reduce =
the
> refractory period, which is the time it takes to get another erection aft=
er
> ejaculating. Some men have reported, however, that it takes longer to
> ejaculate when using Viagra, and a few cannot orgasm at all even though t=
hey
> don't lose the erection.
>
> Does Viagra or any other drug cause reversal of ED?
>
> There is no evidence that Viagra does in fact cause reversal of the
> underlying disease process in ED. However, a number of men are finding th=
at
> after several doses of Viagra normal activity seems to be restored. This =
may
> be because their confidence in getting an erection has been restored and =
the
> anxiety that was contributing to the problem is absent. It may also be pa=
rt
> of the "Use it or Lose it" syndrome. In other words, it's easier to get a
> good erection if you have them regularly. This has to do with the next
> question.
>
> After several doses of Viagra my erections occur without it. Does this m=
ean
> that I have recovered?
>
> There is no evidence that Viagra actually has a direct effect on the
> underlying disease associated with ED. However, what may be happening
> according to one urologist, Irwin Goldstein, is that as your erections be=
gin
> to reappear, you get better tissue oxygenation within the penile tissue
> resulting in some level of collagen breakdown. This collagen breakdown th=
en
> restores tissue elasticity within the penile musculature and enables the
> normal erectile process to reoccur.
>
> Viagra was originally developed for angina. Does this mean my blood
> pressure will change?
>
> Your blood pressure may change on Viagra, although the changes in blood
> pressure observed in clinical studies are considered not to be clinically
> important. If you are on anti-hypertensive medication you should discuss
> this with your primary care physician. Viagra should not be used in
> conjunction with any drugs that contain nitrates, such as nitroglycerine,
> glyceryl trinitrate, isosorbide or amyl nitrate (poppers).
>
> Does Viagra have any side effects, and if so what are they?
>
> No drug is without side-effects. However, Pfizer have worked out the
> effective dose range that can be used to minimize side-effects. If the dr=
ug
> is used within this dose range - usually 25-100mg - side effects are like=
ly
> to be minimal. Incidentally, not every individual will, in fact, experien=
ce
> side-effects.
>
> Most of the side effects you might experience are covered in the product
> information sheet, but a few additional ones have been reported from user=
s=2E
> They can include headache, heartburn, nasal congestion, backache, slight
> dizziness, diarrhea, a next-day "hung over" feeling and some slight visual
> disturbance (blue haze). Some users have experienced delayed or no
> ejaculation, especially after long-term use. Viagra will cause a drop in
> blood pressure, which is why it shouldn't be used with any medication
> containing nitrates, such as nitroglycerine.
>
>
>
> What can I take to help eliminate side effects?
>
> In general, just take whatever you would normally take to alleviate the
> symptom if it occurred on its own. For instance, for headache, take Tylen=
ol
> or Ibuprofen. For stomach upset or heartburn take an antacid. For a stuffy
> nose take a decongestant. If you regularly experience the same side effec=
ts,
> try taking the remedy at the same time as you take the Viagra. For the
> "Viagra Hangover", maybe a Bloody Mary or two. There's not much you can do
> for the 'blue haze' except wait until the drug wears off.
>
> It may be worth noting that Tagamet, the antacid, has been reported to
> increase Viagra's levels in the bloodstream. Pfizer's studies, however,
> showed that this only happens at about four times the usual Tagamet dosag=
e,
> and at this level Tagamet can not only contribute to ED, but also to hair
> loss. It's doubtful you'll see any change in the effectiveness of Viagra
> with a normal dose of Tagamet.
>
> There is a general consensus that the side effects lessen with continued
> use.
>
> The main thing to remember about side effects is this: Increasing dosage
> beyond what is required to get a serviceable erection increases the side
> effects without improving your erection. In other words, to minimize side
> effects (and save money) use the smallest dose that does the job.
>
>
>
> What does half-life mean and what does it have to do with Viagra?
>
> The half-life of a medication is the time at which the level in the
> bloodstream is half of the maximum level. For Viagra, the half life is
> supposedly about 2-4 hours. This means if you take a 100mg dose, after fo=
ur
> hours its effectiveness has dropped to what it would have been if you'd
> taken 50mg.
>
>
>
> After taking Viagra, why do I have erections the next morning?
>
> Although the half-life, that is the time for the plasma level of the drug=
to
> drop by 50%, of Viagra is about 2-4 hours, erections are quite commonly
> experienced for some considerable periods after that. This is probably
> because Viagra may be taken up into tissues and slowly released for up to=
24
> hours after a single dose.
>
> I have been advised that for best results I should take Viagra on an empty
> stomach. What is an empty stomach?
>
> An empty stomach essentially means that you have not eaten food up to 2-3
> hours prior to taking Viagra. The longer you can wait after a meal before
> taking Viagra the better. Additionally, experience has shown that foods h=
igh
> in fat diminish the effect. Some people have had good results by taking t=
he
> pill about half an hour before a meal. This gives the medicine time to get
> into the bloodstream before it can be affected by the food.
>
> The best time to take Viagra is in the morning before breakfast. This way
> you can be sure your stomach is empty, plus you're relaxed and testostero=
ne
> levels are highest in the morning.
>
>
>
> Why is Viagra so expensive?
>
> Viagra has taken Pfizer some 10-12 years to develop at a cost of
> approximately $250-300 million. For Pfizer to maintain a research and
> development investment, they must try to recover this cost. This has to be
> done over a limited time as the patent office only gives about 20 years
> patent protection, which represents 5-6 years after a drug has been
> marketed. These factors are reflected in the pricing of Viagra.
>
> My insurance won't pay for Viagra. How can I minimize the cost?
>
> Viagra comes in three strengths: 25, 50 and 100mg. For some reason known
> only to Pfizer the three dosages all cost about the same; between $7 and =
$11
> per pill depending on where you get it.
>
> Find the lowest price
>
> The most obvious cost saving device is to find the lowest price. Shop aro=
und
> among your local pharmacies; you'll find the price varies a lot. You can
> telephone and ask the price; there's no secret about it. In general, you'=
ll
> probably find the lowest price at discount pharmacies like Wal-Mart or
> Target. There are some reputable online pharmacies who offer very attract=
ive
> prices. Drugstore.com , Planetrx and the AARP Pharmacy are among these.
> Steer away from the online "Viagra without a prescription" sites. They're
> bad news.
>
> Split the pills
>
> Regardless of the dosage you need, get a prescription for the 100mg pills.
> You can use a sharp knife or an inexpensive pill splitter (available from
> the pharmacy) to split the pill into halves or quarters. The medicine is
> evenly distributed throughout the pill, so there's no problem of getting
> more in one split part than another. Also, exact dosage is no problem if =
the
> pill doesn't split evenly; approximate is fine. If you're worried about
> this, just crush the pill into powder, divide the powder and put it in em=
pty
> gelatin capsules you can get from GNC.
>
> If you're worried about your doctor prescribing the 100mg pills when you
> only need 50's, don't. The doctor understands economy as well as you do.
> Just explain what you're going to do and he'll likely be happy to comply.
>
> Is there any way I can make Viagra work faster?
>
> You can dissolve the pill in a little water (a bathroom paper cup is about
> right) and drink it. If you're using a whole pill, break or crush it first
> for faster dissolving. Don't worry about the blue coating - it doesn't
> contain any medicine. Experience has shown that this cuts the time for the
> Viagra to take effect down to about 15-30 minutes. Some people find that
> using hot water works even faster. The resulting drink is bitter but
> tolerable, and you can always follow it a with a little fresh water to wa=
sh
> away the taste.
>
>
>
> I took my first dose of Viagra and nothing happened. What's wrong?
>
> First off, you may be one of the 20-30% of men for whom Viagra just doesn=
't
> work. If that's the case don't despair; there are other alternatives.
>
> Keep in mind that Viagra doesn't give you an automatic erection. It simply
> enables you to get a normal erection with a normal amount of sexual
> stimulation; visual, mental or manual. This means that if you take a pill
> and then the occasion for sex doesn't arise as expected, nothing will hap=
pen
> except you've just wasted a few bucks.
>
> It's very important to take Viagra on an empty stomach. This means waitin=
g 2
> hours at a minimum after eating before taking the pill. Food high in fats
> have the worst effect, but alcohol in moderation seems to be OK. Best time
> is in the morning before breakfast when your stomach is empty, you're
> relaxed and your natural testosterone levels are the highest. Some men ha=
ve
> found that they can take the pill about half an hour before eating. This
> gives the medicine time to get into your bloodstream before the food
> arrives. Since the Viagra will work for at least a couple hours this gives
> you time for a leisurely meal followed by some satisfying sex.
>
> You may be taking too low a dose. Most men find that 50mg is about right,
> but others get the required effect on more or less. Try upping the dosage,
> but keep in mind that the maximum recommended dosage is 100mg in a 24 hour
> period. Also keep in mind that increasing the dosage will increase any si=
de
> effects you experience. Using a higher dosage than you need will increase
> side effects without improving your erection. To avoid disappointment with
> your partner it's probably better to experiment solo, with masturbation
> before going for a home run.
>
> What are some of the contributors experiences with Viagra?
>
> Here is a mixture of individual's reports: (Try this at home. Your
> experiences may vary.)
>
> TIME DELAY: I've had my best results after waiting a couple of days betwe=
en
> pills. I don't know why but it seems to work better even though the
> literature says you can take it daily.
>
> FACE FLUSHING: I delay dick stimulation until I feel flush in my face whi=
ch
> can take as long as 45 minutes after taking the pill.
>
> PURPLE DICK: About 5-10 minutes after the face flush, my dick takes on a
> red/purple hue. Not sure if it's blood or medicine but after this is when
> stimulation works best for me. I don't know why ... maybe prior stimulati=
on
> pushes medicine out of the dick.
>
> LITTLE IS BETTER: Again, I'm not sure why ... but for me ... slower and
> gentler stimulation proves best. Maybe time is needed for the old nerve
> cells to get reactivated, but soft squeezing of the head, body and finally
> the base now gets me close to a "woody".
>
> EATING: The consensus is, don't eat for at least two hours before taking
> Viagra. It slows the effect of the pill. For you morning folks, the fat in
> milk slows it.
>
> PILL ACTION: Instructions say take the pill an hour before sex. The effect
> should last about four hours. (Called a 'Four-hour half-life') Some have
> found that if they crush the pill, then take it the effect is quicker and
> more dramatic. Presumably because they get the effect all at once. The wo=
rd
> is, Viagra's maker (Pfizer) is going to make a wafer, so it will act fast=
er.
>
> FASTER PILL ACTION: Some of us have found that if you chew the pill, or
> dissolve it in a small amount of water and take it (tastes very bitter), =
the
> results take effect in 15 to 30 minutes.
>
>
>
> Can women take Viagra?
>
> Clinical trials on the effects of Viagra on female sexual dysfunction are
> underway, with promising but mixed results so far. Especially for women of
> child bearing age, taking Viagra before it's got a clean bill of health
> through extensive testing could be a risky business. There's no proof that
> the medicine won't affect a fetus and cause any number of birth defects.
> Theoretically Viagra should enable more engorgement of the clitoris and
> labia and increased vaginal lubrication, resulting in more satisfying sex.
> Better to be safe and wait until the verdict is in.
>
>
>
> I don't have ED. Will Viagra or other drugs for ED enhance my sexual powe=
rs?
>
> There is no evidence that Viagra will affect normal sexual function. If y=
ou
> can get a hard erection and keep it until you ejaculate, it's very doubtf=
ul
> Viagra will do anything positive for you. However, there have been a few
> reports of priapism with the recreational use of Viagra. Priapism is a
> persistent and painful erection, and is something you definitely don't wa=
nt
> to experience. It can cause damage to your penis.
>
> Muse suppositories. What are they and how do they work?
>
> Muse is a tiny suppository which is inserted about an inch deep into your
> urethra using a disposable applicator. The medication, Prostaglandin (the
> same medication as in Caverject), is absorbed through the urethra and into
> the corpa cavernosa, the erectile tissues of the penis causing smooth mus=
cle
> relaxation and a resulting erection. It works in just a few mi