IMPOTENCE
Impotence
What about Viagra?
The interest in sexual dysfunction occasioned by an oral preparation for]
treatment has hed physicians to be asked to investigate and treat this condition
as part of routine care.Specifically when to treat, how much to workup, and when
to use Viagra or to refer to a sexual dysfunction specialist is just beginning to
be defined.
In men, erectile dysfunction is organic in 85% of cases, and thus can be a sign
of significant intercurrent or concomitant disease. If an obvious cause of erectile
insufficiency is already known, eg vascular disease in the older patient, and does
not need further workup at the time, Viagra can be prescribed for erectile dysfunction
as a trial. If the patient is younger, ie below 55, and the cause is not readily
established, in addition to doing a complete history and physical exam, referral to the
specialist to determine cause is in order. If Viagra does not work in the older patient,
then referral to the impotency specialist is also in order.
Sildenafil (Viagra) is a 5-PDE ihibitor,works in 50-80%, has side effects of nausea,
flushing or headache, or dizziness or palpitations (contraindications), is taken one
hour before and only works with sexual stimulation. Concurrent use of nitrate-producing
drugs (NTG,arginine) is a contraindication. Usually Viagra is effective except in the
presence of severe vascular disease, arterial or venous, and excessive psychological
inhibition.
There has been interest in the use of Viagra for sexual dysfunction in women, This has not been
tested in completed and published trials, however. Problems of inadequate arousal,libido, and
vaginal lubrication, anorgasmia,vaginismus, and dysparunea due to specific causes should all be
investigated, and any endocrine imbalances corrected (eg with proper use of Testosterone), and
mechanical problems addressed. There is laboratory evidence that impaired circulation to the pelvic
organs can account for inadequate arousal and vaginal lubrication, and in those cases Viagra can
help quite effectively.
David T. Schwartz MD
5252 Dawes Avenue
Alexandria, VA 22311
(703)-998-7333 Phone
(703)-998-7334 Fax
800-726-8011
email:dtayschwartz@pol.net
412 First Street, S.E.
Washington, DC 20003
(202)-488-0837 Phone
(202)-488-1709 Fax
David Schwartz---dtayschwartz@pol.net