Viagra Side Effects

Not simply a medical problem.

Since its FDA approval in 1998, few medications have received as much attention and praise as Viagra. There's no doubt that Viagra, which is used to treat impotence in men, has changed many lives - and relationships - for the better. However, as with any prescription medication, Viagra has potential side effects that every man should be aware of when considering using the drug. As these three experts point out, some of the most important side effects are not necessarily medical - and they don't only affect men.

Is Viagra the first line of treatment for any man with impotence?
DAGMAR O'CONNOR, PhD: I think an important question is: Do we treat the psychological issues first, or do we treat the physiological first? Because now with Viagra, the idea is: "All we have to do is get a pill." But, should we address the psychological first? It's a difficult discussion.

What are some of the potential complications associated with Viagra?
PATRICIA BLOOM, MD: One big potential disqualifier to using Viagra is if you are a man with cardiac disease and you take nitroglycerine for heart disease. That's an absolute contraindication to using Viagra, and there have been deaths.

DAVID KAUFMAN, MD: It's not enough to just not be taking nitroglycerine, but there are probably a hundred compounds that have nitroglycerine in them that are used for the treatment of cardiac disease. So you really do need to talk to your physician, let him know exactly what medications you're taking, before you get a prescription for Viagra.

What about reports that Viagra can itself cause cardiac problems?
DAVID KAUFMAN, MD: It has happened that men who are not all that active physically suddenly start taking Viagra, find that they had a wonderful erection, want to participate in sex, and really stress their cardiac output more than it's been stressed in 15 years. That's why Viagra has had some amount of bad press over the years of causing myocardial problems, not because of the drug, but because of the activities that that drug allows. That's the important point.

A rejuvenated sex life seems like a great development for any couple. Is this always the case?
PATRICIA BLOOM, MD: Sometimes, the woman or the partner may not be ready to resume sex. Viagra does not work when there is no desire from the partner, and there can be complications. I do think that the affect this drug can have on the woman probably gets ignored, and I think women are afraid.

DAVID KAUFMAN, MD: The man, after not being sexually active for years and years, suddenly wants to have sexual intercourse, and in some cases the woman has gone through physical changes that might preclude her ability to actively participate. It's definitely caused social problems.

DAGMAR O'CONNOR, PhD: For couples who have between them a certain distance, they suddenly cross that distance. And they may not be emotionally ready for it. Some couples use it once or twice, and then never use it again, because it was too scary, too frightening, and too close.

DAVID KAUFMAN, MD: On the other hand, there are many men who were sent to me by their wives, wanting their husband to become more sexually active, and requesting an evaluation. So it works both ways.

How has the popularity of Viagra affected the way men approach their sexual health?
DAVID KAUFMAN, MD: Viagra has really revolutionized how physicians take care of men with sexual dysfunction, and it's revolutionized how society sees this problem. Before Viagra, men thought that the only solution to their problem was to have a major surgery -- a penile implant. But once Viagra hit the pharmacy shelves, people really started facing their problem and coming out of the woodwork.

PATRICIA BLOOM, MD: I think it's very important, because those men - many of whom have other medical conditions -- haven't sought medical care in the past. It's important for doctors to do the full medical workup, not just to give men Viagra. Because the patient may have diabetes or hypertension or be taking a medication that they just never told their doctor about, but which is causing their impotence.

DAVID KAUFMAN, MD: Or atherosclerosis, or heart disease. I can't tell you how many men I've diagnosed for impotence who were then set on the road to diagnosis for very serious medical conditions. Everything really needs to be looked at.

By: Dagmar O'Connor, PhD
By: Patricia Bloom, MD
By: David Kaufman, MD