The Viagra (sildenafil) treatment of male erectile
dysfunction will be a pharmaceutical event for the
history books. This is a drug that effectively treats
a male's inability to achieve or maintain an erection
sufficient for satisfactory sexual performance. Is
it a widespread problem? It is estimated that 39%
of men 40 years of age and 67% of men 70 years of
age have this problem.
A recent collaborative study looked at the efficacy
of this treatment--Goldstein I et al.: Oral sildenafil
in the treatment of erectile dysfunction. N Engl J
Med 1998;338:1397- 1404. Various dose regimens were
used, but overall in men, it improved erectile function
(equivalent to the arousal phase in women with clitoral
swelling and vascular swelling) by almost 100%. It
improved orgasmic function by about 20% and it had
ZERO effect on sexual desire. The overall intercourse
satisfaction increased by 100%. The major side effects
increased as dose increased and were predominantly
headache, flushing (both about 20-30%) and stomach
upset (about 10%). Interestingly the side effects
were only a small proportion of the reasons for discontinuing
the study (7-15%, at different doses, stopped participating
in the study).
Why should we write about this at Woman's Diagnostic
Cyber? Because there will be a significant impact
on women whose partners use Viagra. There will be
more frequent demands for sexual intercourse which
may or may not be welcome. Many women who are menopausal
report a decreased sexual desire even if they are
on estrogen replacement therapy. If women are having
any vaginal dryness, they may fear pain with sexual
relations and that certainly turns off libido. Even
if women are on estrogen replacment and have good
vaginal lubrication, if they are having vaginal intercourse
less frequently than once per two weeks, they will
have loss of vaginal elasticity that can cause discomfort
or pain when they first start to increase the frequency
of sexual relations.
Sexual desire is a very complex subject-- see previous
news:
Decreased Sexual Desire - Its Many Causes
There are many different components to possible sexual
desire barriers.
Fear of pain or discomfort with sexual intercourse
Lack of, or numbness to, arousal by normal physical
sexual stimuli
Lack of, or numbness to, arousal by normal visual
or verbal sexual stimuli
Aversion to intimacy with one's partner due to:
Hygiene problems
Lovemaking skills
Anger at one's partner for current or past behavior
Medications that lessen sexual desire
Physical disabilities or pain affecting lovemaking
The list could probably go on and on with different
problems that will demand different solutions or treatments.
I predict that this Viagra epidemic will cause epidemics
in women:
asking for Viagra to improve their sexual arousal
seeking treatment for vaginal dryness, pain and bleeding
related to more frequent sexual intercourse
seeking androgen (male hormone) therapy to improve
sexual desire
with more major, stressful reactions involving their
long-standing partners
On the up side, there will be many more relationships
in which the intimacy happiness level goes up. That
is good!
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