Is Viagra always a success?

Spinal Cord Injury  |  Diabetes Mellitus  |  Penile Prosthesis  |  Dialysis  |  External-Beam Radiation Therapy  |  After Radical Prostatectomy 

Erectile dysfunction (ED) can be caused by a number of different conditions. Some will not respond to any medication. This means either that there will be no effective treatment at all or that additional therapy is required for the underlying cause of the ED (which may extend to surgery, chemo- and radiotherapy, etc.). Thus, when you evaluate Viagra across all possible causes, the success rate varies between 48% and 81% which, under the circumstances, is impressive.

Spinal Injuries

If there is little or no damage to the spinal cord — the part of the central nervous system that carries messages from the brain to the important parts of the body — Viagra is likely to be effective at dosages between 25mg and 50mg. This will include situations in which congenital conditions such as spina bifida are the underlying cause of the nervous system inadequacy. If the scale of the damage is greater and there are lesions in the spinal cord which significantly disrupt message traffic up and down the cord, higher dosages may be tried, but there is no guarantee of success.

Diabetes Mellitus

Whether Viagra will be successful will depend on how advanced the diabetes is. In general terms, the sole factor determining outcome is whether the central nervous system has been damaged. This can occurs in the later stages of diabetes when treatment has been delayed or proves inadequate. None of the following factors is relevant:

• the age of the patient;
• the length of time the patient has been affected by ED;
• the length of time the patient has had diabetes;
• the patient’s levels of glycosylated haemoglobin (haemoglobin A1C, the trace chemical used to monitor the blood sugar level); and
• whether there is damage to the peripheral nervous system.

Kidney dialysis

Clinical testing in patients who have experienced some degree of renal failure show that Viagra is successful without significant side-effects to relieve ED in 60% of cases even though the men who are on haemodialysis and continuous ambulatory peritoneal dialysis.

Penile prosthetic implants

The surgery to make the implants does not remove all the erectile tissue in the corpus cavernosum. It simply inserts the inflatable device alongside that tissue. Thus, when Viagra assists the arteries to dilate and admits blood into the corpus cavernosum, this complements the action of the implant and increase the natural sensation of the resulting erection and intercourse.

External-Beam Radiation Therapy

In cases of prostate cancer, it is likely that radiation therapy will be a first-line therapy choice. Inevitably, this has an effect on sexual ability. Research shows, however, that Viagra improves the quality of erection in an average of 70% of patients. Those who have some residual erectile response following radiotherapy experienced a significant improvement in 90% of cases. Those with no sexual response reported some improvement in 52% of cases. All men in this situation require the larger 100mg dose.

After radical prostate surgery

The success rates vary significantly between 15% and 80%. Whether there will be a significant improvement in the quality of the erection will depend on:

• the degree of ED before surgery;
• the extent of the nerve-sparing during surgery; and
• when the Viagra is taken.

The best success rates are achieved in those men who had little or no ED before surgery. But if the men had almost complete loss of function before surgery, there will be little chance of improvement. A further consideration is the nature of the surgery:

• for men undergoing bilateral nerve-sparing, there is an improvement in 70% of cases;
• for those undergoing unilateral nerve-sparing, there is improvement is 50% of cases; and
• men who do not have nerve-sparing only improve in 15% of cases.

The success rates of Viagra for men who have had a bilateral nerve-sparing radical prostatectomy are around 70%; for those who have had a unilateral nerve-sparing radical prostatectomy, they are about 50%; and for those who have had a non-nerve-sparing radical prostatectomy, the success rates are about 15%.

Drug interactions

In other studies, Viagra has proved to be moderately effective in reversing ED as an adverse side-effect of some antidepressants and antipsychotic medications.

Conclusions

Viagra has a significant track record over the years and it works in the majority of all cases. Nevertheless, it is important to recognise that you may be one of the small number of men for whom it did not work well or at all. If you are unlucky, it is very important that you write down the detail of your experiences. For example:

• how and when did you take the medication in relation to the attempted sexual activity?
• what, if anything, had you eaten just before you took the medication?
• did you eat anything after you took the medication? We should remember that the rate at which we absorb drugs into the blood stream is affected by the quantity and type of food in the stomach;
• how many times did you try taking the medication — research shows that it takes some men up to eight doses before they respond, or that higher dosages are indicated;
• when you took the medication, were you feeling anxious or worried — no ED mediation can overcome the raw fear of failure — you have to have some trust in the power of the medication to help you. This is something you should discuss with your partner.

Many couples in the same situation find that gentle foreplay without any pressure to move straight into full penetration allow both of them to relax, begin to enjoy the experience, and allow the natural bodily functions to begin working.