[Miami-where Viagra rules and scripts get written]--Viagra, the morning after the sex pill
Now that America's relationship with Viagra is a few months old,
it's time to ask: Is it a passing fling, or the real thing?
By FRED TASKER
Herald Staff Writer
Viagra, the next morning: afterglow or hangover?
When the little blue $10 miracle pill came out in
April, demand for it was explosive. The end of
dysfunction seemed at hand. But time has passed
now, and the inevitable backlash has arrived.
"Nameless in Philadelphia'' tells Ann Landers she had
rejoiced when her husband lost interest in sex,
shuddering: "The minute he walks into the house with
those pills, I'm walking out.''
Nearly 200 men report serious side effects, and 31
die after taking Viagra. Many insurance companies
refuse coverage, to the point that 60 percent of men
must pay for it themselves. And one week in July,
prescriptions fell to 184,312; one week in May, they
had totaled 303,424.
The end of an overhyped, flash-in-the-pan fad?
Not on your life.
Even in the cold light of dawn, even as both men and women realize Viagra's
shortcomings as well as its promises, it appears to remain at least as popular as
sliced bread, hot cakes or the free lunch.
Men want it.
"Hundreds of men,'' says Lawrence Winton, a urologist in Pembroke Pines and
Aventura. "You almost need a rubber stamp for the number of prescriptions you're
asked to write.''
Women want it.
"Many, many women,'' says Lawrence Hakim, director of erectile dysfunction and
male infertility at the University of Miami. "Women are just as interested in
improving their sexual function as men. We're not prescribing it for them right now.
It's not approved for women.''
Even people who don't need Viagra want it -- against doctors' advice.
"It could have gone on for 12 hours, if I'd let it,'' said a 50-ish Broward woman of
the night her man, also in his 50s with no impotency problems to begin with,
popped a Viagra anyway.
"I had to tell him the next morning, 'Put that thing away.' ''
Says Miami sex therapist Blanche Freund: "My patients say whoever invented it
should get the Nobel Prize.''
And there may be even more good news soon. At least two new drugs are
undergoing human tests:
Miami-based IVX BioScience is starting human trials of BNP-158, a new
cream to be rubbed directly on the penis to facilitate erection by opening blood
vessels. A spokesman couldn't say how long the trials might take.
Winton, whose office is taking part in the trials, predicts completion in "a year and
a half to two years.''
"There's such interest; the market is so great,'' he says.
Chicago-based Tap Pharmaceuticals is testing apomorphine, a drug that fights
impotence by stimulating neurotransmitters in the brain. The company hopes to
seek FDA approval next year, a spokeswoman said.
"We're helping with the testing,'' said Hakim. "It's supposed to act centrally, in the
nervous system, to help improve erections.
"Viagra is really just the first of a number of new therapies that are going to be
more appealing to men,'' he said.
Not for everyone
What might have been backlash against Viagra may be merely a better
understanding of what Viagra can and cannot do, and what it means to human
relationships.
Yes, some men are dissatisfied. They are coming to terms with the fact that, just as
Viagra's maker, Pfizer, predicted, it works for not all, but about 70 to 80 percent
of men who take it.
"About 20 percent of men are unhappy,'' says Winton.
Yes, some women are sorry their husbands are asking for sex again.
"Sometimes older women get used to not having sex,'' says Winton. "To them, it's
not important. To the husband, it is. They [the wives] kind of wish he would let
sleeping dogs lie.''
Viagra, Freund agrees, can expose deeper sexual problems in relationships that
had been hidden behind the husband's physical impotence.
"Sometimes couples have adjusted to an asexual relationship; it's not easy to start
redefining that at 60 or 70.''
Marilyn Volker, another Miami sex therapist, has seen it too.
"I worked with one couple whose focus had always been on the man not getting an
erection. But when he used Viagra, a lot of other issues surfaced. And the wife not
really wanting sex as much as she claimed.''
"My concern,'' adds Linnea Pearson, pastor of the Eastside Unitarian Universalist
Church in Miami, "is that Viagra reduces what I consider the most sacred of human
interactions to a mere physical act. It might encourage men in a belief that is
already too prominent in our society -- that the male erection and orgasm is the
primary goal of the act of love.
"It's a matter for him to discuss with his spouse.''
Uncovering other problems
Dealing with such issues, experts say, must start before Viagra is prescribed.
"I try to see my patients as couples before prescribing it, looking at the satisfaction
of both of them,'' says Hakim.
Freund agrees. But she says that, by uncovering such deeper problems, Viagra can
force couples to deal with them.
"I've learned that being able to communicate even about the idea of trying Viagra
can be a big step. It's saying, 'I need help.' ''
Freund urges couples to use Viagra as an opening to bring up sex.
"Viagra takes an hour to work,'' she says. "It means intentionally saying, 'We're
going to have sex tonight.' ''
She suggests using that hour that Viagra takes to work "in a spontaneous way,
getting ready for the evening. Make it romantic. Take a bath or shower together.''
And in some new cases today, doctors say, women are responding to their
husbands' renewed desires -- or simply concerns of their own -- with a dose of the
same medicine, Viagra, for themselves.
Women want it, too
It has urologists cautious for today, but hopeful for the future.
"Many, many women are asking for it,'' says Hakim. "Female sexual dysfunction is
just as prevalent as male erectile dysfunction. It's probably related to many of the
same issues -- smoking, diabetes, hypertension, cholesterol.''
And he won't be surprised if Viagra works for women.
"It makes sense, because it improves the blood flow to the genitalia. Women who
have taken it report engorgement of the clitoris, lubrication. But it's kind of
nonpublished data.''
So he's not ready yet to give a woman a prescription.
"We're setting up a study protocol for women right now.''
He expects a better idea of how well and safely it works for women in about six
months.
Winton, the Pembroke Pines/Aventura urologist, has just given his first prescription
to a woman.
"Her complaint was that she's not really interested in sex, and, if she does have sex,
she doesn't get stimulated,'' he said.
"There are no contraindications. We'll try it.''
Not for recreational use
But urologists are unanimous in criticizing potent young men for using Viagra to try
to become superhuman.
"Viagra should not be taken just recreationally,'' says Hakim. "If young, healthy
men start taking these to enhance erections, there are serious potential risks.''
Doctors have little experience with such abuse of Viagra because it's so new,
Hakim said. But young men using an older method of injections to enhance
erections have sometimes experienced the danger and pain of a malady called
priapism.
"A prolonged erection, more than four to six hours, even days, can ultimately lead
to severe erectile dysfunction,'' Hakim said. "There's scarring in the tissue in the
penis. Someone completely potent can develop this and end up totally impotent.''
Clinical trials of Viagra by Pfizer found no cases of priapism, company
spokeswoman Mariann Caprino said. But she strongly agreed that young, healthy
men should not abuse Viagra.
"We're talking about recreational use of a drug; it's just never a good idea.''
But whatever its controversies, Viagra is still one of the hottest drugs on the
American market.
"I've seen patients that, before Viagra, their marriages were on the point of
breaking up,'' says Winton. "They're ecstatic.''
It's batting 1.000 with "Hector,'' a 61-year-old Coral Gables accountant.
"It's wonderful,'' he said. "My wife and I had hardly had sex in a couple of years,
and now we can have it whenever we want. She calls it our second honeymoon.''
It works for men who had given up.
"I've had patients with radical surgery for prostate cancer, whose entire prostates
have been removed, and a good proportion were impotent,'' says Winton. "Viagra
has worked in a number of these patients.''
So Viagra's popularity seems unlikely to dim until those promised better things
come along.
"It looks very hopeful,'' says Hakim. "I think every patient who has an erective
problem can be helped one way or another.'' |
