Fact Checked

How Does Viagra Work?

The golden standard in erectile dysfunction medications came into our lives in the late 90s thanks to a seemingly endless stream of slightly cheesy television commercials. Since 1998, Viagra, which is also known as poppers, has been the first medication that people think of when they think about erectile dysfunction, and with good reason - it boasts effectiveness rates of up to 85 percent. With over 30 million men in the United States alone suffering from erectile dysfunction, it’s no surprise that Viagra is still so popular; in fact, it has been prescribed to over 25 million patients. Since a generic form of the drug, Cialis or Vardenafil, Revatio, Levitra and Sildenafil, was released in 2017, Viagra is more popular than ever. So, what is erectile dysfunction, how exactly does this wonder drug work to treat it, just like tadalafil, and how likely is it that Viagra will work for you?  

What is erectile dysfunction and what causes it?

Before we talk about how to treat erectile dysfunction or painful erection, we should talk about what causes it. Erectile dysfunction, or male impotence, is a condition that occurs when a man has difficulty getting and/or keeping an erection due to limited blood flow, low blood pressure, to the penis and decrease sexual stimulation or sexual activity. It is said that the body needs three things to have an erection: a functioning brain, adequate hormone levels, and good blood flow. Therefore, erectile dysfunction can be caused by physical causes, lifestyle causes, psychological causes, or a combination of all of the above, which has made it notoriously tricky to treat. 

On the physical side, the five most common causes of erectile dysfunction are atherosclerosis (clogged arteries), high blood pressure, high cholesterol, diabetes, and obesity. The five most common lifestyle causes of erectile dysfunction are alcohol abuse, smoking, illegal drug use, common side effects of other prescription medications (including those used to high blood pressure, heart conditions or heart disease, and depression), and side effects of over-the-counter medications such as antihistamines and Sudafed. On the psychological end, erectile dysfunction is most commonly caused by depression, stress, and anxiety. 

Many of the conditions that can cause erectile dysfunction are preventable or reversible and could benefit from simple lifestyle changes, including:

  • Increasing your exercise
  • Managing your weight 
  • Drinking less alcohol
  • Quitting smoking
  • Reducing stress in your daily life

While many men are embarrassed by their erectile dysfunction unlike priapism, it can be a sign of a serious health issue and should be discussed with your doctor for medical advice. Degrees of severity range from noticing a decrease in morning erections to being completely unable to get and keep an erection at all. You know your body best, so if you notice something abnormal - even if it is seemingly minor - you should speak to your doctor.

How does Viagra treat erectile dysfunction?

The short version is that Viagra belongs to a family of drugs called PDE-5 inhibitors and works by inhibiting a natural chemical (PDE-5) that causes blood to flow out of an erect penis. The long version is a bit more complicated! Heart conditions or health conditions such as your heart, blood vessels, hormones, nerves, and mood all work together to cause an erection, and it is not a simple process. A chemical called cGMP causes the tissues and muscles in the penis to relax, allowing blood to flow in. This blood, which can be up to eight times the amount that is in the penis when flaccid, then gets trapped, causing an erection. In a normal penis, the trapped blood would eventually release, the erection would subside, and blood flow would return to normal. Viagra works by blocking PDE-5, which is a chemical that causes the breakdown of cGMP. Because the medication inhibits PDE-5, the cGMP does not get broken down and the tissues in the penis stay relaxed and engorged with blood, allowing you to keep an erection. As noted earlier, you have to be in the mood to get an erection, so Viagra only works when you are sexually stimulated (thank goodness).  

What do the studies say about Viagra’s effectiveness?

Viagra receives a lot of hype; after all, it was the first erectile dysfunction medication approved by the FDA. As the first erectile dysfunction medication approved in the United States, it underwent rigorous testing and numerous studies and clinical trials. A study of approximately 23,000 men with erectile dysfunction in New York City found that approximately 4 out of 5 men taking Viagra at dosages of 50 mg or 100 mg were successfully able to get and keep erections hard enough for sex. This compares to a rate of approximately 50 percent of patients given a placebo medication. Participants were given either 25 mg, 50 mg, or 100 mg doses of Viagra, and it was found that 72 percent, 80 percent, and 85 percent of participants, respectively, were successfully able to get and keep erections hard enough for sex. Since the release of Viagra in 1998, more than 25 million men have been prescribed Viagra. Regardless of how severe your erectile dysfunction is, Viagra is likely to help, as it has shown to be effective for all degrees of erectile dysfunction. 

What can I do to increase Viagra’s effectiveness?

While Viagra is considered very effective, there are also some extra things you can do to make sure you get the maximum benefit from your medication. 

  • Reduce your risk factors: Depression,  diabetes, heart disease, heart attack, heart problems, high blood pressure, high cholesterol, and obesity are all conditions that can cause or worsen erectile dysfunction. Reduce your erectile dysfunction risk factors by eating a healthy diet, managing your weight, working out regularly, quitting smoking, and reducing stress in your life where possible. Easy, right?
  • Avoid heavy meals:  High fat or heavy meals can make your Viagra last longer to work, so it’s best to avoid consuming them prior to taking your medication. Avoid fatty meals like a steak dinner, burger, or lasagna for at least two hours prior to taking your medication. When you eat a heavy meal, your body sends extra blood to the digestive system to help you digest, which can also make it take longer to get an erection. 
  • Choose the right medication: Every erectile dysfunction medication is formulated differently and includes different ingredients.  Make sure you tell your doctor about any health problems you currently have or have had in the past, as well as list all the medications you’re taking, including prescriptions, over-the-counter medication, vitamins, supplements, and herbs.
  • Mention your medicine: While some medications, like nitrates or nitroglycerin, which are often prescribed for chest pain, or guanylate cyclase stimulators such as Adempas (riociuguat), which are prescribed for pulmonary hypertension, can cause serious side effects when taken with Viagra, other medications might simply limit its effectiveness. Make sure you discuss the contents of your medicine cabinet with your doctor.
  • Give it time to work: Viagra might seem like a miracle drug, but it doesn’t work instantly. You’ll need about 30 minutes to let the medication take effect prior to sexual intercourse. 
  • Consider upping your dose: While 50 mg per day is the average starting dose for Viagra, some patients see better results taking 100 mg. Stay in communication with your doctor about how your dosage is working for you.
  • Be patient: Your body may take some time to adjust to the new medication, so it might not work right away. Give your new prescription a few chances to work. Your body can produce stronger responses over time as it becomes accustomed to the drug.
  • Don’t panic: Sexual performance can cause a lot of anxiety for those suffering from erectile dysfunction, which is completely understandable. Give yourself plenty of time to get in the mood, and take it slow if needed. 

Is it possible that Viagra won’t work for me?

The unfortunate reality is that no medication is 100 percent effective for every single patient. While Viagra does boast high effectiveness rates of up to 85 percent (for patients taking the 100 mg dose), up to 15 percent of patients may have drug-resistant erectile dysfunction. There are many factors that influence how medication works in your body, including other medications you might be taking. Your lifestyle and other needs will also play a role in determining the erectile dysfunction treatment that is right for you. If your body doesn’t respond to Viagra or doesn’t work as well as you had hoped, don’t give up -  there are several other prescription medications out there that you can try. 

If you have drug-resistant erectile dysfunction, there could be underlying medical issues that are causing the condition. Psychological issues, such as performance anxiety, sexual trauma, and mental illness, or hormonal imbalances, could also be to blame if other physical causes have been ruled out. Remember also that Viagra only works if you experience sexual desire, and without desire, there’s no erection. If you’re experiencing low sexual desire, you may want to see a therapist.  Prostate cancer treatment, especially removal of the prostate, can cause lasting erectile dysfunction that resists treatment, although many men taking Viagra do experience relief. Other options, including a vacuum device, penile suppositories and injections, can be tried if standard medications are ineffective, and surgery can be used as a last resort. There is hope out there even if Viagra isn’t right for you.
 

Published March 14th, 2020 by Chris Riley
Fact Checked by Chris Riley

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