A Book Review From Australia:
The get-me-up drug
Reviewed by Chong Seck Chim
09/02/98
The New Straits Times
The New Straits Times Press
Life and Times; 2*
Page 07
NOT so very long ago, some three- or four-letter words were hardly ever seen in print: a row of dots did duty for them. We now live in more enlightened times, and sex at last has come into its own. Henry Miller put it memorably: "Sex is one of the nine reasons for reincarnation ... The other eight are unimportant."
This book, we might say, is about functional sex. Or rather, about sex dysfunction - more precisely "erection dysfunction", ED for short. It is also about Viagra , and it is a pity that it could not be used (perhaps with an exclamation mark) for the sole title, given its instant recognition and impact, for by now the "love pill" is known worldwide. Viagra is not so described in the book; the authors prefer to emphasise its potency and virility instead. Still, they do refer to it occasionally as the "erection pill", which is no more than plain, unvarnished truth.
So a certain clinical detachment is desirable for the discussion of this important social development happening in our lifetime. Or perhaps I should say the second, since the first pill had already liberated women. Now the second bids fair to do the same for men, so long restricted to pneumatic pumps and implanted rods to keep their end up in the marital bargain.
Erectile problems are as old as man himself. Some traditional cures have survived to this day: rhinoceros horn, seal penis, and horse testicles; the mandrake plant, ginseng, and our own tongkat ali - all have been used as virility boosters.
Vacuum erection therapy appeared in 1961. A manual or electric pump is used to create an external vacuum around the penis, temporarily sheathed in a plastic cylinder. This draws in the blood flow, whereupon a flexible tension ring is applied to ligature the organ, sustaining erection for about 30 minutes.
Penile injection therapy came in the Eighties. A "tri-mix" cocktail (of papaverine, phentolamine, and prostaglandin E-1) or some other proprietary brand is self-injected at the base of the organ for "erection within five to twenty minutes, the result of the relaxation of smooth muscle tissue, the dilation of main arteries, and blood filling the penis". However, if overdone, priapism or a painful erection lasting three or four hours may result. Fortunately, an adrenaline-like drug can bring speedy relief.
Penile implant surgery costs more, and is generally used for older patients. In one version, a pump is again used, but this time everything is buried: a pair of hollow rods or cylinders in the penis, a container of fluid in the abdomen, and the pump in the scrotum. The last is squeezed by hand several times to inflate the rods. To end the erection, a valve at the top of the pump is squeezed (presumably through the skin) and the fluid returns to its reservoir.
The malleable semi-rigid implant, on the other hand, gives the patient a permanent erection. "Bending the rods so that the penis is close to the body hides it, while straightening the organ with one or two fingers immediately readies it for intercourse."
These early palliatives had several drawbacks, the chief being lack of spontaneity and absence of romantic feeling. One girl said that her boyfriend, after going into the bathroom to gird for battle, reappeared looking like a bionic man, so she terminated the relationship on the spot. The men disliked feeling "like a machine waiting for a fuel-up".
In the case of Viagra (sildenafil), the response to the preliminary trials was enthusiastic. "In fact, one test subject, who had developed ED years earlier, pleaded to be allowed to continue using the drug. Viagra , he said, had altered his life. In his case, the researchers relented and gave it to him. He was, after all, almost ninety."
But to begin at the beginning. Viagra started life as a prospective vasodilator for angina or heart pain, but the yet unnamed drug had little effect on the heart. Instead, it boosted blood supply to the penis, giving it an erection.
What Viagra in fact does, in 20 minutes or so, is to increase the flow of blood (to six times more) through dilated arteries to the penis; also keeps it there by constricting the veins, thereby engorging the organ. In technical language, the whole action "requires good blood flow, which is regulated by the nervous system, to bring about the hydraulic, or lifting, action".
At about the same time, a second cure was found. Unlike Viagra , which is incompatible with nitrate-based medications, Vasomax (phentolamine) has no known negative interaction with other drugs. However, Viagra is more powerful, though Vasomax may be better for men with psychological and early mild erectile dysfunction.
Both pills complement sexual desire and erotic stimulation, without which apparently they are not much good. So they are not aphrodisiacs. But if a healthy person without ED problems asks for "a recreational pleasure- enhancer", should he be given his Viagra ? According to Dr Steven Lamm, the decision should be left to the patient and his doctor.
The mechanical aids are clearly one-sided, and the women were never keen on them. But they have also complained about the new pills. "Why do I have to have sex all the time now? I was happy the way it was." "Is it the pill that's turning him on - or is it me? ... It makes me feel angry and used, and less attractive than ever." Viagra has opened a new chapter in the history of sexual medicine. The authors wax lyrical on its potential for wedded bliss. "With the pill there is no longer any need to restrict sexual activity. Men and women can now enjoy the full repertoire of sexual expression. The magic of the medication is that it allows sex to regain its natural rhythm."
However, the ED patient must learn to understand himself, and also the needs of his partner. So Dr Lamm advises the couples to keep personal diaries for feedback on their experiences.
|
