KEN BADER: Here's a question I suspect is on a lot of listener's minds. It comes from a 52-year-old woman in Michigan. She asks, "What are the side effects to the new pill?"

DR. GOLDSTEIN: Well, those, thank the Lord, the side effects of Viagra are quite minimal. And I'll just introduce an interesting point. It's been out only a month. Hundreds of thousands of people have used it, and to the best of my knowledge there really haven't been reports of serious adverse events. There are side effects like in any medication, but the beauty of this medication is it's quite safe. So, the side effects are headache, facial flushing, nasal congestion, a blue green color discrimination problem, stomach upsetness, leg cramping, skin rashes, urinary tract infections, shortness of breath. All of these are very, very minimal and rarely encountered side effects. It in general is quite a safe medication.

KEN BADER: A 29-year-old male listener from Ohio writes, I am currently taking 200 milligrams of Zoloft per day. Could Viagra help with the erectile dysfunction side effect?

DR. GOLDSTEIN: Oh absolutely. We had a question earlier about Prozac and Zoloft is basically a different form of what we call serotonin reuptake inhibitors, and Zoloft and Prozac are examples of that. Yes, these drugs not only inhibit erection, they also prevent orgasm and ejaculation and for the purposes of erection I would certainly encourage the use of Viagra to countereffect the anti-erection effect of Zoloft.

KEN BADER: A gentleman from New York, 42 years old, writes, "My wife and I have relations every so often, about once or twice a month. On occasion," he says, "I will experience a total misfire. That is to say I will ejaculate without having an orgasm." He says, "My gonads sometimes get ready without me. What is this? Should I be concerned?"

DR. GOLDSTEIN: He shouldn't be concerned. It's unusual in males to ejaculate without orgasm, but it obviously can happen again. Orgasm, ejaculation and erection are separate physical phenomenon. If this 42 year old male has certain medication that he's on, that may affect orgasm. If there's issues of sensation, a loss from multiple sclerosis or spinal cord injury or things like that, or have had surgery, these things need to be discussed obviously at the level of a physician. But I certainly would not worry if there's a rare misfire.

KEN BADER: Dr. Goldstein, we have a question from a 70-year-old gentlemen in Florida. He says, "I was told that impotence in my case was caused by the inability to retain blood in the penis because of a leaky valve. Is this a common occurrence? If so, which treatment is most likely to succeed?" He says, "Currently, I use a pump, but I have difficulty in applying the constriction band quickly enough to prevent some loss of rigidity."

DR. GOLDSTEIN: That's an excellent question and thank you for asking it. Leaky valves are one of the most common physical reasons for men having erection problems. Just to explain quickly, like any hydraulic system and the penis, and a rigid erection is the equivalent of a hydraulic system, the physical requirements are that a pressurized source of fluid be delivered to the hydraulic structure, and in the case of a tire it's pressurized air, in the case of a penis, it's pressurized blood. And the pressurized fluid need to be contained within the hydraulic system. So in the tire it has a valve. In the penis there are in fact valves that keep the blood in the penis. The reasons for leaky valves are the same as atherosclerosis, hardening of the arteries, cigarette smoking, diabetes, hypertension. With men who have impotence, whether it's due to a leaky valve or not, they should start with first line therapies. And the first line therapy in this case would of course be Via gra. Second line therapies would be injections or pellets, and third line therapies would be implants. I would encourage you to use the Viagra and maybe join the Viagra with the vacuum device, even though you're having a few problems with it.

KEN BADER: Here's a question from a male listener in New York. He's 46 years old and he asks, "Does a childhood operation for undescended testicles put one at higher risk for impotence?"

DR. GOLDSTEIN: The surgical treatment for undescended testicles would not necessarily place you at risk for the development of impotence. If the problem is specifically erection problems there really should not be a relationship. If the problem is lack of interest, where the testicle may have been injured, and the hormone, the male hormone released may be diminished, that would be the relationship. A 46-year-old man who has specific erection problems is probably not related to the undescended testicle and may be due to some early vascular disease, such as cigarette smoking, diabetes, high cholesterol, or may be related to some bicycling type accident or injury or fall to the perineum.

KEN BADER: From Indiana comes this question from a 28-year-old male listener. He says, "I have multiple sclerosis. I have a hard time maintaining an erection. And if I am nervous I cannot get an erection. Is this a form of impotence or something that can be associated with my multiple sclerosis and would it be worthwhile to investigate to using this new oral medication to help me stop feeling inadequate?"

DR. GOLDSTEIN: OK, an excellent question. And this is very likely what we call neurologic impotence. Multiple sclerosis is plaque formation within the central nervous system. One of the locations that the plaque can occur is in the nerves to the penis. We call them sacral roots 2, 3 and 4, S 2, 3 and 4. And multiple sclerosis pathology can occur there. We have had nice success with Viagra in multiple sclerosis patients and I would strongly encourage you to seek a physician to prescribe this for you.

KEN BADER: From Georgia, a 23-year-old male listener writes, "I am a 23-year-old man and have ever since the age of 18, suddenly my ejaculatory fluid amount went drastically down, and my erectile ability decreased quite a bit. I've been to a physician and he has tested my testosterone, my adrenal glands and he says those are normal. Can you please give advice on what hormones to test for impotence in someone as young as me? Also, does a high prolactine level cause impotence and decreased semen?"