BY SUE MacDONALD
The Cincinnati Enquirer
Now that Viagra fervor has died a little, the question remains: Is it the wonder sex drug that Pfizer claimed it would be?
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WOMEN AND VIAGRA
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A handful of doctors in Minneapolis, Boston, Miami, Chicago and London say they've prescribed Viagra to small numbers of women to see whether it enhances female sexual response.
Results so far -- though limited -- indicate it helps increase lubrication, libido and sexual arousal, but Pfizer strongly points out that the drug has not yet been proven proved safe or effective in women, and they discourage using it for treatments other than male impotence. |
Well, yes and no, say local doctors, sex therapists and a few men -- whose real names won't be used for this story -- who have been using the erection-inducing pill for the last four months.
Consider their experiences:
Edward, a 62-year-old Cincinnati businessman who's struggled with impotence "for a long time," tried Viagra in May: "They say it doesn't work in 40 percent of men, and I think I'm one of the 40. It was disappointing. With all the hype that they were coming out with and the stories and publicity, I was hopeful that it would work. It didn't."
Ned, a 49-year-old scientist whose erections had begun to weaken over the last two years of his 20-year marriage, began using Viagra shortly after it was OK'd in March: "It's been helpful. It works. It's not necessarily spectacular, but it helps." The major drawback: a next-morning headache that resembles a "tight feeling in the face."
Jim, a mid-50s single man who began using Viagra in early June: "It has worked beyond my expectations." But the pill doesn't work alone, he says; deep affection between two people is critical for a good sexual relationship.
Four months ago this week, the Food and Drug Administration (FDA) approved Viagra as the first oral pill to treat impotence. For at least half the men whose sex lives have been on the back burner, there's heat again in the bedroom. The rest, however, are still looking for a cure or are reverting to earlier, less convenient treatments.
"I think reality has set in," says Dr. Marc Pliskin, urologist at Group Health Associates. "Viagra's not nirvana for everybody, but for more than half of the patients, it helps significantly. I think it represents a genuine, definite advance in treatment." For a lot of men, pre-Viagra impotence was too embarrassing or not serious enough to convince them to ask about other treatments -- an erection-inducing shot, a vacuum pump, a penile suppository drug.
"But give them a pill, and it's well worth trying," says Dr. Kayla Springer, psychologist and sex therapist in Mount Auburn. "I think that's why there was a huge response to its initial entry in the market. . . . It's the least difficult and least invasive of any of the other treatments, even if it costs $8-$10 a pill."
And while national media made hay with stories of sexually renewed men leaving their wives for younger women, Nevada brothels overwhelmed by aging customers and wives complaining of their husband's energized advances -- local specialists say the everyday Viagra reality is far milder.
"I have not seen any of the things like we saw (in the news) regarding lawsuits -- the older man who now leaves his wife and goes for all the younger women," says Dr. William Wester, sex therapist at Behavioral Science Center. "Those who have never tried anything else (for impotence) report that it works, and it has brought some vigor and intimacy back into their relationships."
What are other Tristate specialists discovering?
Effectiveness. In the Pfizer studies, 60-70 percent of impotent men were able to achieve erection, a figure that's closer to 50-60 percent among the masses, says Dr. Thomas Kalin, a sex therapist in Montgomery. "When you're in these studies, you get a lot of attention and a lot of focus. It doesn't always work as well in real life." Unpredictability. There's no way to predict whether Viagra will work. "There are some men in whom I thought it would work great, and it doesn't work at all, and others I didn't think had a prayer and it works pretty well," Dr. Pliskin says. The initial rush to get Viagra -- 1.7 million prescriptions in the first six weeks -- has slowed "considerably," he says.
Failed results. Some Viagra users have given up and returned to Caverject, an erection-producing drug that's injected into the base of the penis before sex, Dr. Wester says. Unlike Viagra, Caverject requires no foreplay or physical stimulation; the erection just happens.
"Their complaint is that the (Viagra) erection doesn't last as long," Dr. Wester says. "They're used to taking the shot and being able to maintain an erection upwards of an hour. Some of these same patients are reporting that they're only getting 8-10 minutes with Viagra, so they've gone back to the shot."
Other issues. Some men are happy with their newfound sexual lives, and some are reporting marital trouble with Viagra, Dr. Kalin says. "In terms of erections, this medication is very effective. But the erection is only one part of a sexual relationship. A number of other components are very important, too. If the couple has not been sexual for a number of years, there's an adjustment that they're going to go through."
Ned, for example, says now that sexual performance has been enhanced by Viagra, he and his wife know they have to work on other issues around each other's needs, desires and expectations.
Men unwilling to deal with relationship issues, Dr. Kalin says, are more likely to have marital and impotence problems than men committed to intimacy, trust, emotions and deeper issues.
"Some men may have looked to Viagra without differentiating clearly within themselves where or what the problem is," Dr. Springer adds. Is impotence physical or psychological? Is it a function of desire, self-esteem, the relationship, emotional problems or trust? "Viagra isn't going to do a thing for that," she says.
Performance anxiety. Now that some men physically are able to have sex, their Viagra-induced abilities are causing performance anxiety, Dr. Kalin says. "I've had one or two cases where there was enough anxiety and performance concerns to override the medication, unless you add some behavioral therapy," he says. After taking the pill, he says, some men begin worrying: How long until it works? Is it working quickly enough? Is it working now? What if it doesn't last long enough? What if I can't follow through? Am I doing OK?
Adverse reactions. Dr. Pliskin and other local urologists say about 10 percent of men report headaches, blurry vision and slight nausea, all of which abate in a few hours. Dr. Pliskin will not prescribe it to elderly men with severe heart disease because of potentially deadly interactions and dramatic drops in blood pressure when Viagra combines with nitrate-containing heart drugs such as Imdur, Nitrogard, Nitrol, Nitro-Dur, Transderm-Nitro, Tridil and other nitroglycerin tablets.
Who pays? Coverage still varies, but about half of men are paying for Viagra without the help of insurance, estimates IMS Health consultants.
"It's $9 a pill average, and that is a burden," concedes Dr. Alan Cordell, Western Hills urologist. "The good news is that we're not talking about a daily pill. For most of these guys, you're talking once a month, or even once a week, and that's reasonable." Some insurers limit men to four pills a month, some pay nothing at all and some pay a few dollars per pill. Some, including Cigna, will cover Viagra only if a man can prove he was being treated for impotence before Viagra's introduction.
"The insurance companies have to make a profit," he says. "If we -- that's you and I -- start subsidizing . . . these impotent men to the tune of $10 a week, you know that your premiums and mine will go up. Insurance companies aren't all of a sudden going to take a multimillion dollar hit, and I don't blame them. I personally think men should pay for it, and I know that may not be a popular position with my patients."
What's ahead? About one-third of men in Pfizer studies responded to a placebo -- a dummy drug used for comparison purposes. Dr. Kalin thinks the placebo effect is worth studying because it might address underlying psychological or emotional issues that make it possible for men to overcome impotence with an inert drug. But no drug company is likely to be interested because there's no money to be made from placebos.
