Bad News About Viagra

In clinical trials of Viagra some alarming results were discovered

This recent trial based in a NHS hospital in Southampton shows that all is not well with Viagra

Objectives- To determine the effects of erectile dysfunction and to explore the impact of treatment with Viagra.

Design - An exploratory qualitative study with semi structured interviews.

Setting - Men's health clinic in NHS hospital.

Participants - 40 men who had had erectile dysfunction and had attended the clinic during the year before interview.
Main outcome measures Impact of erectile dysfunction on men, their expectations of Viagra, and impact of treatment on men and their relationships. Issues explored with exploratory qualitative approach.

Results - Erectile dysfunction caused serious distress to all those men who experienced it, with marked effects on their self esteem and their relationships. The expectations raised by media hyperbole with the launch of Viagra had an adverse effect on the morale of those who found it did not work. When, according to the patient, treatment did not work, the distress was severe and for many confirmed their lack of self worth.

Conclusions - Further study is needed to explore the feelings of men affected by impotence and their perception of treatment. Health professionals should be aware of the extreme distress erectile dysfunction can cause.

HealthyED is a non chemical totally natural solution that has been clinically proven to aid the sexual performance of men suffering from erectile dysfunction.

Some studies do suggest that the condition has a considerable psychological and social effect.9 10 For example, the Impotence Association (now the Sexual Dysfunction Association) found that 62% of participants in their online survey felt that impotence reduced their self esteem; 29% said their relationships had been affected; and 21% reported that their relationship had ended as a direct consequence. The impact is compounded by considerable social stigma, with impotence as a source of jokes, limiting the extent to which men with erectile dysfunction can confide in others or approach health professionals for treatment.

The assumption that Viagra was a "cure" for impotence raised high expectations for the treatment, sustained by high levels of media interest through television, mainstream press, and the internet.11-14 However, not all men find that the tablets work successfully,15 potentially generating further psychosocial concerns.

Reactions to unsuccessful treatment

Patients' perception of failure was related to their high expectations. There was an assumption they had to take only one pill for all to be well. When this did not happen, hopes fell. Most tried again, but a second failure confirmed their negative feelings.

"If I could tell you how empty I feel... it's almost like a bereavement when you've lost something."

Many believed they would never have sex again:

I thought, 'Well this is my last chance, and [then] they don't work... they are supposed to work on 80 year olds and they're not even working on me'—and I felt my last chance had gone.

All respondents who thought that the treatment had been unsuccessful expressed a considerable degree of disappointment. Often respondents attributed this to media hyperbole:

There was a big hype in the press—"This is the be-all and end-all, the wonder drug." And I thought "Great, this is the way to go." And then when you try it and nothing happened—massive disappointment.

It was evident that respondents who felt devastated or who believed that there were no other possible treatments had usually had very high initial expectations of the drug and gave numerous reasons why they thought that Viagra had been unsuccessful. Many thought the treatment was a failure because of a lack of spontaneity in having sex or because their sex life depended on therapeutic treatment:

It's not spontaneous, it's planned. I wish I didn't have to take it, obviously.

It's clinical now... sex has become medical as opposed to spontaneous.

Erectile dysfunction also affected the ability of participants to forge new relationships:

I've got to the point now where... if I was to walk out of here and meet a drop dead gorgeous woman... [I'd] think "Well, it's pointless chatting her up, because I can't do anything"... You are not a man if you can't get an erection... nobody's going to have any respect for you if you can't get a hard-on.

A decline in confidence did not just affect sexual relationships but also had an impact on day-to-day relationships with friends and work colleagues.

Oh it was knocking [my morale] terrible... I work with other men and I think it [my impotence] knocked my confidence in certain ways. Not outwardly. Outwardly, it always seemed that I was one of the lads and that I was okay... but inside... I didn't feel that I was matching up to them... I just felt that I wasn't as good as them basically.

Participants often felt isolated and were despondent because of their belief that erectile dysfunction affects only older men, so that they were "old before their time." This despondency was exacerbated by the feeling that the condition was irreversible and meant giving up sex for the rest of their lives.

I'd got to a point where I thought it's no good, I can't live like this. I was only 46...I could see myself going for however much longer I've got, without ever making love again... You feel as though you're the only one... You're the only one in the world.

Erectile dysfunction raised further concerns about the impact on the participants' relationships with their partners. Almost a quarter of them thought that they were "letting down their partners" by not being able to satisfy them sexually. Six were so concerned about the consequences of impotence on their relationship that they were worried their partners would go elsewhere or, as one put it, "if I can't keep an erection, I'm not going to keep a woman." Fifteen were unable to discuss erectile dysfunction with their partners, principally because of a sense of avoidance or because they felt "belittled" by the condition.

I was expecting Viagra to cure my problem instantly, to take this pill, to have an erection almost within five minutes of taking it, then perform wonderfully.

Respondents described the media coverage as giving the impression of creating an abnormally large erection or a very long lasting one:

All the media that surrounds it Viagra gives you the impression that men are walking around with massive erections all the time.

I had very high expectations but then that, I suppose, is down to the media and the old stories about people taking one Viagra and can't get rid of a hard-on for God knows how many hours.

Reactions to successful treatment

Erectile dysfunction does get you down. It stunts your confidence because you just feel inadequate, and now I just feel more confident... it just generally makes you feel more confident and believe more in yourself.

This confidence did not just centre on being able to perform but was also important in being able to satisfy the sexual needs of his partner.

Discussion

Impotence has a considerable impact on men, with most more deeply shocked than generally realised, their masculinity and self esteem being particularly affected. Whether the cause is psychogenic, physical, or mixed, the effect is the same. Their sense of masculinity is battered, with profound effects on their feeling of worth to their partner and in the workplace. It is therefore important that, to make sure that treatment is effective in a man with impotence, details of his sexual relationship with his partner should also be obtained.

The launch of Viagra generated high, sometimes unrealistic, expectations. Where it was successful, a renewed self confidence occurred, particularly in existing relationships or in forging new ones. For some, Viagra did not work the first time and the blow was severe. Although it is now known that with help and advice, the patient can often succeed eventually, a proportion were so disappointed that they did not try again. Many thought they had failed yet again in their life, adding to their already existing feeling of worthlessness.

Erectile dysfunction has a major psychosocial impact on men, and health professionals might well also anticipate an impact on personal relationships. The media have had a major effect on expectations of the effects of Viagra and in retrospect, less sensational reporting would have lowered those expectations to the patients' benefit.

We have shown that more sensitive and reliable measures need to be developed to detect the results of treatment, and especially the effects of failure, on the men with erectile dysfunction.

HealthyED is a non chemical totally natural solution that has been clinically proven to aid the sexual performance of men suffering from impotence.

Expectations of Viagra are high, led by the media, and the higher the initial expectations of Viagra the more extreme the disappointment with failure

Patients define success or failure of treatment in their own way and if they feel Viagra failed, they are even more devastated

Contributors: JT and DW wrote this paper jointly. JT is guarantor.

Funding: Pfizer.

Competing interests: JT has received an unrestricted grant from Pfizer, manufacturer of Viagra, to pay a part of the costs of this study and has also been paid by Bayer/GSK, Lilly Icos, and Pfizer to lecture about impotence.
Ethical approval: North and Mid Hampshire Local Research Ethics Committee (LREC) 257/B.

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