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impotence.

The Cleveland Clinic
Urological Institute.

Originaly from

May 31, 2000 — A new study shows that Viagra appears to be safe even for
some men with severe heart disease, as long as they are not taking
nitroglycerine or similar drugs for their conditions.

Reports of heart attacks in several men who had used Viagra had led
researchers to worry that the drug might pose a special risk to those with
heart problems such as angina (chest pain). But the study, published in
TheNew England Journal of Medicine, shows that the usual dose of
Viagra causes no damaging changes to the heart’s circulation in men with
coronary artery disease (CAD).

Lead author Howard C. Herrmann, MD, tells WebMD that his findings
“should provide reassurance about the safety of Viagra for patients who
take it, for urologists who prescribe it to treat erectile dysfunction, and for
cardiologists, who probably don’t ask about erectile dysfunction as often as
they should.” Herrmann is professor of medicine and director of
interventional cardiology at the University of Pennsylvania Medical Center in
Philadelphia.

Herrmann and colleagues measured Viagra’s effect on blood flow to the heart
and lungs in 14 men with severe coronary artery disease. CAD is a major cause
of angina and heart attacks. For the study, men had to stop taking
nitrate-containing drugs such as nitroglycerin, which is often used to treat
angina.

All of the men in the study had CAD so severe that at least one of the major
arteries supplying the heart with blood had closed up by 70 percent or more.
The study was supported by Pfizer, the maker of Viagra.

Herrmann reports that careful examination of the blood flow within the
arteries showed that Viagra had essentially no effect on blood flow to the
heart or lungs, or on the heart’s ability to pump blood.

“Our data support the consensus position of the American College of
Cardiology and the American Heart Association that Viagra is safe for patients
with stable coronary artery disease who are not taking medications containing
nitrates,” Herrmann writes.

Rohit R. Arora, MD, who reported one of the first cases of heart attack in a
patient who had taken Viagra, tells WebMD that this “well-done, meticulous,
and focused” study provides useful information about Viagra’s effects on
the heart’s circulatory system, but he would like to see more direct
information about heart attacks in men taking the drug. Ahora, who is director
of critical cardiac care services at Columbia-Presbyterian Medical Center in
New York, was not involved in the study.

Herrmann says the safety of Viagra has not been studied in patients who have
unstable angina, who have had a recent heart attack, or who have severe high or
low blood pressure.

People who have not previously had even moderate exercise (including sexual
activity) or who are taking more than one drug for high blood pressure should
be cautious when beginning Viagra, Herrmann says. He recommends that those who
have not been exercising regularly have a stress test, since sexual activity
itself carries a small increased risk of heart attack. He also recommends that
those with high blood pressure take their first dose of Viagra in a doctor’s
office, where the effect on their blood pressure can be checked
immediately.

Vital Information:

• According to new research, taking Viagra does not cause damaging changes to
  the heart among some men with coronary artery disease, as long as they are not
  on nitrate-containing medications.
• The study found no changes in blood flow to the heart or lungs after
  heart-disease patients took Viagra.
• Patients who never exercise or those on more than one medication for high
  blood pressure should be carefully screened before taking Viagra.

Originaly from

erection problem.

As part of the initial evaluation, your health professional
may:

• Review your risk factors for an erection
  problem. For more information, see the What Increases Your Risk section of this
  topic.
• Ask
  questions about your sexual function.
• Do a
  complete physical examination of the abdomen, penis, prostate, rectum, and
  testicles.
• Do laboratory tests for:
  • Testosterone.
    A low testosterone level may reduce sexual desire, leading to an erection
    problem.
  • Prolactin. A
    high level of prolactin (hyperprolactinemia) may indicate a small tumor in the
    brain, which can affect other hormone levels in the body. When hormone levels
    are affected, an erection problem may result.
  • Thyroid hormone. Either a high or low level of thyroid
    hormone may cause problems with sexual desire or erections.
  • Blood glucose. Elevated blood sugar (glucose) levels
    may indicate the presence of
    diabetes, which can contribute to
    erection problems.

At this point, oral medications such as
Viagra, Levitra, or Cialis are often recommended
unless an easily treated cause (such as a medication side effect or
testosterone deficiency) has been identified. If oral medications do not work
or your doctor feels more testing is necessary, he or she may recommend: (more̷

Oct. 8, 1999 (Atlanta) — Viagra may soon be able to improve matters of the heart in more ways than one. Two new studies presented recently at the Third Annual Scientific Meeting of the Heart Failure Society of America in San Francisco show that the impotence drug’s ability to enlarge blood vessels also may be beneficial in treating heart failure.

In one trial, Viagra (sildenafil) was more effective than placebo in helping to open up a blocked artery, the major cause of heart failure. In the second trial, Viagra increased the effects of inhaled nitric oxide in patients with chronic pulmonary hypertension, or increased blood pressure within the lungs. Pulmonary hypertension, a common condition seen in people with heart failure, leads to increasing shortness of breath over time. Nitric oxide is a gas that can dilate blood vessels, thus helping to lower high blood pressure within the lungs.

In the first study, Stuart D. Katz, MD, and colleagues at Columbia University in New York evaluated the effect of a single dose of Viagra on the dilation of blood vessels in patients with moderate heart failure. The study involved four groups of 12 patients. One group was given a placebo. The other three groups received doses of Viagra, ranging from 12.5 mg to 50 mg.

The group that received 12.5 mg of Viagra experienced a slight improvement in their arteries compared to the placebo, but the groups that took 25 mg or 50 mg had much more significant increases in the size of their arteries.

Still, Katz tells WebMD he’s somewhat guarded about Viagra’s use for long-term conditions. “I have to be somewhat circumspect about the results,” he says. “I think this study shows that in an acute setting, there is perhaps some potential for [drugs like Viagra] … as a therapeutic strategy. This study evaluated a single dose of a short-acting compound. To extrapolate that to chronic use is a huge leap.”

Katz says “the findings are intriguing, but this work needs to be followed up with a longer-acting compound, which currently doesn’t exist.”

In a second study, cardiologists at Massachusetts General Hospital in Boston evaluated the effects of Viagra on patients with chronic pulmonary hypertension who inhaled nitric oxide to help their condition.

Researchers found that giving nitric oxide and Viagra in combination produced the greatest improvement in blood flow through vessels in the lungs. Individually, the two drugs caused improvement, but not as much as when working together. Researchers found that each of the drugs outperformed the ability of oxygen to improve blood flow.

“In other studies, we’ve shown that nitric oxide has beneficial [circulatory] effects in heart failure and beneficial effects on exercise capacity,” Marc J. Semigran, MD, co-director of the heart failure and heart transplantation unit at Massachusetts General, tells WebMD.

In contrast to Katz, Semigran says he believes that Viagra could possibly be used all the time, giving doctors another weapon in their fight against heart failure and pulmonary hypertension. “One of the big problems with inhaled nitric oxide is that it has a very short half-life, so the patient has to use it constantly. If [Viagra] can prolong the effects of nitric oxide, it might be possible to take intermittent puffs of nitric oxide to spike the pulmonary circulation,” he says. (more̷

A sexual problem, or sexual dysfunction, refers to a problem during any
phase of the sexual response cycle that prevents the individual or couple from
experiencing satisfaction from the sexual activity. The sexual response cycle
has four phases: excitement, plateau, orgasm and resolution.

While research suggests that sexual dysfunction is common (43% of women and
31% of men report some degree of difficulty), it is a topic that many people
are hesitant to discuss. Fortunately, most cases of sexual dysfunction are
treatable, so it is important to share your concerns with your partner and
doctor.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or psychological
problem.

• Physical causes: Many physical and/or medical conditions can cause problems
  with sexual function. These conditions include diabetes, heart and vascular
  (blood vessel) disease, neurological disorders, hormonal imbalances, chronic
  diseases such as kidney or liver failure, and alcoholism and drug abuse. In
  addition, the side effects of certain medications, including some
  antidepressant drugs, can affect sexual desire and function.
• Psychological causes: These include work-related stress and anxiety,
  concern about sexual performance, marital or relationship problems, depression,
  feelings of guilt and the effects of a past sexual trauma.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. Sexual problems occur in
adults of all ages. Among those commonly affected are those in the geriatric
population, which may be related to a decline in health associated with
aging.

How Do Sexual Problems Affect Men?

The most common sexual problems in men are ejaculation disorders, erectile
dysfunction and inhibited sexual desire.

What Are Ejaculation Disorders?

There are different types of ejaculation disorders, including:

• Premature ejaculation: This refers to ejaculation that occurs before or
  soon after penetration.
• Inhibited or retarded ejaculation: This is when ejaculation is slow to
  occur.
• Retrograde ejaculation: This occurs when, at orgasm, the ejaculate is
  forced back into the bladder rather than through the urethra and out the end of
  the penis.

In some cases, premature and inhibited ejaculation are caused by
psychological factors, including a strict religious background that causes the
person to view sex as sinful, a lack of attraction for a partner and past
traumatic events. Premature ejaculation, the most common form of sexual
dysfunction in men, often is due to nervousness over how well he will perform
during sex. Certain drugs, including some anti-depressants, may affect
ejaculation, as can nerve damage to the spinal cord or back.

Retrograde ejaculation is common in males with diabetes who suffer from
diabetic neuropathy (nerve damage). This is due to problems with the nerves in
the bladder and the bladder neck that allow the ejaculate to flow backward. In
other men, retrograde ejaculation occurs after operations on the bladder neck
or prostate, or after certain abdominal operations. In addition, certain
medications, particularly those used to treat mood disorders, may cause
problems with ejaculation.

What Is Erectile Dysfunction?

Also known as impotence, erectile dysfunction is defined as the inability to
attain and/or maintain an erection suitable for intercourse. Causes of erectile
dysfunction include diseases affecting blood flow, such as atherosclerosis
(hardening of the arteries); nerve disorders; psychological factors, such as
stress, depression, and performance anxiety (nervousness over his ability to
sexually perform); and injury to the penis. Chronic illness, certain
medications, and a condition called Peyronie’s disease (scar tissue in the
penis) also can cause erectile dysfunction.

What Is Inhibited Sexual Desire?

Inhibited desire, or loss of libido, refers to a decrease in desire for, or
interest in sexual activity. Reduced libido can result from physical or
psychological factors. It has been associated with low levels of the hormone
testosterone. It also may be caused by psychological problems, such as anxiety
and depression; medical illnesses, such as diabetes and high blood pressure;
certain medications, including some anti-depressants; and relationship
difficulties. (more̷

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