The Viagra Alternative -
The Complete Guide to Overcoming Erectile Dysfunction Naturally
by Marc Bonnard M.D.

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The Viagra Alternative - General Information
The Viagra Alternative - Table of Contents
The Viagra Alternative - Excerpts
The Viagra Alternative - Reviews of the Book

Excerpts

Chapter One

What Is Viagra
And Is It Safe?

Sildenafil and a Disturbing Trail of Deaths

In order to be able to make an informed decision on whether or not Viagra is the way you want to treat your erectile dysfunction, you need to have a full understanding of what Viagra — officially known as sildenafil—is, and of how it works. It may surprise you to learn that the medication wasn't even originally intended to treat erectile dysfunction.

In the 1980s, in Great Britain, researchers began studying the properties of a new molecule: sildenafil. It had originally been unsuccessfully tested in cardiology as a dilator of blood vessels. Sildenafil proved to be of no use to cardiac patients, and the tests were discontinued. However, much to their surprise, researchers found that many of the patients asked to continue the medication. Why? When questioned, these cardiac patients, many of whose vascular problems had caused erectile dysfunction as well, admitted that they had experienced significant improvement in their erections. This observation eventually led to European clinical tests on men with erectile dysfunction.

At the 1996 annual congress of the American Urological Association, the first results of this new medication under research for the treatment of erectile dysfunction were presented. The first results in clinical research showed sildenafil to be particularly effective in men with mild physical ED. A program of worldwide research with clinical trials was undertaken, and in 1998, under the brand name Viagra. sildenafil was made available to the general public.

Viagra and the Clinical Trials

Viagra has been studied extensively in clinical trials, at doses of 25 mg, 50 mg, and 100 mg. It has been clearly demonstrated to improve erections. Viagra was evaluated in 21 randomized double-blind, placebo-controlled trials of up to six months. In these trials, Viagra was studied in more than 3,000 patients between the ages of 19 and 87, who had had erectile dysfunction for an average of five years. More than 550 patients were treated for longer than one year. Clinical testing occurred in a "real world" setting.

The efficacy of Viagra was demonstrated in all 21 studies. In clinical trials, patients receiving Viagra reported a 78 percent improvement in erections versus 20 percent for a placebo pill. (Note the high placebo percentage, indicating that a significant number of patients didn't need Viagra or any other medication to overcome their ED.)

Though manufacturer Pfizer claims that the word Viagra was chosen at random, and Alond was almost chosen as the product name, the word does seem particularly rich in connotations. "Niagara" springs to mind immediately, bringing forth visions of rushing, explosive power. Niagara Falls is also, of course, the classic destination for honeymooners, so there is a subtle implication that Viagra can revive those feelings couples had during their honeymoon. "Vigor" also comes to mind—as in young, healthy men with vigorous erections.

Viagra is not an aphrodisiac. It has no effect on sex drive or libido. Thus it cannot cause an erection in the absence of stimulus: it doesn't send the message for an erection to occur, nor does it create extra blood to make the penis that much harder. So while the drug does facilitate an erection, it does not necessarily enhance one. It won't increase pleasure beyond what is felt during normal, healthy intercourse. If a man does not have erectile dysfunction, Viagra will have no effect on his erection. Similarly, a patient who has achieved success with a 50 mg dose of Viagra will find no additional benefits from a 100 mg dose. Picture a dam where the wheels that open the floodgates have rusted shut. Viagra is simply the grease that frees those wheels up and allows the water to come pouring through. It doesn't turn the wheels of its own accord, doesn't force the floodgates open any wider than they would normally go, and doesn't generate any additional water. It simply allows the dam to function as it normally would—and for most men with ED, this is certainly enough.

Contraindications

No doubt you have heard the reports of hundreds of deaths linked to Viagra. At last count 220 deaths had been associated with Viagra in some way, and by the time you read this the number will have climbed further. While investigators are still determining what role Viagra played in these deaths, one thing is overwhelmingly clear: for a large group of men with erectile dysfunction, taking Viagra could cost them their lives. Pfizer does not dispute this and warns that Viagra is absolutely contraindicated in patients taking nitrates in any form and at any time. There are 125 drugs currently on the market that contain nitrates, which are commonly used to treat hypertension—high blood pressure. They work by dilating blood vessels, thereby lowering blood pressure. Viagra potentiates this effect, causing a feeling of sickness and, more importantly, a potentially dramatic drop in blood pressure. Think of a hose that is widened so that the water flows smoothly out of the end, but then is widened again, so much that only a trickle now comes out, and none gets to your flowers.

Here is a list of commonly used nitrates, all of which should never be mixed with Viagra, along with the brand names under which they are sold:

Erythatyl tetranitrate
Cardilate
Isosorbide mononitrate
Imdur
Ismo
Monoket tablets
Isosorbide dinitrate
Dilatrate-SR
Isordil
Sorbitrate
Nitroglycerin
Deponit
Minitran
Nitrek
Nitro-Bid
Nitrodisc
Nitro-Dur
Nitrogard
Nitroglyn
Nitrolingual Spray
Nitral Ointment
Nitrong
Nitro-Par
Nitrostat
Nitro-Time
Transdermal-Nitro
Pentaerythritol tetranitrate
Pentritol
Peritrate
Sodium nitroprusside

The same warning holds true for the "poppers" taken in clubs. Poppers are inhaled amyl nitrate, which can also cause a dramatic drop in blood pressure. In any case, If you need to rely on Viagra and poppers to have a satisfactory sexual experience, you probably have psychological issues that should be dealt with first.

Men with an anatomical deformity of the penis such as Peyronie's disease, with conditions known to produce priapism (such as anemia, multiple myeloma, and leukemia), or with retinal problems like macular degeneration and retinitis pigmentosa, should use caution in using Viagra. If it is used, doses should be kept at the absolute lowest level possible.

Men taking protease inhibitors to suppress their HIV infection may be at an increased risk of heart attack. At least one patient with HIV and no history of heart problems died of a heart attack after taking Viagra. Doctors are researching this drug interaction further, but for now other options are probably a better bet.

Before using Viagra, all men should consider their level of cardiovascular health, given the physical exertion involved in intercourse. So often being overweight causes the vascular problems that lead to both heart conditions and impotence in the first place. The body is an amazingly complex network of interacting systems; when something goes wrong with it, the whole body must be considered in the treatment if there is to be any permanent cure. In these cases the erectile dysfunction can even be seen as a self-regulating safety mechanism: the body taking care of itself. If the body was physically prepared for intercourse, it would be able to achieve an erection. That it can't is a clear sign that there are significant underlying problems, and some significant changes in lifestyle are called for.

This is where conventional medicine frequently misses the boat, and Viagra is a classic example. Treating the one symptom—erectile dysfunction—and ignoring the larger problems is tantamount to bypassing the body's own safety mechanism. It can lead to a far worse condition than erectile dysfunction: it can lead to death. This is one of the reasons why Viagra is not doing favors for as many men as the early press reports led us to believe. Men at risk of heart attack would be much better served by a program of exercise and dietary changes. This will lead to weight loss, reduction of arterial blockage, increased stamina, more energy, and even a better mood. Then, when the erection spontaneously returns, it can be seen not only as a sign that it is time to resume sexual intercourse, but also as a reward for all the hard work and dedication that has resulted in a new, improved you.

In addition to overweight men, older men who haven't enjoyed sexual relations in a long time should heed the same warnings. They, too, can die from placing too much demand on their hearts. Approximately 2 percent of heart attacks occur during sexual activity, and this number will probably be much higher among Viagra users who don't undergo proper cardiac examinations. Viagra, though certainly not responsible, may encourage a sexual confidence that exceeds a man's physical capacity. You pop a pill, and for the next hour or so your mind is completely focused on sex. You want your money's worth. An erection is on the way, it hasn't been easy to get one lately, and by god you're gonna have sex before it disappears, come hell, high water, or heart attack. Worse still, the older men most likely to find themselves in this situation are also the ones most likely not to have told their partners that they have taken Viagra (especially if their partners are much younger), and the medical personnel who treat the heart attack may administer an injection of drugs containing nitrates, which when combined with the Viagra increase the likelihood of death. The advice here is as old-fashioned and simple as it is sound: listen to your body. Don't make it do anything it isn't ready for.

The good news is that it is never too late to get back in shape, to reverse the aging process, and to once again engage in wonderful sexual intercourse. And rare is the case where this can't be achieved through behavioral changes, coupled, when necessary, with all-natural supplements that don't set a timetable for your erection.

Other Adverse Side Effects of Viagra

In clinical trials other adverse effects reported by patients receiving Viagra were generally similar and insignificant. Their intensity varied in proportion to the size of the dose. The following adverse effects were reported by patients:

EFFECT VIAGRA PLACEBO
Headache 16% 4%
Flushing 10% 1%
(reddening of the face)
Dyspesia 7% 2%
(upset stomach)
Nasal congestion 4% 2%
Urinary tract infection 3% 2%
Abnormal vision 3% 0%
Diarrhea 3% 1%
Dizziness 2% 1%
Rash 2% 1%

One unusual side effect encountered is slight colorblindness, in which the patient temporarily becomes unable to distinguish blue from green. This is probably due to Viagra's effect on the enzyme PDE-6, which is found in the retina of the eye and is closely related to the PDE-5 found in the penis. PDE-6 is involved in the phototransduction process that allows us to see colors. While Viagra is highly effective at inactivating PDE-5, and pretty much ignores the other phosphodiesterases, it is slightly effective at inactivating PDE-6. This generally only occurs with doses of 100 mg or more, and at that dosage affects about 11 percent of users, lasting from several minutes to a few hours. Interestingly, this phenomenon is most often described by patients who have light-colored eyes. Under most circumstances this is little more than an inconvenience, but there was a small plane crash in Maryland in 1998 in which it was speculated that the pilot, who was known to be taking Viagra, may have had trouble distinguishing the colors of the runway lights. The long-term effect of Viagra on the eyes remains unknown.

Form

Viagra is supplied as blue, film-coated, rounded diamond-shaped tablets containing sildenafil citrate in doses of either 25, 50, or 100 mg. For most patients the recommended dose is 50 mg. One tablet of Viagra costs approximately $10 and can only be attained with a doctor's prescription. However, it is being sold on the black market—especially in countries in which it has not yet been approved—for many times that amount.

Viagra has a relatively short plasma half-life of approximately four to five hours, but the drug must not be taken more than once a day.

Disturbing Trends

As a medication, Viagra has been a clear success. It has lived up to Pfizer's claims, and, when the instructions on how to use it are followed to the letter, it seems to cause only minor side effects (its long-term effects will not be known for years). As a social phenomenon, however, Viagra comes dragging many question marks.

Clearly too many men are dying due to Viagra. True, they ignored (or never saw) warnings about mixing Viagra with nitrates and other drugs, or they ignored their own cardiovascular condition. But ED is a powerfully emotional issue, so it may not be fair to tell these men, "Here is a medicine that will allow you to have sex again, but it may kill you." It is a bit like putting a pie in front of a three-year-old and saying, "This is for later; you can smell it, but don't eat it now." We know that temptation and desperation are regularly going to triumph over common sense in these situations.

The desire to obtain Viagra anonymously, due to the embarrassment many men with ED feel, has driven an explosion of online pharmacies that may ultimately prove to be far more damaging than Viagra could ever be. The best of these "pharmacies" ask a few questions about your situation and other medications you may be taking; the worst are set up overseas, beyond the regulatory power of the United States, and for the right price will simply ship you whatever prescription medicines you want. In one case, the physician approving prescriptions for a domestic online pharmacy was found to be a retired veterinarian living in Mexico. And, though these online pharmacies have become vastly more popular due to Viagra, they also prescribe a host of other potentially dangerous drugs, including Demerol, Propecia, and Xanax.

Obviously, if many men begin obtaining Viagra without proper oversight by qualified physicians, and without essential preliminary and follow-up physical exams, the death toll will rise dramatically. This is why it would be so much better for the word to get out that ED can usually be successfully treated with completely natural physical, behavioral, and psychological methods.

The Bottom Line

A great deal of progress has been made in the pharmacological treatment of erectile dysfunction, and Viagra is the greatest leap forward that field has ever taken. You need only review the following chapter, on other medical treatments for erectile dysfunction, to understand why a simple pill that effectively facilitates erections is like a dream come true for some men. So let us give Viagra its due: it is a step forward, and for some men it is indeed the answer. But there is still a 20 to 50 percent chance of failure from treatment with Viagra, depending on the origin of the erectile difficulty. It is not a panacea, even for men not interested in addressing the underlying causes of their ED.

More importantly, good sex does not happen on its own. Yes, the penis is the focus of therapeutic attention. But the penis is connected to a body, which has a brain, and frequently that body is associated with another body—a partner. Regrettably, this is often forgotten in ED treatments. Restoring erectile function is one thing. For restoring good sex, it is essential to address personal and emotional factors in the sufferer, as well as conflicts in his relationship with his partner—all of which may be instrumental in causing or maintaining the present erectile disorder. Often sex therapy—which I'll discuss in a later chapter—can be extremely useful, with or without the use of natural or pharmaceutical "helpers." It is important not to neglect this ever-present component.

 

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