Erectile Dysfunction Treatment Before Viagra 

Erectile dysfunction is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. The condition has been documented since the beginning of written history, with mentions in Egyptian tombs, Greek cup paintings, and the Old Testament. Erectile dysfunction affects men of all races and social classes. King Louis XVI of France, for example, was rumoured to have experienced erectile dysfunction as early as age 15. The historical prevalence of erectile dysfunction underscores its timeless and universal nature.

Treatments for erectile dysfunction date back to ancient times. In the eighth century, men in Rome and Greece wore talismans made from rooster and goat genitalia, believing they would enhance sexual function. Remedies like ingesting roasted wolf penis were suggested by the 13th-century friar Albertus Magnus. Romans also consumed the genitalia of animals with high libidos and drank hawk and eagle seen. By the 18th century, Dr Samuel Solomon’s “cordial balm of Gilead” aimed to prevent masturbation and conserve semen, which was thought to cause impotence. This balm, made of cardamom, brandy, and cantharides, was applied to the testicles in a cold-water bath. 

In the 19th century, understanding testosterone’s role led to Dr. Charles Edouard Brown-Séquard injecting himself with extracts from animal testicles and Dr. Serge Voronoff attempting testicular grafts from apes. Although these were ineffective, they paved the way for the synthetic testosterone creation by Adolf Butenandt, who won the Nobel Prize for his work. More invasive treatments have also been explored. In the 17th century, Dr. William Hammond recommended using electric currents applied to the spine, perineum, testicles, and penis. In modern times, low-intensity extracorporeal shock wave therapy and vacuum erection devices, first developed in the early 1800s, remain in use. Intracorporeal injections or intraurethral placements of prostaglandin E1 are also effective, relaxing vascular smooth muscle to increase penile blood flow.

The Accidental Discovery Of Viagra For Erectile Dysfunction

Viagra, or sildenafil citrate, emerged from Pfizer’s laboratories in Kent as an unintended breakthrough. Initially developed as a treatment for angina, a heart condition characterised by severe pain, sildenafil showed no promise for this purpose during clinical trials in the early 1990s. However, a curious side effect quickly became apparent: many male participants reported experiencing significant improvements in their erections. Recognising this unexpected benefit, Pfizer decided to pivot and repurpose the drug for the treatment of erectile dysfunction. In 1998, Viagra made its debut on the market, fundamentally transforming the landscape of sexual health treatment.

Interestingly, the unintended benefits of Viagra were not limited to humans. In 2007, three Argentinian scientists were awarded the Ig Nobel Prize for their research showing that Viagra helped hamsters recover faster from jet lag. Sildenafil’s journey from a heart medication to a global sensation underscores the unpredictable nature of scientific discovery, much like the story of Prozac (fluoxetine). This “wonder drug” quickly gained popularity, with word spreading rapidly about its potential to enhance sexual performance, leading to its illicit distribution in the UK’s club scene, where it was dubbed the “recreational drug of choice.”

How Viagra Works On Erectile Dysfunction

Viagra, or sildenafil, works by helping men achieve and maintain an erection. It does this by targeting a specific enzyme in the body called PDE type 5. Typically, this enzyme breaks down a substance called cGMP, which is crucial for the relaxation of muscles and the increase of blood flow in the penis. By inhibiting PDE type 5, Viagra allows cGMP to accumulate, enhancing the natural process triggered by nitric oxide (NO) that leads to an erection. When you take Viagra, it usually takes about an hour to reach its maximum effect in your bloodstream, and it remains effective for around 4-5 hours. It’s typically taken in doses of 25 mg, 50 mg, or 100 mg, with 50 mg being a common starting point. You should take Viagra about an hour before you plan to have sex, but it can start working in as little as 14 minutes for some men. Its effects can last up to 12 hours, giving a wide window of opportunity for sexual activity.

The First Billion Dollar Erectile Dysfunction Drug

On March 27, 1998, the Food and Drug Administration (FDA) approved Viagra, an oral medication designed to treat impotence. This marked a significant milestone, transforming the pharmaceutical landscape. Recognising a lucrative opportunity, Pfizer decided to pivot and market sildenafil for erectile dysfunction, the clinical term for impotence. Patented in 1996, Viagra received FDA approval in just two years—a remarkably swift timeline compared to other medications. Although it’s not definitively confirmed, Peter Dunn and Albert Wood are often credited with inventing the drug.

Viagra’s success was nothing short of spectacular. In its first year alone, the $8-$10 pills generated around a billion dollars in sales. This breakthrough not only revolutionised treatment options for erectile dysfunction but also had a profound impact on the pharmaceutical and medical industries and even on public consciousness. Despite being a prescription-only medication, Viagra was heavily marketed on television, famously endorsed by former presidential candidate Bob Dole, who was in his mid-70s at the time. This kind of direct-to-consumer advertising was almost unprecedented for prescription drugs, highlighting a shift in the industry. Today, sales and marketing expenses often exceed research and development costs, comprising about 30 per cent of pharmaceutical company budgets.

With an estimated 30 million men in the United States affected by erectile dysfunction, Viagra’s market impact was immense. It paved the way for competitors like Cialis (tadalafil) and Levitra (vardenafil), expanding the market beyond older men to include those in their 30s and 40s. While the long-term effects of Viagra on men’s health remain a topic of ongoing research, especially for those with heart conditions, its popularity continues to soar, showing no signs of slowing down.

The Downside Of Viagra For Erectile Dysfunction – Side Effects & Limitations

Headaches

Headaches are a common side effect of Viagra, affecting 16%-28% of users. They occur more frequently at higher doses due to changes in blood flow and brain chemistry. 

Flushing

Up to 20% of users experience skin flushing, which is redness and warmth caused by widened blood vessels. This usually resolves on its own, but lowering the dose can reduce this side effect.

Upset Stomach

Viagra can relax smooth muscles in the gastrointestinal tract, causing upset stomach in 3%-17% of users. Avoid alcohol to minimise this effect. If discomfort persists, consult your healthcare provider for over-the-counter remedies.

Stuffy Nose

Viagra can cause nasal congestion by widening blood vessels in the sinuses. This typically goes away on its own. Avoid decongestants as they may interfere with an erection. 

Nosebleeds

Some users experience nosebleeds due to increased blood flow to nasal tissues. Frequent or severe nosebleeds should be reported to your healthcare provider for potential dose adjustment.

Low Blood Pressure

Viagra can lower blood pressure, leading to lightheadedness and dizziness, especially if combined with other blood pressure medications or nitrates. Monitor your blood pressure and seek immediate medical help if you feel faint.

Prolonged Erection

An erection lasting longer than four hours (priapism) is rare but serious. Seek immediate medical attention to prevent permanent damage.

Vision Changes

Viagra can cause mild and temporary vision changes like blurred vision and altered colour perception. Rarely, it may lead to vision loss due to reduced blood flow to the optic nerve. Report any vision changes to your healthcare provider immediately.

While Viagra is effective for erectile dysfunction, it’s essential to be aware of these potential side effects and consult your healthcare provider to ensure safe use.

Modern Viagra Alternatives For Erectile Dysfunction

Penile Shockwave Therapy

Penile shockwave therapy, specifically low-intensity extracorporeal shockwave therapy (LI-ESWT), is emerging as a potential alternative treatment for erectile dysfunction, especially for those with vascular-related erectile dysfunction. Originally used to enhance blood vessel function in cardiovascular disease, LI-ESWT has been adapted to improve blood flow to the penis, which is crucial for achieving erections. In 2010, a protocol developed by researchers demonstrated that LI-ESWT was well tolerated and significantly improved penile blood flow, correlating with better erectile function six months post-treatment. Although still experimental, LI-ESWT has shown promise in enhancing the effectiveness of oral PDE5 inhibitors (like Viagra), potentially enabling men who previously did not respond to these medications to achieve sufficient erections.

Intracavernosal Injections

Intracavernosal injections (ICIs) offer an alternative to oral medications for treating erectile dysfunction. This method involves injecting medication directly into the penile corpora at the lateral base of the penis, carefully avoiding the neurovascular bundles and the urethra. The most common medication used is prostaglandin E1 (PGE1), also known as alprostadil, which helps induce erections by stimulating cyclic adenosine monophosphate (cAMP) to relax smooth muscle.

The main challenge with ICIs is patient anxiety about penile injections. However, those who use this therapy consistently report high satisfaction rates. According to the American Urological Association guidelines, men considering ICIs should undergo an in-office injection test dose to determine the optimal dosage and ensure they do not develop priapism or systemic side effects. ICIs are not suitable for patients with a history of recurrent priapism, Peyronie’s disease, or bleeding disorders. Despite these limitations, ICIs remain a valuable option for many men seeking effective treatment for erectile dysfunction.

Vacuum-Assisted Erection Devices

A vacuum-assisted erection device (VED) offers a non-pharmaceutical alternative for treating erectile dysfunction. This device is placed over the penis and creates a vacuum that pulls blood into the penis, causing an erection. A band is then positioned at the base of the penis to maintain the erection, which is removed afterwards to allow the penis to return to its flaccid state.

While VEDs can be effective in generating erections in about 90% of users, they may be challenging for patients with decreased dexterity or those with significantly lower abdominal fat. Long-term use often declines due to the perceived inconvenience, potential pain, and temporary changes in penile sensation caused by the constriction ring. Patients on blood thinners should use VEDs with caution due to the increased risk of penile bruising. Despite these challenges, VEDs can be prescribed as part of a rehabilitation program following radical prostatectomy for prostate cancer to minimise the risk of corporal fibrosis and support erectile function during recovery.