Part two: Q&A about Viagra and Cialis

The second interview with Dr. Marion Davis. Read the previous part at the link.

Viagra was initially created for something like that, wasn’t it?

Yes, it was being tested for heart disease. But the issue arises when men get angina or chest pain from heart disease, and they pop a little pill under the tongue called Nitro, which relaxes the blood vessels (that’s how it works for the heart), allowing the blood to flow through.

So, if you take these medications simultaneously, they will relax your blood vessels too much, and the blood pressure will go down, and that’s the danger. So, it’s not causing heart disease, but it is for men with heart disease who are already taking Nitro. That’s a very dangerous mix.

And what about alcohol? Is it safe to drink some wine?

Alcohol can have an effect on erections, but there’s no problem with that. It may decrease the effectiveness of the drug a little bit, but it is certainly not dangerous. Some men feel more disinhibited when they drink alcohol, and that can actually be a good thing in a way, but the more you take it, the more it will impair your senses. At that point, it is actually bad for erections in general, but it’s not dangerous if taken with Viagra or Cialis.

Is it more effective if taken on an empty stomach? Can it be affected by food absorption?

If you go out on a date and you plan to have sex, and unless you take it a couple of hours before dinner, it can actually affect the absorption to some extent. But I don’t want my patients thinking too much about it because the more they think about sexual intercourse, the bigger the pressure and the anxiety, which will affect their performance.

At what point do you decide to prescribe the medication? Like, if an individual walks into your office and says, “I want Viagra”, do you simply give it to him, or is there a series of questions?

Some people come into my office thinking they suffer from erectile dysfunction, and they don’t – what they have is premature ejaculation or painful orgasm. So, I’ve got to make sure that, when they say they have erectile dysfunction, weak erections, or no erections at all, they do actually suffer from that specific problem and not some other sexual dysfunction.

And I want to make sure that we go through all the basic health problems. I will prescribe the medication if and when the patient needs it, but I want to make sure that we are treating erectile dysfunction. Another important thing is, we should be treating the whole body, like losing weight, stop smoking and doing some exercise. If you suffer from erectile dysfunction, and you’re not a 20-year-old with psychogenic ED, then you are at risk of heart disease.

If I have a 40-year-old patient with vascular erectile dysfunction, I will send him to a cardiologist for an evaluation. As I said before, our aim is to improve the patient’s general health before we proceed to specific disorders causing his erection problems. Viagra will help them today, but in the long run, if they want to get and maintain stronger erections, they should have a healthy heart, control their diabetes, lose weight, etc. So, I’m not just going to tell my patients: “Here’s a Viagra, now go and have a good time.”

Can patients get addicted to these medications?

Patients do not become addicted to the medication, they don’t become dependent on it, and it won’t lose effectiveness because they’ve been taking it more lately. What I tell young patients, especially if they suffer from psychological erectile dysfunction, is: “Take the medication, have some good sex, and then the pressure will be off, and you won’t be needing it so much simply because you will be thinking about it less and you will have more confidence.

It’s not as if you take Viagra or Cialis now and you won’t be able to have a strong erection without it in the future. You don’t become addicted or dependent on it. It’s exactly like training a muscle – the more you exercise, the better. It’s the same with erections – the more you have, the better it’s going to get.

What is good for your heart is just as good for your sex health. Cardio exercises, healthy diets, quitting smoking. Viagra is not the only medication that was studied for the heart but was found out to have benefits for erections. There’s a treatment that we do called “shockwave therapy”, which is a series of 12 sessions of 20 minutes each.

Is it painful?

No, it doesn’t hurt. It was initially designed for treatment of heart disorders, to improve blood flow. It is also used in other areas of the body to stimulate blood flow.

So, you take the patient’s penis, and you shock it with something?

Yes, there’s a probe like a flashlight, you put it on the base of the penis and it works. Studies have shown a success rate of around 70%. This is meant for patients who suffer from vascular disease in the penis to stimulate and increase blood flow.

Tells us more about this machine that checks if the blood flow is good.

We call it “Penile Doppler”. It’s an ultrasound machine that measures blood flow. A lot of patients come into my office and say: “I am confident that something is wrong. This is not psychological. I need to know.” The unpleasant part of the process is we have to give an injection into the penis to create an artificial erection, so then we can measure the blood flow in and the blood flow out.

This will tell us several different things about the quality of the blood flow to the penis. For example, some individuals may have good blood flow in, but they have a venous leak. The blood flow comes in, but it leaks out too quickly. There are various things we can do with the results of the Penile Doppler.

Anything you’d like to say to summarize our today’s talk?

Essentially, Viagra and Cialis, this entire class of drugs, are completely safe when used correctly. Patients come in and say: “I’m considering to switching to two pills of Cialis a day, because I took one and it’s not working”. That represents a higher risk of side effects. I am not going to prescribe that, and you have to realize that’s against my advice.

So, use it safely, use it properly and, in combination with other things like exercises to improve your health, a good and balanced diet, weight loss, you can get and maintain good erections for longer.