SEX ENHANCEMENT DRUGS CAN'T WORK WITHOUT DESIRE
Dr. Amadi
Dr Casmir Amadi, a consultant cardiologist at the Lagos University Teaching Hospital (LUTH), Lagos, talks about sex enhancing drugs and their effects on the heart.
What are sex enhancing drugs?
Sex enhancing drugs are medications that increase sexual drive so as to give a person a better sense of sexual satisfaction. In a man, it can increase the quality of penile erection.
Why would a person go for such drugs?
When people have sexual problems such as weak penile erection, quick ejaculation, low libido or low sexual drive, what they do is to seek remedies. Most times the problem is psychological; therefore, the remedy can come in the form of psychotherapy where the doctor talks to the patient in order to find the cause of the problem. The doctor might prescribe medication which is in about 10 percent of cases where the doctor thinks or feels that the cause of sexual dissatisfaction or abnormality is organic, that is there is an organ in the body that is having a disease process or not functioning very well and thus inhibiting sexual performance.
Why do people have sexual problems?
In about 95 per cent of cases in men, sexual problems are usually due to psychological factors such as stress, depression and anxiety which could be either economic or domestic. At times, a man has such a problem because probably he is not sexually attracted to the woman because sex typically is a mind thing. Sex is generated from the mind that is why Viagra or any other sex enhancement drug won't work if there is no desire for sex. If a man wants to have sex with a woman, his mind should be ready for it and he should be sexually attracted to her. Also in about 10 percent of cases where there have been an identifiable cause of weak penis, the problem could be due to hormonal dysfunction where the hormones necessary in a man to exhibit those manly characteristics is low or some other hormones are found in high level in the blood stream working against/suppressing the masculine hormones.
Can you give an example of such hormones?
Hormones like prolactin for instance.
I thought prolactin is a hormone associated with women, do men have prolactin?
Yes, men have prolactin but in very low level. So when a man has very high level of prolactin or a lot of female hormones, he could have sexual/erectile problem as well. Every man has some measure of female hormones and every woman also has some measure of male hormones (like testosterone) but it is just the level that is important. But when there are hormonal imbalances, it can affect sexual performance. And also when there is organic disease like diabetes that could destroy the nerves that supply blood to the penis so that even when sexual impulses is generated, there will be no nerves to make the person have an erection.
So how are the psychological causes of erectile dysfunction handled?
Fine! Through psychotherapy involving the physician and the patient chatting to find out maybe there is so much pressure at work/office or a nagging wife or a wife that feels the man can't perform in bed and how to manage these pressures. But there is no drug that will increase that drive but only by talking. You will be so amazed by the level of success a doctor achieves by listening to a patient. There are also some men who have problems with drugs. When they take a lot of alcohol this affects their erection and sexual drive.
How does alcohol affect sexual drive?
Alcoholism can weaken the penis. It is not only men alone that alcohol is not good for but everybody.
But I think the advice is mainly for the men?
That is because men generally take it more than women. How many bottles of beer can a woman take in a week? If you do a random sampling with 100 women; only 10 percent might actually take alcohol on a regular basis while 5 percent may take once in a while. But if you randomly sample 100 men, about 45 percent takes alcohol regularly while 15 percent takes alcohol intermittently. A total of 60 percent takes alcohol when you sum it up while another 10 percent may just be social drinking; and then only about 20 percent will be total abstinence. That is why it appears as if the pressure on adverts on alcohol is more on the male side than on the female side. Watch out for TV adverts on alcohol, you will find out that the ladies only carry the beer but they don't sip it but it is the men who even do the drinking. But traditionally speaking, it is believed that ladies do not take alcohol.
But you find women nowadays who take alcohol.
That is because of civilisation/liberalisation
How then does alcohol affect sexual performance/libido?
Taking of alcohol on a long-term basis would have suppressed some hormones that enhance male virility. I know that it reduces testerone level and so makes a man become more of a woman by increasing the feminine hormone relative to the masculine hormones. But I don't know what it does to the female.
Men are also told to avoid sugary substance. What can you say about that?
No, sugar does not have any bearing on sexual function, quote me.
Apart from Viagra which is very popular, are there other sex enhancing drugs?
Yes, Viagra is a common one but there are other drugs as well which are close to Viagra in terms of activity. Viagra is the trade name but the generic name is Sildenafil while other drugs like Levitra and Cialis are trade names with Vardenafil and Tadalafil as their generic names respectively.
How does Viagra work in rectifying the problem of low libido?
First, Viagra was designed for men who could not have strong erection and not for men who do not have desire for sex. These are two different things. I have a desire for sex but my penis is not strong enough to do the job while the other is that I don't even have any desire for sex at all and that means the issue of erection doesn't exist. If a man doesn't have the desire for sex and takes Viagra, he wouldn't have maximum satisfaction. So, for Viagra to work, the desire to have sex must be there because it is the desire that produces erection in normal circumstances. But in a case of low libido the desire doesn't translate into erection strong enough for penetration. So, Viagra only works when someone has innate ability to desire sex but has limitation with erection. In some cases the desire is there but the penile erection is weak. When you take Viagra in such a case, you boost penile erection.
What then is a good erection?
A good erection is when the penis is strong enough to allow a man have penetrating sex and for it to remain so until he has satisfactorily finished copulating. It means if a man starts off with a good erection, penetrates the woman and before he ejaculates the erection becomes weak, then that erection is not good enough because it was not long enough for the man to have maximum sexual satisfaction. I think to the woman as well, she would equally have appreciated it if the erection was long enough till she has her orgasm.
When you give Viagra to a person who has a desire but no erection, how does it work to correct that defect?
Viagra is a chemical that releases substances into the body; when taken, it makes the veins that supply blood to the penis to open up, allowing more blood to flow and when blood flows into the penis, it makes the penis stand and get heavy or fully erect thereby achieving erection; it is called vasodilatation.
What is the side effect of Viagra on the heart?
Now, Viagra has ability to lower blood pressure by causing the blood flow to the heart muscles to be reduced. Viagra reduces blood pressure such that if somebody who has a heart problem, especially that of a narrowed artery to the heart muscles (called ischaemic heart disease), takes Viagra and he equally takes a group of drugs called nitrates which also will do the same thing because they work in synergism, blood flows to the heart muscles and the person can suffer heart attack. That is why when people have heart problem they are asked to be careful in taking Viagra because first if the person per chance is taking nitrates as well as Viagra, the nitrates will work in synergism with Viagra causing a very sharp drop in blood pressure that will equally translate into a drop in the amount of blood flowing into the coronary arteries (which are arteries that supplies blood to the heart). This will cause that person to have a heart attack that can be very massive as to cause sudden death. That is why Viagra per say is not contraindicated in those who have heart problems but only contraindicated in those who have coronary artery disease and are taking nitrates.
In another way, if someone has hypertension and is not taking nitrates because there is no need for it, then he can go for Viagra. As a cardiologist, I have seen patients who are either diabetic or hypertensive taking Viagra because of problems of erection. They are alive, but if they were to be on nitrates, then I wouldn't give them nitrates together with Viagra. If they so need Viagra but they are on nitrates, I will stop nitrates for a few days before giving Viagra. And if they are on Viagra routinely for sexual benefit and suddenly I discover that they will need nitrates, I will stop Viagra and give them nitrates. In other words, Viagra and nitrates are never co-administered together in the same patient because they have the same mechanism of action with regards to the coronary artery. If the two of them go in together, they will drop the blood pressure so sharply that the amount of blood that goes through the coronary artery to supply the heart will be reduced and this could lead to a heart attack which could be very fatal.
How then will a person with heart disease or high blood pressure who wants to enjoy sex handle such a situation?
Somebody who has high blood pressure and does not have a need for nitrates but has weak erection (erectile dysfunction) can go on Viagra as long as his doctors are sure that there are no contraindications to the use of Viagra. Viagra as a drug was not designed for sex but for what is known as pulmonary hypertension-that is when the artery to the right part of the heart is narrow or blocked so that there is much pressure on the right part of the heart. But it was discovered that those who were taking Viagra for that particular heart condition started having strong erection even more than they desired; so scientists diverted the drug from its original purpose to satisfying men who had weak penile erection during sexual intercourse.
Can you clarify the difference between side effects and contraindication?
Side effect is that when a patient takes a particular drug it gives him an unpleasant experience apart from what it is supposed to do. For instance, some people take chloroquine for malaria but their bodies itch as well when they do; so itching is the side effect of taking chloroquine. While contraindication is that something bad/catastrophic will happen or there is going to be an organic event which could lead to death as a result of taking a particular drug.
What could cause those heart conditions that will lead to the use of Viagra?
Well, some of those heart conditions could be congenital; that means the individual was born with those heart conditions that primarily affect the blood vessels like the pulmonary artery that supplies blood to the right part of the heart. Or somebody could be born with the heart and blood vessels normal but acquired the disease conditions through various mechanism like an infection that causes a damage to the blood vessels or the person has problems with the lungs and these affect the right part of the heart. All these could lead to a heart disease (pulmonary hypertension) that Viagra could solve because that was its intended purpose.
How efficacious are herbs and roots as well as bitters in enhancing sexual drive? Do they have any side effects?
I don't have enough confidence to discuss herbal medications because all through my years of practising and studying, I never studied herbs; so those claims on herbs by herbal medicine practitioners I cannot substantiate. But generally speaking, we are extremely cautious when asking people to take herbal medications no matter what benefits is accruable to their use. The reason is that while I can predict the side effects of Viagra or chloroquine or any other drugs, no doctor can reliably predict the side effects of these herbs or verify the claims, potency or efficacy of these medications. So, when somebody takes a medication that is designed to cure a particular disease, nobody ever takes into account the side effects. Some of these herbs, much as they contain beneficiary properties, they have harmful side effects that can damage major organs such as the brain, kidney, liver and the heart. We have heard about patients who do herbal medications and their kidneys or liver shut down because of the lack of knowledge of the medication. So, I don't encourage the use of herbal medication but I can only prescribe drugs that I have knowledge of. So, all those sexual medications that are sold all around that the sellers claim could give men strong virility or strong erection might be good stuff, but I can never prescribe them.
So what should a patient with heart condition taking these drugs do?
Such a person should desist from taking herbal medication for the love of his live. If a patient with a heart problem develops erectile dysfunction (weak penis), the options are very open: seek medical advice from a doctor or better still a cardiologist who will sit down with him and analyse his medical history, especially the heart condition and know if Viagra will be okay or not. Apart from the coronary heart problem we talked about, those with cardiomyopathy, aortic stenosis which is called heart flow obstruction, the doctor could prescribe the use of Viagra for them; albeit with so much caution. Therefore, it is so easy to say somebody has a heart condition so he shouldn't be given Viagra but rather, it is better to find out what kind of heart conditions he has and if it can go well with the use of Viagra. So the man with erectile dysfunction, diabetic or hypertensive should seek audience with the cardiologist who will look and listen to his history; examine and do the necessary test and if convinced that prescribing Viagra won't be risky then give Viagra. Viagra is not a drug people should run away from but rather should be taken with guidance.