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What We Do For Love By Herbert M. Goldberg, M.D., F.A.C.S.  Herbert M. Goldberg earned a B.S. in
Biological Sciences and an M.D. from the University of South Carolina Medical School in
1967. After completing a general surgery internship and residency at the University
of Wisconsin Medical School in Milwaukee, he spent two years in the U.S. Navy practicing
general surgery. He was a teaching fellow in plastic and reconstructive surgery and
resident at the University of South Carolina Medical School. Certified by the
American Board of Surgery and the American Board of Plastic and Reconstructive Surgery,
Dr. Goldberg was a Fellow in the American College of Surgeons. He was in private
practice in plastic and reconstructive surgery in Encino, California, has written for
national journals, and presented papers at local, regional and national conferences.
Since ending his practice two years ago, Herbert Goldberg has traveled extensively,
volunteering his services in Vietnam, Tanzania, Ecuador and Guatemala.
The
subject of sexual dysfunction in the mature male has moved from the bedroom into the
boardroom. Those of us 50 and older now represent a large and growing market for a drug
that has proven effective in the treatment of erectile dysfunction (e.d.). Today, Viagra
(sildendafil acetate) is one of the most prescribed medicines in the world, averaging over
three prescriptions written every second and costing its users between $6 and $10 per
dose. Viagra has been the subject of much humor, but there is a serious side to
its rising popularity. Not since the introduction of birth control pills has a drug made
such an impact on the lives of millions of men and women. Here are some thoughts on this
new "sexual revolution."
The male sex drive stays with us our entire lives. The sex act, however, can be affected by many physical and psychological factors, including some not associated with the normal maturing process. According to Kinsey's pioneering sexual research, e.d. occurs in about 5-10% of men aged 50-60, about 20% in men aged 60-70, 30% in men aged 70-80, and over 50% in men over the age of 80. For men with chronic conditions, however, the numbers are higher. Over 35% of long term diabetics, 65% of men with kidney failure, severe heart disease or chronic alcoholism, 50% with thyroid disease or with severe blood vessel disease, 70% with strokes or multiple sclerosis, 35% with emphysema, and over 50% with Hodgkin's Disease or with schizophrenia suffer from e.d. Although enlarging prostate disease, present in most men over 50, or the surgical removal of the prostate, do not cause sexual dysfunction per se, the operation to remove the gland especially for a malignancy, is associated with e.d. in about 50% of post operative patients when the nerves to the penis have been injured. Prescribed drugs may also interfere with sexual performance. These include commonly used beta blockers (used for heart disease), anti-high blood pressure medications, antidepressive drugs (such as MAO inhibitors and tricyclics), antiapsychotics, sedatives (e.g., Valium), sleeping pills, and controlled substances such as excessive alcohol or heroin. Some of the important causes of sexual dysfunction are psychological. Indeed, one of the criticisms of the extensive and sole use of Viagra to treat e.d., is that it sidesteps psychological problems often associated with this distressing condition. Issues such as body image, anxiety, depression, and fear of sexual incompetence all have an impact on libido, and can also contribute to the problem. Enter Viagra In the early 1990s, a drug company (Pfizer) conducting research into the treatment of hypertension and heart disease began to notice an unintended side effect of the drug it was using, in its male subjects. Many had a significant and somewhat surprising penile erection. This finding led to the eventual introduction of Viagra into the world market after its approval by the Food and Drug Administration in March, 1998. Viagra received unprecedented press attention in the last three years. It is now approved for use in over 100 countries, has been prescribed over 40 million times for over 13 million men. Whatever the cause of sexual dysfunction, Viagra has thus far proven to be a relatively effective drug with relatively few side effects. Unlike previous treatments which produced erections with a sexual stimulation, Viagra enables a man to respond more naturally to sexual stimulation. Here’s how it works. Taken orally in various doses one hour before sex, Viagra usually begins to work about 30 minutes after ingestion, and may be effective for up to 4 hours. Through a complex biochemical and mechanical pathway, Viagra causes smooth, involuntary muscles to relax and blood to then flow into and engorge the penis. In most men, the blood pressure will be lowered about 10% for a few hours. There are electrocardiographic changes indicating some functional changes in the heart. In some men, the blue-green vision is altered and some report seeing a blue haze for several hours. About 15% experience headache, flushing and as many as 7% have an "upset stomach". It should NOT be taken by men who use nitrates (nitroglycerin) . Since the kidney and liver function are necessary to destroy and break down the drug after its use, any man with a disease of these organs should probably not use Viagra. If there has been a demonstrated allergy to this medicine then it should not be used. Obviously, a knowledgeable and experienced physician should be consulted before using this or any other high potency drug Viagra is not an aphrodisiac and will not cause sexual stimulation. (For that, we must still rely on our learned romantic skills and/or the stimulation of an intimate sexual partner.) When the medicine is used as the sole treatment for e.d., it has proven to be about 75% effective in that intercourse has resulted. The 25% failure rate points to the value of established treatment regimens, such as psychotherapy and treatment of the primary problems causing the condition. Clearly, an erection is a necessary component to the completion of the sex act and without it, most men feel incomplete. However, it is obviously no substitute for an intimate, caring relationship. Nor does erectile dysfunction mean the end of a long, happy sex life. Instead of predictability, we can opt for more excitement and more friendship in our relationships. The real goal of any relationship, at any age, should be the mutual enjoyment of intimacy and sharing. Becoming a better partner, having a relationship that is constantly evolving and renewing itself are of equal importance. Home | True
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