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Erectile Dysfunction: When Viagra Doesn't Work

Erectile Dysfunction: When Viagra Doesn't Work

April 10, 2000 (Mill Valley, Calif.) -- In his early 40s, Ron Hanson was tooyoung to be having trouble getting and sustaining erections. But like many men,he was too embarrassed at first to talk about the problem. Hanson (not his realname) waited seven years to see a urologist. By the time he spoke up, erectiledysfunction had become a household word, thanks to the popularity of the drugViagra. But the widely touted drug, Hanson soon learned, doesn''t work foreveryone.

When Viagra (sildenafil) hit the market in 1998, some men thought it was thelong-awaited answer to their problems. Many rushed to doctor''s offices to giveit a try. According to the Grey Clinic in Indianapolis, which specializes inerectile dysfunction, 17% of men between 18 and 55 experience occasionalimpotence, while 6% have regular erectile difficulties. For men over 55, thatnumber jumps to about one in three. Some common causes of impotence arediabetes, heart disease, and psychological problems. It also frequently occursafter prostate cancer surgery.

Because Viagra works in a way that''s similar to drugs that contain nitrates,however, it isn''t recommended for men who take nitrates for heart disease orthose with certain other heart conditions. In some men, it causes badheadaches. In others, it just plain doesn''t work. In some instances, men maynotice they have trouble telling blue and green colors apart when they starttaking the drug.

During an erection, blood flows quickly into the penis, which increases itslength, width, and firmness. If the "in" vessels (arteries) are toonarrow or if blood drains too quickly through the "out" vessels(veins), men may have trouble achieving or maintaining an erection, says ArnoldAigen, MD, a urologist with Camino Medical Group in Sunnyvale, Calif. Viagra,which increases inflow, may not be strong enough to work its magic if thearteries are too narrow.

Hanson tried Viagra, but he couldn''t tolerate the headaches it caused.Luckily, when Viagra fails, he discovered, there are several alternatives.

Alprostadil to the Rescue

A drug called Alprostadil, either alone or sometimes in conjunction withothers such as papaverine and/or phentolamine, can be injected directly intothe penis to dilate the arteries, experts say. The drug produces an erection inabout 10 minutes that can last up to an hour. But there are severaldisadvantages, says Teresa Beam, MD, a urologist with the Grey Clinic. Somepatients are averse to using a needle, which is why many men abandon thetherapy. Those who give it a try may experience pain at the injection site orpriapism (a painful erection lasting too long).

As an alternative, Alprostadil is available as a pellet-like suppositorythat is inserted into the tip of the penis and absorbed through the lining ofthe urethra. This can help produce erections lasting for 30 to 60 minutes,according to the Impotence World Association (IWA). Unfortunately, thesuppositories are less effective than injections and may cause pain andirritation, according to both Aigen and Beam.

Last November, a topical gel formulation of alprostadil was approved by theU.S. Food and Drug Administration. It is too soon to know if this form ofalprostadil therapy will become widely used.

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