It has been 21 years since Viagra® burst onto the Australian market as the first oral medication to treat erectile dysfunction.
What quickly became a multi-billion-dollar industry all began with an accidental discovery during a standard drug trial for a completely different condition – angina.
The new drug the scientists were trialling was sildenafil, a medication that causes blood vessels to relax and widen. It was hoped that these effects would counteract the reduction in blood flow through blood vessels supplying the heart that happens with an angina attack.
Unfortunately for people suffering from angina, it didn’t work.
But fortunately for men suffering with erectile dysfunction, there was an unexpected side-effect.
A number of men in the study reported having prolonged erections1. This surprise finding led to new research and drug trials, and ended with the development of Viagra®. Twenty years later, Viagra® has become one of the most prescribed medications in the world.
Other medications that act like Sildenafil (Viagra®) to produce erections have since been released, including tadalafil (Cialis®) and vardenafil (Levitra®). These drugs are all phosphodiesterase type 5 (or PDE-5) inhibitors, which refers to the way they interrupt chemical signals so that an erection can occur.
How do PDE-5 inhibitors (Viagra, Cialis and Levitra) work?
To understand how these medications work, it is helpful to understand how an erection normally happens.
An erection occurs when the penis becomes filled with blood and expands. This requires a number of events to take place.
Firstly, during sexual arousal, the brain responds to images, smells and touch, by sending signals along nerves to the penis. This causes nerves and other cells in the penis to release specific chemicals that control muscles and blood vessels. When released, these chemicals relax and widen the blood vessels, which means more blood can enter the penis.
At the same time, the spongy tissue running within each side of the penis rearranges itself to allow more space for blood. This space fills as more blood enters the penis, and the tissue expands. This expanding tissue then presses on the blood vessels leading out of the penis, which prevents blood from leaving. The penis becomes filled with blood and stretches, resulting in an erection.
PDE-5 inhibitors, like Viagra, work by increasing the availability of the chemicals that cause the blood vessels to relax. This means the blood vessels can get wider, letting more blood enter the penis which leads to an erection.
According to Professor Rob McLachlan, director of the national men’s health network Andrology Australia, PDE-5 inhibitors like Viagra have changed the lives of millions of men around the world who have erectile dysfunction.
“Erectile dysfunction is a very common problem that was rarely talked about before Viagra came onto the market. Viagra played a very important role in shedding light on this condition. Plus, for most men, it offered an easy and life changing solution.”
Do they work for everyone?
Unfortunately, about one third of men find that PDE-5 inhibitors (Viagra, Cialis and Levitra) do not work for them or are not suitable to take.
For some men, this is because they have side effects from taking the medications. This can include headaches, stomach problems, nasal congestion, facial flushing and abnormal vision.
Other men can’t take them because they have other serious health conditions that can get worse if they take this medication, like heart conditions, blood pressure problems, and liver or kidney disease.
And for other men, the inability to get an erection is not related to a blood flow problem, but instead is a result of other medical or psychosocial factors, including a lack of interest in sex.
Viagra in itself does not improve sexual desire (libido), although improved erectile function may indirectly enhance sexual interest.
Do you need a prescription to buy Viagra, Cialis and Levitra?
In Australia, a prescription from your doctor is needed for Viagra, Cialis and Levitra. This is because your doctor needs to identify the cause, decide whether medication will help, and choose the right type of medication for you. This will ensure you stay safe, and avoid any harmful interactions with other conditions or medications. Your doctor can also talk to you about other alternatives that may help.
And while it may seem difficult to talk to your doctor about erectile problems, your doctor will know how to help.
Erectile dysfunction is very common – around 1 in 5 men over 40 years have trouble getting an erection. More importantly, while erectile dysfunction is potentially treatable, it might be a symptom of something else that needs treatment, like (diabetes, high blood pressure or high cholesterol) or a warning sign of a more serious heart problem in the future2. It may also be a side effect of other medication you are taking.
So even if you aren’t planning to have sex, seeing your doctor about erectile dysfunction is important.
The longer erectile dysfunction or any other medical condition is left untreated, the more problems may arise – to your health, relationships and overall well-being. Plus, the longer you wait, the more difficult they can be to treat.
Can you buy Viagra, Cialis and Levitra online?
The need for a prescription has led many people to try and buy these drugs online.
However, these are some of the most counterfeited medications in the world3 and buying them from an online site means you don’t really know what you are getting. There have been reports of counterfeited Viagra tablets containing no Viagra at all or very high doses, as well as brick dust, talcum powder, ink and other poisonous chemicals. The risk of taking pills from unverified sources far outweighs the time and effort to see your doctor to get a prescription.
Is it safe to take medication to get an erection when you don’t have erectile dysfunction?
Despite the myths surrounding it, there is no evidence to suggest Viagra, Cialis or Levitra improves the sex lives of men who can already produce and sustain an erection.
It only benefits men with erectile dysfunction.
What’s more, taking medications for erectile dysfunction when you don’t need them can develop into drug dependence. This means men who use these medications recreationally can find it hard to get an erection unless they take the drugs. The likelihood of this occurring is hard to determine, as it relies on men self-reporting both their recreational use and their symptoms to their doctor, which doesn’t always happen.
Given there is no evidence that Viagra, Cialis or Levitra improves sex in men who do not have erectile dysfunction, taking these drugs if you don’t need them is a completely unnecessary risk to take.
The use of erectile dysfunction drugs in ChemSex
The use of drugs to enhance sexual experience is not a new phenomenon. This is referred to as ‘chemsex’.
Viagra and similar drugs are often used in chemsex4. This is because they may rescue the effects of alcohol or recreational (‘party’) drugs that make it more difficult to get an erection. The online availability of counterfeit erectile dysfunction drugs has meant chemsex is becoming more common, in both the heterosexual and GBTQI community.
One very real concern with chemsex is that when people use party drugs, they are more likely to take part in risky behaviour. When this is combined with erectile-promoting drugs, like Viagra, the result can be more unprotected sex. This has resulted in an increase in sexually transmitted infections, including HIV5.
Take home messages
- Erectile dysfunction is very common.
- Viagra and other erectile dysfunction medications can help some men with erectile dysfunction.
- These medications belong to a group of drugs called PDE-5 inhibitors, which work by increasing blood flow to the penis.
- For men who can get an erection without medication, there is no evidence these drugs improve sex.
- Taking these medications when you don’t need them may lead to drug dependence (meaning you can’t get an erection without medication).
- Erectile dysfunction may be an early warning sign of other serious health conditions.
- Men with erectile dysfunction should seek expert medical advice.
Author Information
Nicolette Hodyl PhD is the Director of Vertex Health, a consultancy specialising in health research strategy and health communication. She is the Head Writer for Hormones Australia and has over 15 years’ experience working in medical research.
Expert Review
This article has been medically reviewed by Prof Bu Yeap and Prof Carolyn Allan.
References
- Goldstein I, Burnett AL, Rosen RC, Park PW, Stecher VJ. The Serendipitous Story of Sildenafil: An Unexpected Oral Therapy for Erectile Dysfunction. Sex Med Rev. 2019;7(1):115-128.
- Raheem OA, Su JJ, Wilson JR, Hsieh TC. The Association of Erectile Dysfunction and Cardiovascular Disease: A Systematic Critical Review. Am J Mens Health. 2017;11(3):552-563.
- Chiang J, Yafi F, Dorsey P, Hellstrom W. The dangers of sexual enhancement supplements and counterfeit drugs to “treat” erectile dysfunction. Translational Andrology and Urology. 2017;6(1):12-19.
- Mullins A, Ray M, Fein E. Queensland Chemsex Study’: Results from a cross-sectional survey of gay and other homosexually active men in Queensland–substance use and sexual activity2017.
- 5. Giorgetti R, Tagliabracci A, Schifano F, Zaami S, Marinelli E, Busardo F. When “chems” meet sex: A rising phenomenon called “Chemsex”. Current Neuropharmacology. 2017;15:762-770.
