Viagra Is Misunderstood Despite Name Recognition

What the Viagra experience is really like

By TARA PARKER-POPE

Nearly five years ago, a diamond-shaped blue pill called Viagra was introduced to an eager public.

Since then, news organizations have written 54,678 stories about Viagra. A Yahoo Internet search for Viagra produces 1.98 million hits. Jay Leno has made 944 Viagra jokes.

More than 20 million men around the world use it regularly. In the U.S., one out of every five men over 40 has tried it. An average of nine Viagra pills are dispensed every second.

What more could anyone possibly need to know about Viagra?

Plenty. Because for all its ubiquity, Viagra is surprisingly misunderstood. We all know what it does -- and what it helps men do -- but beyond that, how much does anyone really know about the Viagra experience?

"It has the name recognition of Coke and Nike," says Harin Padma-Nathan, clinical professor of urology at the University of Southern California Keck School of Medicine. "But when you ask people about it beyond the name, they really don't understand it."

Men -- and women -- who use it rarely talk about it openly. But in the U.S., an estimated 34% of all men ages 40 to 70 -- about 20 million men -- suffer from some significant level of erectile dysfunction. Most of them, about 80%, never seek treatment.

That may change next year, when two chemically similar rivals to Viagra are expected to hit the market, further fueling interest in ways to treat erectile dysfunction. And new markets for the drug are on the horizon. Studies are showing that the drug not only can help some women, but may also work as a preventative, helping healthy men to stave off impotence.

So, from doctors who prescribe it and people who use it, here are the answers to the Viagra questions many people wonder about -- but rarely ask.

What Happens When a Man First Takes a Viagra Pill?

Absolutely nothing. Pfizer Inc., the maker of Viagra, long has said the drug isn't an aphrodisiac, but many men who take it still expect to feel something.

They don't. Among several men interviewed who have used the drug, not one of them experienced any feeling or sensation after taking the pill. The nothingness is so intense that the most common reaction is a slight panic that the drug isn't going to work.

"That was my worst fear, that it wasn't going to do anything," says Steve Brykman of Los Angeles, who tried Viagra once nine months ago, when he believed job and financial stresses were interfering with his sex life. After taking the pill, "there was nothing at all," says Mr. Brykman, 33 years old. "I just felt completely normal."

Though you may not feel anything, things are happening in the body. As the pill moves into the bloodstream, it starts to block an enzyme called PDE-5. Blocking the enzyme eventually increases blood flow to areas where PDE-5 is most heavily concentrated -- the penis, nose and skin. Diminished blood flow to the penis is the cause of most erectile-dysfunction problems.

So How Do You Get It to Start Working?

Viagra gets the blood flowing, but your brain has to be in the mood as well. "The biggest misperception is that it changes your psychology and makes you want sex," says the editor of ViagraStories.com (http://www.viagrastories.com/), which claims to document the experiences of real people who take Viagra. "But if you're sitting talking to Grandma and you pop a Viagra, unless you have issues, nothing's going to happen."

Viagra takes about 30 minutes to kick in. Men who don't normally have problems, or who have only mild dysfunction, say it takes only a minor stimulus -- such as the brush of a hand that wouldn't cause arousal under normal circumstances -- to trigger an erection.

For men who have serious erectile dysfunction, getting things going may still require extra effort, partly because of nervousness or embarrassment about unsuccessful past attempts at intercourse.

Because Viagra doesn't increase desire, it's not prescribed for men with desire disorders, such as a low sex drive. However, if the man has lost interest in sex because he has had problems with erections in the past, Viagra may help.

Does Taking Viagra Make a Man More Virile?

It might. A surprising new area of research is whether taking a small dose of Viagra every night works as a preventative to stave off impotence, just as people can take an aspirin a day to prevent heart attack.

Though you wouldn't think you'd get much out of Viagra while you're sleeping, it turns out that nighttime erections -- most men get three or four every night -- are crucial to maintaining potency. Because most men don't have several erections during the day, the nocturnal erection, which allows blood and oxygen to flow to the genitals, is nature's way of keeping the penis in working order. The theory is that anything that increases the intensity and duration of nighttime erections is good for long-term potency.

But don't you need a sexual stimulus for Viagra to work? You do, and the likely trigger for nighttime erections, rapid-eye-movement sleep, is said to be the strongest sexual stimulus a man can experience. The brain shuts down all other activity to the penis and the level of adrenaline, which interferes with erections, plummets.

An Italian study of 44 men gave half the men 50 milligrams of Viagra before they went to sleep. The men averaged 39 years of age and didn't have erectile dysfunction. Those who took Viagra had significantly longer and more rigid nighttime erections than the men taking a placebo.

Irwin Goldstein, a noted Boston urologist, says about 400 of his patients are using 25 mg of Viagra each night as a preventative measure. "Men say, 'I'm potent. I don't want to become impotent. Is there something I can do?' " says Dr. Goldstein. "It's a very simple strategy for preserving sexual health."

But while it makes sense in theory, whether nighttime Viagra use can prevent impotence is far from proven. Pfizer says it's studying whether nighttime Viagra use can help improve sexual function in patients who have had prostate surgery but it won't present the results until early next year.

Meanwhile, it's worth noting that the best way to prevent impotence is to keep your veins from clogging up in the first place. Don't smoke, eat healthy foods, lose weight and lower your cholesterol.