Viagra: Reality sets in
SUE MacDONALD
ÿ
08/11/98
Gannett News Service
Now that Viagra fervor has abated a bit, the question remains: Is it the wonder sex drug that its maker, Pfizer, Inc., claimed it would be?
Well, yes and no, say doctors, sex therapists and a few men -- whose real names won't be used for this story -- who have been using the impotence pill for the last four months.
Consider their experiences:
-- Edward, 62, a Cincinnati businessman who has struggled with impotence ''for a long time,'' tried Viagra in May. ''They say it doesn't work in 40 percent of men, and I think I'm one of the 40. It was disappointing.''
-- Ned, 49, a scientist whose erections had begun to weaken over the last two years of his 20-year marriage, began using Viagra shortly after it was approved in March: ''It's been helpful. It works. It's not necessarily spectacular, but it helps.'' The major drawback: a next-morning headache that resembles a ''tight feeling in the face.''
-- Jim, a mid-50s single man who began using Viagra in early June: ''It has worked beyond my expectations.'' But the pill doesn't work alone, he says; deep affection between two people is crucial for a good sexual relationship.
Four months ago, the Food and Drug Administration approved Viagra as the first oral pill to treat impotence.
For at least half the men whose sex lives have been on the back burner, there's heat again in the bedroom. The rest, however, still are looking for a cure or are reverting to earlier, less convenient treatments.
''I think reality has set in,'' said Dr. Marc Pliskin, urologist at Group Health Associates in Cincinnati. ''Viagra's not nirvana for everybody, but for more than half of the patients it helps significantly. I think it represents a genuine, definite advance in treatment.''
Before Viagra, many men were too embarrassed to discuss the topic or were put off by the available treatments: -- an erection-inducing shot, a vacuum pump, a penile suppository drug.
''But give them a pill, and it's well worth trying,'' said Dr. Kayla Springer, psychologist and sex therapist in Cincinnati. ''It's the least difficult and least invasive of any of the other treatments, even if it costs $8-10 a pill.''
And while there were stories of sexually renewed men leaving their wives for younger women, Nevada brothels overwhelmed by aging customers, and wives complaining of their husband's energized advances, specialists say the everyday Viagra reality is far milder.
''I have not seen any of the things like we saw (in the news) regarding lawsuits -- the older man who now leaves his wife and goes for all the younger women,'' said Dr. William Wester, sex therapist at Behavioral Science Center in Cincinnati.
What are other specialists discovering?
-- Effectiveness. In the Pfizer studies, 60 to 70 percent of impotent men were able to achieve erection, a figure that's closer to 50 to 60 percent among the masses, said Dr. Thomas Kalin, a sex therapist in suburban Cincinnati. ''When you're in these studies, you get a lot of attention and a lot of focus. It doesn't always work as well in real life.''
-- Unpredictability. There is no way to predict whether Viagra will work. ''There are some men in whom I thought it would work great, and it doesn't work at all, and others I didn't think had a prayer and it works pretty well,'' Pliskin said.
-- Failed results. Some Viagra users have given up and returned to Caverject, an erection-producing drug that is injected into the base of the penis before sex, Wester said. Unlike Viagra, Caverject requires no foreplay or physical stimulation; the erection just happens.
''Their complaint is that the (Viagra) erection doesn't last as long,'' Wester said. ''They're used to taking the shot and being able to maintain an erection upwards of an hour. Some of these same patients are reporting that they're only getting 8-10 minutes with Viagra, so they've gone back to the shot.''
-- Other issues. Some men are happy with their new sex lives, and some are reporting marital trouble. Is impotence physical or psychological? Is it a function of desire, self-esteem, the relationship, emotional problems or trust? ''Viagra isn't going to do a thing for that,'' Springer said.
-- Performance anxiety. Now that some men physically are able to have sex, their Viagra-induced abilities are causing performance anxiety, Kalin said. ''I've had one or two cases where there was enough anxiety and performance concerns to override the medication, unless you add some behavioral therapy,'' he said. After they took the pill, he said, some men began worrying: ''How long until it works? Is it working quickly enough? Is it working now? What if it doesn't last long enough? What if I can't follow through? Am I doing OK?''
-- Adverse reactions. Pliskin and other urologists say about 10 percent of men report headaches, blurry vision and slight nausea, all of which abate in a few hours. Pliskin will not prescribe it to elderly men with severe heart disease because of potentially deadly interactions when Viagra combines with nitrate-containing heart drugs such as Imdur, Nitrogard, Nitrol, Nitro-Dur, Transderm-Nitro, Tridil and other nitroglycerin tablets.
-- Who pays? Coverage still varies, but about half of men are paying for Viagra without the help of insurance, estimates IMS Health consultants.
''It's $9-a-pill average, and that is a burden,'' said Dr. Alan Cordell, a Cincinnati-area urologist. ''The good news is that we're not talking about a daily pill. For most of these guys, you're talking once a month, or even once a week, and that's reasonable.''
Some insurers limit men to four pills a month, some pay nothing at all and some pay a few dollars per pill. Some will cover Viagra only if a man can prove he was being treated for impotence before Viagra's introduction.
''The insurance companies have to make a profit,'' Cordell said. ''Insurance companies aren't all of a sudden going to take a multimillion dollar hit, and I don't blame them. I personally think men should pay for it, and I know that may not be a popular position with my patients.' |
