Chapter 1
The Medical Miracle That Can Change Your Life
Finally, it's Friday, Dennis thought to himself as he made the turn off the freeway toward his house in Silicon Valley. Exhausted, with another sixty-hour workweek behind him, he looked forward to some well-deserved rest and relaxation at home. There, he knew Jennifer would be waiting for him with a bottle of chilled white wine, the stereo playing softly in the background, and the big leather sofa waiting to envelop them.
When he opened the front door he was already anticipating the evening ahead. It didn't matter that his body and mind were tired enough for ten hours of sleep; he'd be otherwise engaged, soon. Greeting Jennifer with a kiss, he settled himself down in the living room, and waited for her to join him.
Very soon she did, carrying a tray with a bottle of wine, two glasses, and a small china plate with a small blue pill for Dennis. Both he and Jennifer knew that it would ensure them a night of intense sexual pleasure, and the anticipation of those events brought a flush to both their faces. With that pill, their weekend, their sex lives, and most of all their ongoing relationship would be enhanced and enriched.
Jennifer poured the wine and passed Dennis a glass. He leaned over, picked up the pill, and, toasting his wife, swallowed it. Both Jennifer and Dennis were willing participants in the new world of sexual medicine, which gave them the security of knowing that they could have what they wanted, when they wanted it.
Everyone can.
All adults are entitled to a fulfilling sex life. An active component of complete health, the ability to have satisfying sex is a marker signifying that all the elements which define us are working together seamlessly. By this I mean not only the physical, but the very important psychological and emotional factors as well. What it comes down to is this: sex is good for you.
As an internist in New York City, I see patients who represent a cross section of the population, from every background and of every age. They come to me for a range of reasons, from yearly checkups to follow-ups to surgery, and everything in between. Increasingly, however, my male patients are coming in to discuss their sex lives and, more specifically, their inability to consistently have erections. Whether they are in their thirties, forties, fifties, sixties, or older, this vital part of their being can sometimes falter, for any number of reasons. Wanting to be the best they can be, at every stage of their lives, they ask about the options available to them.
My goal is to give them the best that medical science has to offer to help restore erections. Today, there are extraordinary new additions to the world of prescription medicine which, without a doubt, rank among the most exciting discoveries in recent medical research. Drugs which accomplish what millions of men, and their partners, have been waiting for are finally available.
For every man who is worried about the possible loss of potency -- the ability to have a firm erection each and every time he wants to have sex -- for every male who has already experienced it, and for every partner who ever wondered what to do, there is not only hope, there is this new medical miracle.
Simply stated, a revolution has begun. Most men who suffer from erectile dysfunction, or ED, may now restore their virility by taking a prescription pill. The impact on the estimated thirty million men who experience ED cannot be underestimated. Today, ED can be treated successfully more than 95 percent of the time. Nevertheless, fewer than 5 percent of those affected have received treatment.
Effective, and well tolerated, these amazing pharmacological virility remedies are Viagra, the brand name for sildenafil, and Vasomax (phentolamine). For the first time, it is possible to restore optimal sexual function to nearly every man who desires it. And they will put to rest the myth that ED is an irreversible function of aging. In a matter of minutes, the new oral medications can:
* allow a man to have firmer erections to ensure fulfilling sexual intercourse
* renew and strengthen an existing -- or even dormant -- sex life
* bolster self-confidence
* lift depression associated with ED, thereby positively affecting all facets of a man's life, including his work
* help to create a relaxed, unhurried window of opportunity to proceed at a couple's individual pace
* mend relationships torn by frustration
* offer joy in the sexual arena, where little or none had been felt for years
* solidify sexual bonds with a partner
* restore intimacy and thereby deepen relationships
The Relationship Pills
My growing awareness of the great need for such a medical intervention was sparked by my patients, as is often the case. In their visits to me, most bring with them their hopes and fears as well as colds and worries about cholesterol counts. This was the case with Mark and his wife, Lucy.
Mark, a thirty-eight-year-old bond trader on Wall Street, was certainly healthy. A handsome man with movie-star good looks, he had been coming to see me for five years, but in this visit something in his demeanor seemed to have changed. I asked him point-blank if anything in particular was bothering him.
"There's a lot of stress in my life -- more than usual," he told me. "With the type of economy we've got going, I see no end to the stress. It's make-or-break time for me and my partners."
"How is that affecting your eating and sleeping patterns?" I asked. "And what about your quality of life in general?"
"I'm pretty good about what I eat," he said, avoiding the last question. "But I could be sleeping better. And, I have to confess, I'm drinking more wine with dinner. I really need it to decompress."
Since all of Mark's tests were in the normal range and I didn't suspect anything physically amiss, I suggested that he limit himself to one glass of wine a night and try to get an extra hour of sleep. As he was preparing to leave, I inquired after Lucy.
"She's great," he said brusquely and hurried out the door.
It so happened that Lucy's yearly appointment was the following week. She, too, checked out fine physically, but seemed subdued and anxious. I knew something had changed since I last saw her, and I wondered what it was. Obviously it was affecting both husband and wife.
"Did Mark speak to you?" she asked.
Not certain what she was referring to, I shook my head no.
"He promised he would," she said with a sigh.
Gently, I asked her what was bothering her.
"It's not just me -- it's both of us," she said. "But it's not right for me to speak to you alone. I'm going to talk to him tonight and try to convince him that we both should see you -- together."
Whatever Lucy said to Mark after leaving my office clearly had the desired effect. A couple of weeks later the two of them came to see me, looking rather tense and nervous.
"I know something is wrong and I want to help you both," I said. "But without knowing what the problem is, I'm stuck."
"Okay," Mark began. "Here it is. Our sex life has not been working right for the last ten months -- because I'm not working right. I can't get a hard-on. I thought it was the stress and the alcohol. I actually stopped drinking altogether after my checkup -- I read somewhere that alcohol can affect performance -- but it hasn't helped. Not only is my personal life suffering, so is my professional one. Frankly, it's a bummer. My confidence is shaken," he admitted.
"You're right about drinking," I agreed. "It can often inhibit penile function."
"But if that's not the cause, and there isn't something physically wrong with Mark, then maybe I'm doing something wrong," Lucy said. "We have a strong relationship in every way and we don't believe we need marriage counseling, but maybe we will if we can't get back on track sexually. What can we do?"
The solution, I told them, might just be ready and waiting for them. "Your experience is a very common one, more usual than most people think." I said. "Mark, given the results of your recent checkup, I have no reason to believe that your erection problems have a physical cause. They are probably due to your increased business pressure. I call it the 'phenomenon of busy people' and I'm seeing it in more and more of my patients.
"Hopefully, there will be a time when the pressure eases up and you can resume a more relaxed workweek. Maybe that will help your erections. In the meantime, however, there is an effective solution. There are two new safe medications in pill form that help restore erections, no matter what the primary cause of the problem is. One of the drugs, Vasomax, is what I have been using with men as part of an ongoing study for a pharmaceutical company. The other, Viagra, is also undergoing review, but in other centers around the United States. I'm still enrolling patients and their partners. And since you are both here, would you like to join the trial?"
I explained that the best aspect of these medications is the unique way in which they react biochemically as facilitators and amplifiers of erections. But there must be normal sexual stimulation in order for an erection to occur. In other words, emotion and caring play a big part in how they work successfully. But one thing is certain: they will help a man achieve the best possible combination of desire and physical functioning.
Their expressions mirrored their skepticism, but Mark and Lucy were ready to try anything. After Mark and Lucy signed the necessary papers required for the study and I took a blood sample, I gave him a Vasomax pill to swallow. I noted his blood pressure and heart rate over the course of the next hour. A possible side effect of Vasomax is a sharp decrease in blood pressure and an associated rise in pulse. If his blood pressure dropped by more than 30 points over his predose reading, Mark would be ineligible to use the drug. His blood pressure dropped only 10 points, with no other noticeable change to him. His pulse went up 10 beats per minute, which was to be expected. Mark was eligible for the trial and I supplied him with a month's worth of the drug.
Several days later, I received a fax from Mark with just two words: "It worked!"
And a few months later, Mark was not only his old self, he was even better. He was surprised to find that on some occasions he no longer required the medication to achieve an erection. His job performance was stronger than before and he was drinking moderately, if at all. Most importantly, he understood how his ED had developed and hoped that soon he would not need the medication at all, But should his ED recur -- for whatever reason -- he felt confident knowing that he could go back on the medication under my supervision.
The Intergenerational Drugs
Mark was so impressed with the results of taking Vasomax that he convinced his father to pay me a visit. A widower for four years, Jim, at sixty-five, had recently met a woman whom he felt at home with and who made him laugh. While he never thought he would be sexually attracted to another woman again, to his amazement he now was. Unfortunately, the new pair's budding sex life was at a standstill because Jim couldn't get an erection. He was worried that Emily, at fifty-four, would give up on him.
The first thing I did, as I always do with a new patient, was take a medical history. Then I had a lengthy conversation with Jim on his habits and any changes he noticed in himself.
"I'm not really comfortable carrying around the extra twenty-five pounds I've gained in the last couple of years," he admitted. "But what really troubles me is my inability to have sex. I can only get about as hard as a limp noodle and it makes me feel terrible. After my wife died, I was depressed for a long time. Then I met Emily and started to feel sexual desires and longing for a woman once again. And now this -- "
I explained to Jim that ED is sometimes a sign of illness and I wanted to give him a checkup to rule out that possibility. After a thorough examination, it turned out that, unlike his son, Jim's ED was not brought on by lifestyle factors. The true culprit was an undiagnosed case of diabetes.
"Type II diabetes, the kind you have, is very common," I explained. "It can start as early as age thirty, although it's much more usual in middle age, and the majority of those with the disease are often overweight."
"But I don't feel sick," Jim replied.
"The symptoms of type II diabetes are slow to appear," I told him. "ED is often the first real sign that something is wrong. In fact, about half of all the men in whom diabetes has been detected will develop some form of ED within ten years of the onset of the disease."
"So how does diabetes put the brakes on my sex life?"
"For the most part, the ED is induced by vascular disease caused by the diabetes, which results in blood vessel blockages, including the arteries of the penis. Nerves can also be damaged by the disease, which is another factor that hurts your erection capabilities."
"So, can you fix my problems?" he asked hopefully.
"First of all, control of your diabetes is your most critical health issue right now," I said. "That means you must make a serious effort to lose the extra weight you have put on over the last few years. And you can do that through regular exercise and adjustments in your diet. As for your erection problem, I can tell you this: while your specific type of ED is not curable, because it's caused by diabetes, which is a chronic disease, it may be able to be successfully treated with a new oral medication."
I explained to Jim that in the future Viagra would be one of the new medications available to him and that it had a great likelihood of being effective despite the strong biological impact of diabetes on his erectile performance. At the present time, I was using Vasomax in my study. Although it is less effective for men with moderate to severe dysfunction, it can work well for those with either mild to moderate dysfunction or ED caused by psychological reasons.
I told Jim it was certainly worth trying Vasomax because it was well tolerated, with an excellent safety profile. I explained how the Vasomax study worked and offered him the opportunity to enroll as long as he met all the criteria. He did and three weeks later he called me. "I'm a private kind of guy, but I just had to tell you what happened," he told me. "It's been great, being able to really feel again and give Emily pleasure. It just made us grow even closer. I'm a complete man again. I can't thank you enough. It's a miracle -- and I never thought I'd live to see it."
Jim's response gave me two reasons to be thrilled. One, I knew that the quality of Jim's life had improved. And, two, the fact that he had responded to Vasomax pointed out that his diabetes was not as advanced as I had feared. Jim has since shed the extra weight, his diabetes is under control with Glyburide, an oral diabetes treatment, and he still takes his ED medication. The beauty of both Viagra and Vasomax is that they are compatible with drugs most commonly prescribed by physicians.
The Psychological Link
Psychological causes of ED are not unusual. In fact, it's estimated that up to 50 percent of all cases fall into this category. Given the times we live in, and the way the roles of men and women have changed in the last twenty years, in addition to the expectations we hold ourselves to, 50 percent isn't surprising.
Take the case of Robert and Jane. Their six-year marriage had hit serious snags and they were working -- seemingly to no avail -- with a psychiatrist to iron things out. Robert had trouble getting an erection, and seven months of very expensive therapy was fueling his anger, making his ED a burden that grew heavier day after day.
The primary conflict in their marriage was Jane's career. While Robert was proud of her accomplishments -- she was a successful and highly visible banker -- he chafed at her absences from home. And although he certainly admired her financial acumen and respected her choice to keep her personal finances and investments separate from his, the fact that she was more savvy at it than he was bothering him.
Jane, on her part, craved intimacy with her husband. She knew that her extended absences were a strain on their marriage and she felt that closeness was even more important those times when she was home. But when she was there, she was tired and sex wasn't necessarily what she needed or wanted.
Robert, on the other hand, began to feel that Jane's frequent absences were growing proof that she didn't really love him. And when they did have time for sex, he found, to his growing dismay, that he was often unable to achieve an erection. His anxiety increased, leading to more erectile failure, which, in turn, led to even more worry about his performance in bed. Eventually, he avoided any kind of physical closeness altogether.
Jane took his behavior as a clear sign that he was no longer interested in her. One night, they finally had the confrontation that had been building for months. When Robert, after two glasses of Scotch, told Jane that her career left no room for him and made him feel worthless, she was stunned. The ultimate accusation was even worse: his ED, he said, was her fault.
Stung by his words, Jane knew they were at a turning point in their marriage. Fortunately, she had heard about the clinical trials of the new oral ED medications from a colleague. Feeling there was nothing to lose, she mentioned them and offered to accompany Robert to my office.
Because he initially felt that his wife was taking charge of yet another facet of their lives, Robert took a couple of days to think it over. Then he made the decision to see me. And for both of them, their marriage did turn -- but this time, they found the footing they needed to head in the right direction. Acknowledging that she had to make changes, too, Jane cut back on her travel and began to spend more time with her husband. Robert responded to the erection pills; his anger and anxiety diminished and his self-confidence returned.
Now they began to make headway in their work with the psychiatrist, and they were willing and able to address the issues that concerned them. Defining what intimacy and sex meant to each of them, as well as dealing with the problems brought about by careers and finances, brought them closer. And as their communication skills improved, their relationship flourished. Over time, Robert's erectile difficulties began to vanish. Soon, he found that he didn't always need a pill to achieve an erection.
But the best part of this story is this: the effect of psychotherapy is jump-started by the medication, and the time an ED patient will spend in a therapist's office is, therefore, vastly reduced. Had Robert come to me for the medication as soon as his problem began, I might have been able to shorten his time on the psychiatrist's couch by half.
Mark, Jim, and Robert are just three of my many patients who have had their sex lives fully restored using the new medications. Whether the syndrome is provoked by changes in circumstances, which cause a temporary and easily rectified problem, or by ongoing worries about endurance, past performance, or other conditions, this medication regimen can help. Its effect is so profound that it is capable of aiding those men who suffer from ED as the result of certain diseases. It can even produce startling results for men who have suffered with ED for a decade or more.
The Rational Treatment
The search for a safe, painless, and efficient solution to ED has been a long and arduous one. Many physicians, myself included, as well as the patients we've treated, have been dissatisfied with the old medical options -- none of which included a pill. Previously, the only choices for men were injections into the shaft of the penis, a vacuum device to increase rigidity, or the insertion of bendable rods into the penis. None of these past interventions, two of which were physically invasive, was totally satisfactory.
Today, sexual medicine is in its infancy and virility programs are just beginning to come into use. Viagra has only recently been approved for general use by the Food and Drug Administration (FDA), with FDA approval of Vasomax expected shortly. So it's understandable that many millions of men are unaware of the new oral medications that are at their physician's disposal. With such medications, their erectile problems can be treated immediately, successfully, and unobtrusively.
Beginning in 1997, I had the opportunity to work, with my medical colleagues, in the testing of Vasomax for the treatment of ED. Both Vasomax and Viagra had been in use for several years in worldwide medically supervised programs and the results had been nothing less than astounding. These two miraculous pharmaceuticals temporarily correct ED in a natural manner. This is because they require an appropriate sexually stimulating environment in order for an erection to occur. These drugs do not increase sexual desire. What they do so well is enhance performance that grows out of sexual desire. If a man takes either pill and is not physically attracted to his partner, he is not going to get results. That's what makes these drugs so revolutionary: for the first time since birth control pills were prescribed, the effects of a drug touch the sex lives of two people: the one who takes it and his partner.
While the previous methods of enhancing an erection were effective, they worked in a very rudimentary fashion. None of them required a partner. Neither stimulation nor the desire of a partner was needed in order for these sex aids to bring on an erection. For this major reason, many women found themselves excluded from the process. This has all changed with the erection pill. All it takes is a prescription from your doctor.
You Can Take Control
ED is an unbiased condition. It affects men of all ages and circumstances, whatever their sexual habits or preferences. At least one out of every three men over the age of fifty will experience it. Men whose sex lives are irregular, due to any number of causes, can suffer from ED to the same extent as men with more frequent sexual encounters. But ED is not about standards of performance or an arbitrary scale of how frequently you should or need to have sex. After all, our sex lives are private and dependent on the two people involved. But whatever causes the problem, it can now be treated quickly and painlessly.
For decades, ED was believed to be a psychological rather than a physiological problem. However, in many cases, the problem is physical or oftentimes a combination of both. And, like other medical conditions, it may require medication. Do you believe that high blood pressure is a "mental" problem? Or that your cholesterol level is based on what's "in your head"? Or, even worse, that if a medical problem is left untreated, it will just go away? I sincerely hope not.
Modern medicine has treatments for many of today's ailments, and now an incredibly effective medication has been added to its arsenal. However, as with any complaint, your doctor can't treat you unless you tell him, or her, what is wrong. As both a man and a physician, I understand that there is probably no other medical condition which has so great a potential to frustrate, humiliate, and devastate as ED. You may have been too embarrassed to mention the problem or you may have gone to your doctor in the past and been given choices that were so off-putting and emotionally punishing that you chose to forgo help. I myself was always displeased with the limited and unpleasant options available to my patients in the past, and I fervently hoped that better, far-reaching alternatives would someday be attainable. Now, thankfully, they are. But you have to take control of the situation by admitting to the problem, examining its probable causes, and seeking treatment.
The earlier the intervention, the better the result will be. If ED is something you worry about or have already experienced, whether it is occasional or more frequent, help is now available. Remember: ED has a profound effect on the lives of the people it touches. Countless marriages and long-term relationships have been broken by it; people who otherwise deeply cared for each other felt separation was a better solution; and innumerable others continued to live together sexually unfulfilled. Sex is, of course, not the only component of a strong and lasting relationship, but I believe it is an important one. And if ED is a problem, the new drugs will not only treat it, they will help you renew your bond to the person you care about.
Copyright © 1998 by Steven Lamm, M.D., and Gerald S. Couzens