Brothers and the new sex pill

Ebony, July, 1998 by Walter Leavy

When David M. Johnson experienced his first bouts with impotence, he was devastated, overwhelmed by the nagging thought that he and his wife would no longer be able to enjoy the kind of intimacy they had shared for more than 40 years.

Like many men, Johnson hesitated to seek treatment, waiting a year before using a penile pump that gave him limited success and didn't come close to making him the man he was. But a little blue pill called Viagra has turned his life around, giving back, he says, everything that nature and prostate surgery took away. "I used that pump for about a year, and it wasn't working to my satisfaction. But with this pill, it's just like old times again," says Johnson, a high school math teacher and supervisor at the U.S. Postal Service in Washington, D.C. "Viagra certainly gave me a part of my life back. It works!"

The ringing endorsement from the 70-year-old Johnson is being repeated by thousands of reinvigorated men -- some older than Johnson, some much younger. And that kind of unbridled enthusiasm is the reason many doctors are saying that not since the approval of the birth-control pill has a medical breakthrough generated so much, excitement. Public response great that Viagra quickly took control of more than 94 percent of the impotence drug market, resulting in 120,000 prescriptions in its second week alone. And medical officials are predicting that what some call "the most promising impotence treatment ever" will even outpace the antidepressant drug Prozac to become the top-selling prescription drug of all time.

It's just unbelievable. If I see 25 men a day, then I write 23 prescriptions for Viagra," says Dr. Terry Mason, a Chicago urologist who is one of the most respected doctors in the country. "Before Viagra men knew about available alternatives, but many weren't really interested in trying them. So the reason there's so much excitement surrounding this pill is that for the first time in history, there is an FDA-approved oral drug with few side effects that treats a very important problem in a man's life."

Since Viagra was approved on March 27, doctors across the country have been dispensing the pill in rapid-fire fashion, making it the centerpiece in the fight against a problem that many men have been embarrassed to talk about. Those in the medical community -- like Washington, D.C., urologist Dr. Edward Saunders -- say this is how Viagra works: The pill, which is to be taken an hour before sex and taken only once during a 24-hour period, creates the release of certain chemicals in the penis that cause muscle tissue in the organ to relax, thereby increasing blood flow in the area and allowing an erection to occur when the man is stimulated. (A faster-acting version of the drug already is in development.) In clinical studies, 70 percent to 80 percent of impotent men have gotten favorable results, and so far, side effects are minimal -- including headache, upset stomach, flushed skin, diarrhea and, in some cases, changes in perception of the colors blue and green.

These are small prices to pay, men say, if their sexual function is restored, oftentimes after prolonged experiences with impotence, described as the inability to get and maintain an erection satisfactory for intercourse. For the typical middle-aged male, physical causes of impotence include diabetes, medication for high blood pressure, hardening of the arteries leading to the penis and, for some, impotence follows prostate surgery. (There also are non-physical contributors, like depression, and a nationwide study is under way to determine whether Viagra can break the depression-impotence cycle.) The condition affects 30 million Americans and doctors say 50 percent of all men who are 40 to 70 years old experience some form of erectile dysfunction. The highest percentage of men (42 percent) seeking treatment for sexual dysfunction are between ages 40 and 59.

It's easy to understand Viagra's overwhelming appeal because, previously, patients could only choose from a variety of basically undesirable treatments -- including prosthetic devices, pumps, suppositories and injections. "If a man has a choice between a [penile] injection and taking Viagra, which do you think he will choose?" Dr. Mason asks, referring to Viagra's popularity. "It's so easy for anybody to take a pill." (Doctors say Viagra should not be taken by men who are taking medications that contain nitrates, such as nitroglycerin, because it could cause a drastic drop in blood pressure.)

Viagra has varying effects on men, doctors say, but research indicates that it's most effective within a four- to six-hour period after it has been taken, although -- for some men -- it can produce multiple erections during the entire 24-hour period it is present in the bloodstream. But, contrary to popular thought (or hope), researchers say the drug doesn't produce hours-long, sustained erections, and the pill doesn't work unless there is some kind of erotic stimulation. Apparently, though, there are exceptions to that rule. Although it didn't occur during the studies, doctors say there is a possible risk that men with sickle-cell anemia who take Viagra could experience a condition called priapism (an erection that lasts four hours or more) that if left untreated could cause tissue damage. Additionally, there are reports of a few cases where erections apparently occurred without erotic stimulation. "When I first took Viagra, I had sex with my wife, went to sleep and, two hours later, I was awakened by another erection," says Johnson, the father of six children.