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August 1, 2014

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Thrills & Pills: Relationships boosted by erectile-dysfunction treatments

Travis Duque wasn't really looking for help in the bedroom.

There was nothing wrong with him physically. It's just that, two years ago at age 40, Duque couldn't perform as often or as long as he wanted.

"I like to have a little fun and party," said the pysically fit Las Vegas taxi driver. "But then I would get tired and run down."

Duque discovered Viagra. The results, he said, were magical.

"With Viagra in the system, you don't think about it or worry about it," he said. "Viagra keeps you from losing that moment."

Duque's girlfriend was equally impressed with its effect as well.

"For the first three months I didn't tell her I was on it. She thought I was God," he said.

Being "God," however, has its price.

A single tablet of Viagra is nearly $12, about the same price for Levitra and Cialis. And there are no generic equivalents for any of the medications.

Duque estimates he spends $190 for a bottle of 15 100-milligram Viagra pills per month. It's not cheap -- for him, or anyone else -- but the expense is worth it, he said.

"I think it's great because it puts your mind at ease," Duque said. "If you're going out and you do find her, you want to have that little blue pill."

Duque isn't alone in his appreciation of erectile-dysfunction medication.

In a September 2003 interview with the Las Vegas Sun, Playboy founder Hugh Hefner also sang the praises of Viagra.

"I've got six girlfriends, so, yes, it helps. It definitely helps ..." Hefner said. "As soon as I started using it I bought some stock. I saw the future."

In ad campaigns, Viagra has relied on testimonials from the likes of former Sen. Bob Dole and baseball slugger Rafael Palmeiro. Levitra, meanwhile, hired ex-Chicago Bears and New Orleans Saints coach and noted tough guy Mike Ditka as its celebrity spokesman.

Such endorsements "break down barriers for a lot of men," said Matthew Scampoli, spokesman for Levitra. "You've got a guy like TIron' Mike Ditka talking about erectile dysfunction, it makes an impact."

Still, Scampoli concedes, there is much work to be done in reaching the millions suffering from erectile dysfunction (ED).

"We've come a long way with awareness, but we still know a high number of men are not being treated for this," he said. "There's still more work to be done."

ED awareness

The American Foundation for Urologic Disease estimates that up to 30 million men in the United States suffer from ED. Of that 30 million, only 10 percent seek treatment.

The causes of ED vary from ailments such as diabetes or high blood pressure to psychological problems.

In most cases, though, medicines such as Viagra, Levitra and Cialis are a cure.

"They are extremely effective," said Dr. Mark Swierzewski, a noted urologist and men's health advocate who appears regularly on national talk shows. "What they do is increase a man's ability to get an erection. They're really just an amplifier.

"They take a normal response and improve it."

But these drugs aren't just about sex, he said.

A study found an increase in hugging, kissing and cuddling by more than 30 percent in men just by taking Viagra on a regular basis.

"I call it the male intimacy drug," Swierzewski said. "It's really not just about intercourse. It gives men back their sexuality. It makes them male."

While ED drugs were initially marketed to middle-aged men and older, there's been a gradual shift to younger men.

Swierzewski said when Viagra was first introduced in 1998, the average age of a user was 55. At his practice in Tampa Bay, Fla., the average age is 40.

These drugs are marketed not only as cures for impotence, but also "performance enhancements," which allow for fuller erections and less waiting time between erections.

"It originally came out as the Bob Dole drug (and) getting an erection or not getting an erection," he said. "But they don't talk about that anymore. It's the quality of the erection."

As far as Swierzewski is concerned, the new wave of ED pills are more than a wonder drug. "They're the greatest thing that ever happened to 40- and 50-year-old men."

Sex ED

Although the volume of media publicity would indicate otherwise, Viagra et al. are not the first treatments for impotence.

In the 1970s there was the Inflatable Penile Prosthesis (IPP), which involved placing a pump in the scrotum and two flexible cylinders in the penis. The surgery for the IPP was costly -- $15,000-$20,000, often with no insurance coverage -- and resulted in a near-constant erection.

A decade later saw the introduction of the first medication to treat impotence, Caverject, a drug injected directly into the penis via a small needle that created an hourlong erection.

While the results were effective, many men complained of discomfort from the drug as well as the method of injection. When Viagra was introduced in the late '90s, it was considered by doctors and patients as the first easy and safe treatment for ED.

In its first year alone, 50 million Viagra pills were prescribed worldwide, according to Pfizer, maker of the drug.

"The stuff was flying off the shelves," said Gerald Weeks, a UNLV professor, board-certified sex therapist and co-author of "Erectile Dysfunction: Integrating Couple Therapy, Sex Therapy, and Medical Treatment" ($30, Norton).

"It had virtually no side effects -- nothing serious like Caverject. Once doctors got comfortable with it, word got out and they cranked up the advertising machine. Then everyone wanted it.

"Nowadays, almost any doctor will write a prescription for it."

The risks for ED drugs are few, but it should not be taken by:

Those who have had a heart attack or stroke in the last five years, or who are taking beta blockers or other heart medications.

Those who use steroids or other stimulants.

Those who have high blood pressure or extremely low blood pressure.

Although the ED medications are marketed for men, Weeks considers the pills a "relationship drug."

"You're not just prescribing it for a male, but for a couple," he said. "It will have a positive or negative impact on the couple."

One older couple Weeks was counseling, in particular, were experiencing problems as a result of an ED medication.

The woman told Weeks the couple were losing interest in sex together, when her husband started taking Viagra, increasing his sex drive considerably.

"She said, 'Viagra has turned my husband into an animal,' " Weeks said. "He used the medication the whole three hours.

"But when is it enough? That's a couple-related issue."

ED-vice

ED drugs have become so popular as a performance enhancement, even women are willing to try the medication.

"Women are taking it," said Sherman Baker, president of Advanced Medical Weight Loss & Wellness Center in Las Vegas. "It keeps the blood supply there longer, which increases sensation."

While the center is is waiting for FDA approval before it prescribes ED medications to women, Baker said physicians in Las Vegas and around the country are prescribing the drugs anyway.

Meanwhile, the clinic has seen thousands of male clients since the introduction of Viagra.

Before getting a prescription, though, each patient must consent to a preconsultation, filling out two medical questionnaires and consenting to weight and blood checks.

"We don't just prescribe it," Baker said.

Baker is particularly concerned about men who purchase ED medication "off the Internet or a floating island somewhere" without medical supervision.

"There are a lot of people who are taking risks by not coming in and having their blood work done and seeing a doctor," he said.

Even with all of the fuss about including ED drugs under the new Medicaid bill, Baker still doesn't think the pills are in danger of being overprescribed.

"There are still a lot of conservative people in the world" who won't acknowledge that there's a problem, he said. "Plus, men are more active sexually, but I don't think it's a bad thing."

Although the upside to ED drugs seems mostly positive, others remain concerned over the message that may be inferred by a medication for impotence.

"It continues to perpetuate the idea that the only sex that counts is sex with an erect penis and there is so much more that can happen in a sexual encounter," Barb Brents, a professor of sociology at UNLV, said. "I think with older couples, they were able to explore this. Now with Viagra, it's almost regressed.

"We've gone back to a singular notion of what counts for sex."

Brents is quick to add that she's not trying to "downgrade a guy's experience" by using medication to combat impotency.

"It's important for him and for a woman, in that respect," she said. "But it's narrowed our culture's perspective on what could lead to sexual fulfillment.

"Technically, he doesn't have to have an erect penis for her sexual fulfillment. It's not the only way nor is it the best way."

Still, Brents does applaud the drugs and their commercials for getting society to discuss a serious sexual problem more openly.

"Whether through the birth control or the pill, how we have come to talk about sex openly as a culture is through medicine," she said. "It opens up the ability to talk about sex."

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