Viagra Turns 5

By Christine Gorman

If this story were an E-mail message, chances are you would have trashed it by now. That's because the subject is Viagra, the little blue pill that allows many otherwise impotent men to achieve erection and, not coincidentally, continues to generate a torrent of Internet spam. Hard to believe it has been almost five years since Viagra was approved by the Food and Drug Administration. In that time early fears that the drug might cause nerve damage to the eye or directly trigger cardiac deaths have been laid to rest, while its status as a cultural phenomenon has grown. (The pill has an entry in the Shorter Oxford English Dictionary.)

Viagra may soon get some tough competition. GlaxoSmithKline and Bayer are on schedule to bring a drug called vardenafil (trade name: Levitra) to market in Europe later this year. Another drug, called tadalafil (Cialis), is also being launched there. Like Viagra, these new pills facilitate an erection by trapping more blood in the penis. Pfizer, the maker of Viagra, believes both new drugs infringe on its patent. The company lost its case in Europe; another lawsuit in the U.S. is pending.

Meanwhile, the uses for Viagra seem to be growing. A study in the Journal of the American Medical Association two weeks ago showed that Viagra successfully counteracts some of the sexual side effects experienced by men who take Prozac or similar antidepressants. Researchers at Pfizer are also intrigued by reports that because it dilates blood vessels, Viagra may help reduce pulmonary hypertension, an often deadly and difficult-to-treat form of high blood pressure that affects the lungs.

Viagra users are only getting younger. Five years ago, the typical patient was a married man in his 60s. Nowadays, he's still married but more likely to be in his 50s. One trend that has started to worry public-health officials, however, is the growing recreational use of Viagra in some settings. Gay men seem to be at the vanguard of this trend. Viagra, often in combination with illegal drugs like ecstasy, enables patrons of sex clubs to have sex with more partners, which increases their risk of contracting sexually transmitted diseases (STDs) like syphilis and aids. "One out of three sexually active gay men at our STD clinics has used Viagra in the past year," says Dr. Jeffrey Klausner, director of STD Prevention and Control Services in San Francisco. The same was true for 1 of 14 heterosexual men at the clinics.

Despite the potential for abuse and the usual risks associated with any physical activity like sex, Viagra has been a boon to many men. "It is still the most patient-friendly method of treating erectile dysfunction," says Dr. Ira Sharlip, assistant clinical professor of urology at the University of California at San Francisco. Although Viagra doesn't work for everyone, it's what most patients want to try first, before turning to such alternatives as injections, vacuum pumps and surgical implants. Perhaps all those unsolicited e-mail come-ons are a small price to pay after all.

For more on sexual dysfunction, visit www.smsna.org