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Since its introduction in 1998, sildenafil � better known by its trade name Viagra � has been one of the most popular prescription medications on the market. It is the first "as needed" pill treatment for erectile dysfunction (also called impotence ), a problem that may affect up to 30 million American men. Although a number of other treatments are available, Viagra has the advantage of being simple, effective and generally safe. If you or your partner is thinking about using Viagra, the following information may help you decide if this treatment is right for you. What is Viagra? Viagra is a prescription medication that helps men with erectile dysfunction to achieve and maintain an erection. It is taken as a pill, usually one hour before you anticipate engaging in sexual activity. Back to top How does Viagra work? A normal erection is more complicated than it may seem. During sexual arousal, the brain sends signals to the penis via nerves that travel through the spinal cord. These nerves trigger changes in blood vessels, which allow blood to flow into the penis but prevent the blood from draining out. The accumulation of blood in the penis causes the penis to enlarge and stiffen. After ejaculation, the vessels in the penis relax, and blood drains out. Any disease or injury that interferes with this complex process � such as damage to the blood vessels or nerves � may cause erectile dysfunction. In most men, erectile dysfunction is caused by inadequate flow of blood into the penis. Viagra works by helping the blood vessels relax, which increases blood flow. It does not cause an erection without sexual stimulation, and the penis will return to its normal size and flaccid state after ejaculation. It also has no effect on sexual desire (libido) and does not change sensation in the penis. Back to top Is Viagra effective? Yes, Viagra is very effective. In some studies, up to 70 percent of men had some improvement in erections after taking Viagra. Viagra appears to work in men regardless of why they have erectile dysfunction � including vascular disease nerve problems and even psychological causes. Back to top Does Viagra work for everyone? No. One in three men with mild to moderate erectile dysfunction do not respond to Viagra. Men with more severe erectile dysfunction (severity is based on many factors, including frequency of erections, stiffness and sexual satisfaction) are even less likely to respond. This is particularly true if the cause is nerve damage, such as that associated with diabetes or certain types of prostate surgery. In addition, many men have a partial response to Viagra that does not totally restore normal erections. Back to top Can women take Viagra? Currently, the U.S. Food and Drug Administration (FDA) has not approved Viagra for use in women. Preliminary studies suggest that this medication is safe for women, although its effectiveness in treating female sexual problems is unclear. Some studies suggest Viagra may improve the sexual response in women who have impaired orgasm as a side effect of certain types of antidepressant medications. Other studies suggest it may also help some women who have difficulty with desire or arousal. However, more studies are needed to help us understand if and when Viagra should be used by women. Back to top Is Viagra safe? This issue has raised considerable concern. Within the first year of Viagra's release, the FDA documented the deaths of 130 men who were taking the drug. Most of these men died of heart disease. Some of them were taking nitrates (nitroglycerin), a type of heart medication that is known to have devastating side effects when combined with Viagra. In other men, it is unclear whether Viagra contributed to their death. One theory is that heart problems may be triggered by vigorous sexual activity rather than by Viagra itself. Subsequent studies suggest that, in fact, men with stable heart disease may safely use Viagra. However, Viagra should never be combined with nitroglycerin or other forms of nitrates (such as isosorbide). This can produce a life-threatening drop in blood pressure, even in men without heart problems. If you seek medical attention for chest pain and have taken Viagra within the past 24 hours, be sure to inform your doctor of this fact. Viagra should also probably not be taken by men with the following medical problems: - Recent heart attack or stroke (that is, within six months)
- Unstable heart disease or heart failure
- High blood pressure that is controlled only with multiple medications
- Very high or very low blood pressure
- Liver or kidney disease
- Retinitis pigmentosa (a rare eye disorder)
Men who have multiple risk factors for heart disease (high blood pressure, high cholesterol, diabetes) and lead a sedentary lifestyle should consider having a stress test if they anticipate resuming vigorous sexual activity after starting Viagra. If you are unsure whether Viagra is safe for you, be sure to discuss this frankly with your doctor. Viagra can also interact with multiple medications other than nitrates, so it is important to provide your doctor with an accurate list of the medications you take. Back to top What are the side effects? Viagra can cause a number of minor side effects, including headache, lightheadedness, dizziness, flushing and change in vision. A few men choose not to use Viagra because they are bothered by these side effects. Back to top Can Viagra be abused? Viagra is not habit forming or addictive. It does not increase sexual desire or sexual enjoyment, other than by helping a man to achieve and maintain an erection. There is concern that Viagra will be misused as a "performance enhancer" by some men who do not have erectile dysfunction. However, there is no reason to believe that the medication is unsafe when used in this manner, as long as it is taken in the recommended dosage and with the usual precautions. Back to top How do I get Viagra? Men with erectile dysfunction who would like to try Viagra should discuss this with their doctor, who can prescribe the drug. In most cases, your doctor will want to review your medical history, perform a physical examination and possibly order blood tests to measure such things as hormone levels. Erectile dysfunction may be caused by a number of different medical and psychological conditions. Some of these conditions also increase the risk for heart attack and stroke, so it is important that your doctor evaluate you carefully before prescribing Viagra. In some cases, your doctor may suggest an alternative treatment, such as testosterone injections or psychotherapy. There is some concern that Viagra is such an effective treatment that it will be used as a "cure-all" and important treatable causes of impotence will be overlooked. Thus, a thorough evaluation is necessary. Back to top How is Viagra taken? Viagra should be taken on an empty stomach. The medication takes about one hour to work. The usual dose is 50 milligrams. Some men get good results with half that dose, whereas others need a higher dose. The maximum dose is generally considered to be 100 milligrams. Back to top How will Viagra affect my sex life? Some couples who have not had sexual intercourse for many years are able to resume doing so with the help of Viagra. Usually, this is a positive experience, and both members of a couple are able to enjoy greater sexual satisfaction. However, some women who have grown accustomed to not having intercourse may experience discomfort or anxiety when intercourse is resumed. It is thus important for couples to communicate about sexual matters. Men who would like to resume intercourse after a period of abstinence should be sure to discuss this with their partner. Back to top Are alternative treatments available? Yes. Although few other treatments for erectile dysfunction are as easy to use as Viagra, alternatives are definitely available. Some of these treatments � such as a penile implant � may help men who don't respomd to Viagra. In addition, new treatments are in development, including faster-acting pills and creams applied directly to the penis.
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