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Along the Latex Highway
Valley of the Dolls '98
A Look at Prozac and Viagra

By David Salyer

November 1998

Back in 1994-95, I took the antidepressant Prozac for a year. It had certain advantages. Prozac enabled me to tell the blunt, unvarnished truth. For instance, I once told a particularly formidable and irksome telephone solicitor that I'd have a lot more respect for her if she got a real job. Like prostitution.

Personally I felt somewhat numbed by Prozac. I didn't much care about anything. When my mother died, I went through the motions, made arrangements and did all the right things. Except grieve. It was months later, post-Prozac, that I broke down and cried while decorating my Christmas tree, something my mother and I had done countless times together when I was a child. I missed her, and without Prozac coursing through my veins, I was able to experience a full range of emotions about the loss of my mother.

I'm not knocking Prozac. It works miracles for some people. One side effect, however, that often goes unmentioned is the drug's affect on a man's ability to get an erection, maintain an erection or have an orgasm. Sometimes I could get an erection, but ejaculating was nearly impossible. Sometimes after what seemed like an eternity of trying to climax, I would simply hit the TV remote and search for a Lucy rerun, a habit most disconcerting for my partner at the time.

But guess what? This column isn't about Prozac. It's about Viagra. You know, Viagra , the little pill that could. Viagra was approved for impotence by the FDA in April of 1998. And perhaps because 10 to 20 million American men suffer from impotence, erectile dysfunction or the inability to sustain an erection, Viagra sales have caused Pfizer Pharmaceuticals stock to soar on Wall Street (a male-driven place if there ever was one). In fact, 570 million prescriptions were filled the first month it was available.

Viagra (sildenafil citrate) is a small, blue tablet that affects the response to sexual stimulation. The drug acts by enhancing the smooth muscle relaxant effects of nitric oxide, the substance normally released locally in response to sexual stimulation, thus allowing more blood to enter the penis and cause an erection. However, Pfizer claims you will not get an erection just by taking the medication; you already have to be sexually aroused.

Given the "quick fix" mentality of our culture, Viagra seems a ripe candidate for abuse. For some men it will surely end performance anxiety, provide a salvo for the male ego and earn its place among the 20th century's most celebrated achievements. Gay men are no less intrigued by the possibilities than their heterosexual counterparts. Viagra is rapidly becoming a staple at circuit parties, too. I would not be at all surprised if the same marketing genius who coined the phrase cocktail to describe our HIV regimen came up with an even more asinine way to give Viagra kitschy appeal. Like putting it in Pez dispensers capped with famous gay icons heads such as Bette Midler, Joan Crawford or RuPaul.

It would not be wise to use Viagra as a recreational drug. I spoke to a user recently who confirmed consuming several drinks before popping Viagra and still got an erection that lasted three hours. He was relieved to find condom wrappers on the floor the next morning, and feels that in his particular case his judgment was not impaired. But let's be realistic: anything that sets the stage for sexual activity when you would normally be unable to perform could influence unsafe behaviors. Let's not hold Viagra in lieu of personal responsibility.

Let's also not forget the many causes of impotence. Psychological factors are often cited. For gay or bisexual men, impotence may be caused by feelings of guilt about sexual orientation. Or it could be fueled by excessive concern about contracting HIV. But ultimately impotence problems are more often due to diabetes, kidney disease, high blood pressure, atherosclerosis, prostate surgery or thyroid disease. According to experts cigarette smokers are at greater risk for impotence than nonsmokers. And some medications for high blood pressure, ulcers, angina and depression (been there) may be to blame.

With so many potential causes for impotence, discussing your situation candidly with a physician is prudent before demanding a prescription for Viagra. It may be possible that Viagra is not for you. Here's why: Viagra must NEVER be used by men who are taking any medicines that contain nitrates, like those used to treat angina (chest pain due to heart disease). Examples include nitroglycerin (sprays, ointments, skin patches, or pills dissolved in the mouth), OR isosorbide mononitrate and isosorbide dinitrate (tablets swallowed, chewed or dissolved in the mouth).

And one more BIG WARNING. Nitrates are also found in illicit drugs such as amyl nitrate (poppers). Combining Viagra and poppers is dangerous, and rather than enhancing sexual arousal, the combination can lower blood pressure, cause a stroke or heart attack, loss of consciousness and possibly be fatal. Viagra and poppers are a very bad idea.

If you still feel you are a candidate for Viagra, at least consider the following. As with all drug products, side effects occur. Only you can decide if morning-after headaches, flushing of the face, stomach aches and mild visual changes such as color and light perception and blurred vision are worth a raging, three-hour erection. Don't forget either that Viagra does not protect you or your partner from getting a sexually transmitted disease.

Finally, at $10 a tablet, a number of HMOs and insurance companies have declined to cover the cost of Viagra, implying that a lack of sex does not constitute a real medical problem. I suspect consumers will ... ahem ... rise up against this policy.




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