Upcoming Erections

With the 2004 presidential election frenzy poised to take center stage, I am reminded (in a free-associative, slightly irrelevant way) of a famous Saturday Night Live skit by Gilda Radner's hearing-impaired but always outspoken alter ego, Miss Emily Litella. 'What's all this fuss I hear about presidential erections?' she fumed indignantly in her 'Weekend Update' guest commentary. Well, little (as I, personally, obsess about the intimate performance details of Dubya's presidential heat-seeking missile), but erectile dysfunction is quite a hot topic these days. According to the American Urological Association, 25 million men in the United States suffer from erectile dysfunction, and only 10% have received any form of treatment for it. It was once thought to be a condition affecting only older men, but it has been determined that up to 50% of men over 40 may suffer from at least occasional erectile dysfunction. In the past several years medical researchers and clinicians have revolutionized the diagnosis, treatment, and open discussion of male erectile dysfunction'a topic once too taboo to speak freely about but one that is now the subject of multimillion-dollar, celebrity-laden pharmaceutical endorsement campaigns. There are three very similar orally administered pill-based options for correcting this problem'Viagra, Levitra, and Cialis. Viagra and Levitra are relatively short-acting, lasting up to five hours, while the newly approved Cialis works at least four times longer (24 to 36 hours). Onset of action is slightly faster for Cialis (acts within 16 minutes compared with 25 or more for Levitra and 30 to 60 minutes for Viagra), and these newer drugs are both reported to work better than Viagra on a full stomach. Side effects of the three erectile dysfunction drugs are similar and may include headache, facial flushing, runny nose, indigestion, back pain, and temporarily blue-tinged vision. Occasionally, a person using an erectile dysfunction pill may suffer from a painful and prolonged erection for longer than four hours'a condition called priapism, which requires immediate medical attention to avoid irreversible damage to penile erectile tissue. Each pill costs around $8 to $10, and many insurance plans offer little or no reimbursement for them. There are a host of drugs that one should not mix with these pills, including nitrates (found in certain heart medications and in poppers) and blood pressure and prostate medications called alpha blockers (e.g., Hytrin and Minipress). A combination of these could cause dangerously low blood pressure. For patients taking the protease inhibitor Norvir or other ritonavir-containing anti-HIV medications like Kaletra, the maximum dose of Viagra should be no more than 25 milligrams every 48 hours; for Levitra, no more than 2.5 milligrams every 72 hours; and Cialis must be reduced to at most 10 milligrams every 72 hours to avoid overdosing. Antifungal medications, such as Sporanox or Nizoral, as well as the antibiotic erythromycin and, believe it or not, grapefruit juice may increase erectile dysfunction drug levels; therefore, they should be used together with great caution. Erectile dysfunction pills are not medications that you should borrow casually from a friend, buy on the Internet, or procure on the black market. A detailed medical history and a comprehensive medical examination are necessary prior to prescribing erectile dysfunction medications. This approach allows your doctor to diagnose and advise you properly about underlying conditions or medication interactions that could result in serious side effects. Since none of these medications do anything to prevent sexually transmitted diseases, strict adherence to safer-sex guidelines is especially important. Above all, don't feel embarrassed to ask your doctor about erectile dysfunction advice and treatment'an adequate erection should be regarded as being just as important to your quality of life as a good night's sleep. Cohan is an attending physician and vice president with Pacific Oaks Medical Group, one of the nation's largest practices devoted to HIV care, located in Beverly Hills, Calif.