The Truth About Impotence - Treatment to Correct Impotence

Written by Krista

DR. GOLDSTEIN: Well, this is a tough question because it's a little more specialized. I don't know what tests your vascular specialist did to rule out or rule in that you had a vascular problem. A man who is 35 years old who has erection problems statistically is more likely to have a blood vessel vascular problem, if he's going to have a physical problem. Of course there could be psychologic problems. Viagra would be an excellent treatment for any man, whether young or old, who meets the definition of impotence, which is a consistent problem obtaining and maintaining an erection for satisfactory sexual activity. It sounds like you would meet that definition and Viagra may be useful for you. Should you wish to be considered for potential curative surgery, if the problem is physical and related to blood vessel blockage, I guess another consulting doctor would be indicated here.

KEN BADER: Here's an interesting question from a gentleman 47 years old in Michigan. He writes, "What is the relationship to sexual dysfunction, if any, to protracted sexual inactivity or abstinence?"

DR. GOLDSTEIN: We answered this question in a roundabout way earlier. Protracted sexual activity, actually has a name, and we call it Widower's Syndrome...

KEN BADER: Inactivity.

DR. GOLDSTEIN: Yeah, inactivity, protracted inactivity. We use the word, Widower's Syndrome. And that is someone, for example, who is happily married and unfortunately, the partner passes on. And this man takes many years until he has enough energy to find a new partner and is essentially inactive for a protracted period of time. And we go back to the concept of, if you don't use it you will lose it. We have strong scientific beliefs in this statement that having an erection is good for an erection. For men who have impotence and believe that it's related to protracted inactivity, having Viagra would be a useful tool. But perhaps taking Viagra as a sleeping pill. We're going to look into it that way in the future. Taking it as a sleeping pill would enhance the nighttime erections, so these wouldn't be sexual erections. So the protracted inactivity could actually be generated or reversed, if you like, by taking the pill at night, and enhancing the duration of the natu ral erections that you get when you sleep. You get about three hours of erection if you sleep eight hours. It's about four or five or six episodes, each lasting about 30 minutes to 45 minutes. And Viagra has the capability of enhancing that. When you speak to men who take Viagra, one of the universal findings and statements by them is that they wake up with erections like they were 18 years of age again. And that's because it enhances the nighttime erections.

KEN BADER: From Connecticut comes this question from a 45-year-old male listener. "Does hernia scar tissue from an operation cause any type of blood flow dysfunction?"

DR. GOLDSTEIN: No. From Connecticut, I can say to you emphatically, hernia scar tissue does not impair blood flow function. There are cases where people say having had a hernia leads to erection problems. There's very little reason for hernia to impact on erectile function in a negative way, but I would strongly encourage you to get tests, since you are young, and find out what the basis for the erection problem is. Again, if you have impotence and wish to get managed by Viagra that would be a good choice for you.

KEN BADER: A 47-year-old listener from Michigan writes, "My wife has almost no sexual desire. She has had diabetes for 28 years and is on Prozac and Valium. What is the more likely cause of the sexual problem, the diabetes or the medications and what would be the best treatment?"

DR. GOLDSTEIN: Boy, that's a great question and one day we will have all of the research on what causes female sexual dysfunction. At the present time where the research is a little scarce what my opinion would be in this case is that the diabetes is doing what it does in men. It's blocking blood vessels, injuring nerves and affecting tissues of the female genitals. Prozac, as it does in men, inhibits erectile function, would inhibit vaginal and clitoral function. In her, low desire may be reflective, possibly of diminished circulation to the vagina and/or clitoris during sexual activity. And we are now finding that Viagra can help in these cases. Now there's a caveat here. Viagra is not FDA-approved for the treatment of female sexual dysfunction at the present time. We are prescribing Viagra at Boston University for such women under controlled environment and controlled circumstances to assess the effect. Hopefully, in a short period of time, Viagra will be assessed by a large drug company, like Pfizer for the safe and effective treatment of female sexual disorders such as your wife.

KEN BADER: No shortage of questions tonight, Dr. Goldstein. This one comes from right here in Massachusetts, a 41-year-old male. He writes, "The day after I take Viagra I feel hung over. I have a headache and feel slightly sick." He asks, "Do the other drugs that are coming onto the market have similar side effects? How do these other drugs cause an erection?" He adds, "I was left impotent as a result of surgery to remove a tumor from my rectum one year ago. I tried the injection therapy and that worked fine. But," he adds, "It is not very appealing. Not my idea of foreplay."

DR. GOLDSTEIN: Well, lots of information in this question but let's do the best we can. If you're having side effects from Viagra, my suggestion is, if you're using the 100 milligram tablet, cut back to the 50 milligram tablet, and you may not have your headache and feel sick. And you would still have the advantage of using an oral pill and not having the need to inject. The new drugs coming on the market are drugs that will be shown by the FDA one day, hopefully, to be safe and effective for the treatment of impotence. The next drug, which appears likely to be submitted to the FDA is a drug that blocks how stress affects the penis. Stress acts on the penis through specific receptors called alpha receptors, and these drugs are alpha blockers. There's also another drug which stimulates the erection center in the brain and you take that as a tablet underneath your tongue, what we call sublingual. They're not going to be available for at least a year, so we have to get som ething active in you right now. The first advice is to cut back on the dose of Viagra, and the second advice may be to go back to the injections. While it may not be appealing, it obviously did work in you and you may have to do that.

KEN BADER: Dr. Goldstein, here's another question that I suspect is on a lot of people's minds. It comes from a 58-year-old male listener in Virginia. He says, "Does a vasectomy cause any of the symptoms of male impotence as one grows older?" He says his sex life and functions were fine before 50 but have gradually diminished. Again, he's 58 years old now. And then he asks, "Would a reversal be possible and would it help me function?"