Posts Tagged ‘Male Sexual Function’

How Often Do Impotent Men Recover Erectile Function After Viagra?

// October 27th, 2010 // 1 Comment » // Impotence

Several investigators have asked this question and have had slightly different responses. In another large study, 351 generally healthy men with psychogenic impotence were questioned before and after treatment with placebo or Viagra about whether treatment improved erections. A surprisingly large number, 38 percent, of placebo-treated men were convinced that the pills they were taking improved their erectile function. In contrast, 65 percent of men on the lowest and 89 percent of men on the highest Viagra doses reported better and stronger erections.

Reports of Erections Satisfactory for Sexual Intercourse After Treatment with Different Doses of Viagra

The results of an American study of 416 men treated with placebo or 5, 25, 50, or 100 mg of sildenafil (Viagra) are shown in the table below. Participating men were asked two types of questions:

1. Was overall sexual function improved with treatment?
2. On a scale of 1 to 4 (with 1 indicating “inadequate” and 4 indicating “maximal” erection), how would you rate your ability to acquire and maintain an erection with treatment?

As is evident from the table, the numbers of men who said their sexual function was “better” with treatment ranged from 28 percent with placebo to 78 percent with the highest 100-mg dose of sildenafil.To assess the effectiveness of treatment, impotent men in this study were asked:

1. During sex are you able to achieve an erection that is firm enough to penetrate your partner? (Penetration requires that the tip and base of the penis remain rigid for several minutes )
2. Once you have penetrated, are you able to maintain your erection until you reach orgasm?

Fundamentally, the investigators wanted to know how often men could enjoy sex before and after treatment with Viagra or placebo.

More than one-fourth (28 percent), of placebo-treated impotent men reported that they had improved sexual function. However, the number of men who recaptured the ability to have and enjoy sex with Viagra dwarfed the numbers of men who responded to placebo. The majority of men experienced stronger, more lasting, and more useful erections following Viagra. Doses as low as 25 mg produced a significant improvement over the placebo responses Eventually Viagra was used to treat not just men with psychogenic impotence but others whose sexual problems were caused by both psychologic and physical (organic) problems, including those with high blood pressure, diabetes mellitus, heart disease, high cholesterol levels, or prostate cancer.

Responses of 416 Men Reporting Improvement from Treatment with Placebo or Escalating Doses of Viagra
Responses of
416 men
Placebo 5 mg
Viagra
25 mg
Viagra
50 mg
Viagra
100 mg
Viagra
% Better 28% 48% 61% 72% 78%
Acquire (scored 1-4) 2.0 2.7 2.9 3.2 3.3
Maintain (scored 1-4) 2.0 2.4 2.9 3.3 3.6
Characteristics of impotent men treated with Viagra and placebo
Characteristic Dose Response Study Dose Escalation Study
Placebo Viagra Placebo Viagra
Average Age 57 years 58 years 59 years 60 years
Range of Ages 20-79 years 24-87 years 31-81 years 26-79 years
Average duration of
erectile dysfunction
3.2 years 3.2 years 4.7 years 5.0 years
Cause of erectile dysfunction (% men)
Organic 77% 78% 63% 55%
Psychogenic 10% 9% 16% 14%
Mixed 13% 13% 22% 31 %
Concomitant conditions (% of men)
Hypertension 26% 30% 28% 24%
Ischemic heart disease
(past or present)
8% 8% 8% 15%
Hyperlipidemia 16% 19% 14% 15%
After prostatectomy 10% 12% 11% 9%
Diabetes mellitus 15% 13% 11% 8%

Once again, some of the impotent men (in this study about 24 percent) did say that they had improved sexual function when they were taking placebo pills. However, more improved with Viagra and the degree of improvement seemed to be related to the dose of Viagra. With the 25-mg Viagra dose, 67 percent improve compared to 78 percent with 50 mg, and 82 percent achieve increased erectile vigor and sexual success with the 100-mg Viagra dose. Men participating in this study were asked rather pointed questions to determine whether with Viagra treatment there was:

1. An improvement in erections.
2. Change in orgasms.
3. Overall sexual satisfaction.
4. Any change in sexual desire.

These issues — erections, orgasms, sexual satisfaction, and sexual desire -are referred to as domains of normal male sexual function.

Several currently available questionnaires allow doctors to gauge the level of men’s sexual desire. Viagra-treated men notice an improvement in their ability to acquire and maintain their erections, indicating that with Viagra, erectile function was significantly improved. As a result, men’s contentment with their ability to have sexual intercourse was also enhanced  and pleasure with orgasms intensified, but surprisingly, even with this remarkable improvement in sexual functioning, their level of sexual desire did not increase.

Thus, one domain of normal male sexual function, sexual desire, or libido, does not improve with Viagra. This indicates that Viagra alone may not be effective when decreased sexual interest or diminished libido is the primary sexual problem.

The Six Phases of Normal Male Sexual Function

// October 25th, 2010 // No Comments » // Impotence

It is tempting to think of sexual intercourse as a seamless process flowing effortlessly from arousal to erection to ejaculation. This level of understanding suffices only for those men fortunate enough never to have experienced sexual problems. In this chapter, you will find a discussion of the individual components that make it possible for a man to want to have sex and then see how he can render that desire into a complete and pleasurable experience for him and his partner.

One way of understanding the cycle of a man’s sexual responsivity is to look at the individual steps that make it possible for him to have sex. The six critical stages are: libido,erection,plateau,ejaculation and orgasm,detumescence, and refractory period. Proper sequencing and integration of these phases is critical.

Libido describes the intensity of sexual desire or drive.
Erection refers to the transition of the penis from a limp to an erect state. Increased blood flow into specialized chambers in the penis is necessary for this transition to occur. Nerve signals that originate in the spinal cord are responsible for activating increased blood flow.
The plateau phase occurs at the peak of sexual excitement and is associated with increases in pulse, blood pressure, and respiration rate.
Ejaculation, the pulsatile release of semen, is entirely under neurologic control. Orgasm is the pleasurable feeling and sense of relaxation following ejaculation.
Detumescence is the loss of erection after ejaculation.
During the refractory period, men are unable to acquire another erection.