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PRESCRIPTION FOR DEBATE
Will Viagra change the way Americans view sexual health? May 15, 1998 |
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Questions asked
in this forum:
What liabilities do doctors face if Viagra causes long-term side effects? Can Viagra help a low libido? How successful would a blue "sugar pill" be? Can Viagra be habit forming? Are insurance companies guilty of a double standard? 
John Burbank of Bristol, VT asks: I've used injections in the past to overcome what my urologist believes is a vascular problem. This has been helpful even when my libido has sometimes been pretty low. As I understand it, Viagra might not help in those instances, or will it?
Ira Sharlip responds:
Viagra does not directly affect libido. It is simply an erection-enhancing product. Some men will experience an increased interest in sex once they develop the confidence that Viagra produces a reliable erection. In these men, Viagra will produce, indirectly, an improvement in libido.
Eileen Palace responds:
Sex is more than blood flow. Blood flow accounts for the hydraulics portion of the physiological process. However, research has shown the cognitive component to be equally powerful in determining the outcome of erection. Cognitions, or thoughts, such as internal dialogue ("What if this doesn't work tonight?", "this never works for me anyhow," "what will she/he think?"), trust, respect, intimacy, communication skills, problem-solving skills, feelings about body image, and expectations about yourself and your partner, interact to create or prevent at sexual response. As I described in response to question #1, my research has found that when I gave women with sexual dysfunctions inaccurate information (i.e., that they were more aroused than they thought they were), those women who significantly increased their expectations, increased their actual physiological response in 30 seconds. Within 3 minutes these dysfunctional women increased their cognitive and actual physiological responses to match sexually functional women. This sample included women with low desire, (libido), low arousal, inorgasmia, and dyspareunia (pain during intercourse). When women were given a physiological treatment without seeing the feedback of their responses (and therefore did not change their expectations), the beneficial effects of the physical treatment faded.
I am suggesting, that even if there is a vascular component, positive changes in cognitive, behavioral and relationship factors may be most helpful in increasing your interest in sexual activity, and when combined, facilitating the effectiveness of a medical treatment like Viagra.
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