ASK THE DOCTOR: Viagra isn't the answer for all sexual dysfunction
By DR. JIM MITTERANDO
The Patriot Ledger

A pair of male readers have different questions about the same prescription drug, Viagra:

Q. I tried Viagra recently and it didn't work. What else can help?

Q. I have read a lot about Viagra. Does it help treat premature ejaculation?

A. With the advent of Viagra, men are talking more about impotence (also called erectile dysfunction) and finally seeking help for the problem. I find many men know as much about this drug as their doctors do.

When Viagra first hit the national scene, I was skeptical of the drug, but I soon became impressed with how many people it has helped. Viagra is a pill taken one hour before sex that helps men attain an erection with sexual stimulation. It is neither an aphrodisiac nor a panacea.

Individuals and couples may need to seek therapy with sex counselors to resolve other physical or psychological issues affecting their relationship.

Men with premature ejaculation, for instance, have asked me for Viagra, but it is not the solution. Viagra may help maintain an erection, but to solve their problem, these men (with the help of their partners) need to practice delaying ejaculation.

Prozac, Paxil, Zoloft and Celexa, antidepressant drugs called serotonin reuptake inhibitors (SSRIs), sometimes work to delay orgasm/ejaculation.

I find Viagra treats about 60 percent to 70 percent of men who are impotent. The other 30 percent to 40 percent need one of the other multiple treatment options.

Generally, if Viagra does not work, there may be underlying health problems, such as atherosclerosis (clogging of the arteries), hypertension or diabetes that may require further medical evaluation or treatment.

After Viagra, the most common treatments are prostaglandin drugs, administered either in a suppository or injection, that help increase blood flow to the penis.

The suppository, called MUSE - the width a toothpick and a quarter-inch long - is inserted directly into the urethra, the tip of the penis. This method is pretty well tolerated, though about 30 percent of men report initial mild burning.

Otherwise, a doctor can inject a drug, called either Caverject or Edex, into the side of the penis. The injection is the most effective treatment for impotence; the needle is so small, that most men, usually anxious at first, do not even feel it.

Side effects of the injection can include bruising, and, rarely, scarring or priapism, a prolonged erection that requires treatment with an antidote injection at an emergency room.
In the next year or two, a prostaglandin cream will become available, but it probably will not be as effective, because it will have pass through skin to work on the blood vessels in the penis.

Another option is the surgical implantation of a rigid or inflatable prosthesis inside the penis, a costly and invasive option seldom used these days because of the many better options available.

Viagra can help both physical and psychological causes of impotence. If Viagra does not work, talk to your doctor about these other options, especially the MUSE suppository or Caverject/Edex injection.

Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2001 The Patriot Ledger
Transmitted August 7, 2001