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First there was the little blue pill. This year it has two
companions: The little orange pill, and the , yellow pill.
Men with erectile dysfunction now have three drugs to choose
from — Viagra, Levitra, and Cialis. If that’s news to you, you must not have
turned on a television set or opened a magazine in the last few months.
Everywhere you look, it seems, there are famous athletes singing the praises of
their drug-restored virility. It’s hard to remember the no-so-long-ago time
when “erectile dysfunction” were words no man dared speak.
Does one drug work better than another? That depends on the
man.
All three drugs work the same way, says urologist Gerald Brock,
MD, associate professor at St. Joseph’s Health Center in London, Ontario,
Canada. Brock is past chair of the Canadian Male Sexual Health Council. He’s
treated many patients with Viagra and, in clinical trials, with Cialis and
Levitra.
“The big difference is length of action,” Brock tells
WebMD. “All are very safe and have proven in tens of thousands of men to be
a valuable treatment for erectile dysfunction.”
Viagra starts working in about half an hour — although an
effect has been seen in as little as 12 minutes — and its effect lasts for
about four hours. Levitra has about the same window of effect at lower doses.
Cialis gets to work a bit faster — one-third of men respond in 15 minutes –
but lasts for 36 to 48 hours in some men.
All of the drugs block an enzyme called PDE-5. PDE-5 is a key
link in the chain of chemical messages that tell a man’s erection to go away.
Brock says that there’s more PDE-5 in the penis than in other muscles, so the
drugs have a pretty specific effect.
Chad Ritenour, MD, teaches urology at Atlanta’s Emory
University. He says lots of patients are trying the newer drugs.
“I tell patients it is going to be like Pepsi versus Coke
– get ready for the blitz,” Ritenour tells WebMD. “But I
don’t think anybody can say one works better than the other. Each drug probably
will work better for some patients than for others.”
More to Sex Than Erections
It’s good to get men talking about their sexuality. But being
sexual is different than having an erection, says Jeanne Shaw, PhD, an
Atlanta-based clinical psychologist and certified sex therapist.
“What I see as a problem is the public has been educated to
believe that good sex requires an erect penis that stays hard through the
entire sexual encounter,” Shaw tells WebMD. “This definition of good
sex changes the basic nature of an encounter from intimacy and pleasure to
achievement and performance.”
This focus on performance, Shaw says, robs men and their
partners of the to deepen their relationships — and their
sexuality. The sexual needs of adolescents, she says, are different that those
of adults. Yet by making erections the be-all and end-all of sex, grown men are
retreating to adolescent sexual values.
“Having an erection does not mean you are being sexual.
Being sexual comes from inside your sense of yourself,” Shaw says. “You
can be sexual, you can feel sexual, you can behave sexually without an
erection. A penis is not the only part of a man’s body that can be used
sexually.”
Shaw makes a distinction between genital behavior and sexual behavior.
Mistaking one for the other, she says, leads to dishonesty and
dissatisfaction.
“You can behave genitally whether you feel sexual or
not,” Shaw notes. “Women and men can fake it. Lots of men get an
erection, penetrate, and lose the erection and pretend they have had an orgasm
because they want to be perfect. They don’t say, ‘Hey, I didn’t have an orgasm
but maybe next time. Being near you is enough.’”
In her practice, Shaw finds that physical problems don’t lie at
the heart of most men’s sexual problems.
“Actually, it is psychological distress associated with not
measuring up rather than physiological problems that causes most sexual
dissatisfaction,” Shaw says. “For many, many men — maybe most –
problems with sex are due to ignorance, anxiety, and inability to communicate
with their partners. I think sexual dysfunction is the inevitable result of the
effort to attain perfection.”
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