Articles on Medical Diseases and Conditions

Tag: Viagra

  • Sexual relationships: Difficulties with erections

    First, it may be helpful just to explain a little of the ‘mechanics’ of an erection. The penis is made up of the ‘urethra’, which runs through it and carries both urine from the bladder and semen from the testes, and which is surrounded by the ‘prostate gland’. On the underside of the penis, and running along its length, is a mass of spongy tissue called the corpus spongiosum. Alongside this spongy tissue are two ‘chambers’ called the ‘corpora cavernosa’ in which millions of tiny pockets fill up with blood during an erection. Special cells in the penis limit the flow of blood into these pockets most of the time, for otherwise there would be a perpetual erection! When these special cells ‘relax’, they allow the pockets to fill with blood, and thus the penis becomes erect, and when they ‘contract’ the blood is expelled and the erection subsides. A range of enzymes and other chemical substances work together to facilitate blood flow into and out of the penis.
    Erections may not occur, either because of vascular problems, i.e. problems in the blood supply to penis, or, and much more likely in MS, problems in the control of erections through the nervous system, which controls the process of erection and ejaculation.
    Managing erectile problems in principle involves attempting to deal with the problems in the nervous system; dealing with problems in the vascular system, and in addition dealing with psychological and related issues. For many men with MS with erectile problems, drugs like Viagra have appeared to provide an immediate and helpful way forward.

    Viagra and other help for erections

    The introduction of Viagra was a breakthrough in the management of erection problems. Two more drugs, Cialis and Levitra, have now been added to the options available. It is important to explain how this type of drug works. They do not repair any of the nervous system damage caused by MS. Essentially they act on the vascular problems in MS, by assisting the penis to fill with blood. They do this by breaking down an enzyme (a chemical messenger in the blood) that is preventing or seriously slowing down the process of engorgement of the penis. By magnifying the effectiveness of the erectile process, even where this was previously weak or virtually non-existent, erections can be maintained as long as the drug effect lasts. These drugs may be able to help such problems in many men with MS; indeed, there is very strong evidence that men with erection difficulties caused by Multiple Sclerosis are likely to benefit from them.
    At present they are taken orally (by mouth) and, because of the relatively slow digestive process, it may be an hour or two before the drugs produce their ef fects – certainly an issue in planning sexual activity. Viagra, Cialis and Levitra affect not just the penile area, but have potential ef fects all over the body, so there may be some side ef fects elsewhere. Your cardiovascular health will be carefully assessed before they are prescribed. Not everyone will benefit, although firmer, more frequent and longer lasting erections have been found in two-thirds to four-fifths of men who used Viagra.
    Because the drugs are costly, and the demand is assumed to be large, the Department of Health has been extremely circumspect about those who can be prescribed them. However, MS is now one of the designated medical conditions by the Department of Health for which these drugs can be prescribed, and so there should be fewer difficulties in obtaining them on these grounds, although there may still be local variations in supply plus, of course, any clinical reasons for their non-prescription.
    Currently there are a number of other drugs under development, which promise similar overall effectiveness to that of Viagra, but with a greater immediacy and convenience of use. In particular the aim has been to ensure as far as possible that spontaneity can be preserved in relation to sexual activities. The forms in which Viagra can be used are also being developed and before long there will be several different ways in which it can be administered.

    Side effects
    With the publicity for these drugs have come reports of some potentially dangerous and unpredictable effects. We need to clarify the position.
    We have already noted that they work on the vascular system. Most reports have centred on vascular incidents, such as deaths from heart attacks. There are several points that need to be made here. In the population at large, impotence and erection problems increase with age, and so statistically much of the demand has come from older men. However, cardiovascular problems – heart disease and high blood pressure – also increase with age. Although these drugs have been found to enhance erectile function in those with such problems, men who are taking medications such as organic nitrates, which reduce blood pressure, e.g. nitroglycerin (trade names Nitro-bid, Nitrostat), isosorbide dinitrate (trade names Isordil, Sorbitrate), pentaerythritol tetranitrate (trade names Penitrol, Peritrate), and erythrityl tetranitrate (trade name Cardilate), may well suffer a dangerous further drop in blood pressure by taking such drugs. Such medications are also likely to be prescribed more to older men. In addition, and a rather obvious point, sexual activity, and particularly sexual intercourse, involves vigorous exercise, and men who have undertaken almost no exercise for several years, perhaps with an underlying undiagnosed cardiac problem, may find themselves in difficulty – as in undertaking any vigorous activity without prior preparation. The doctor prescribing these drugs will understand these problems. However, because many men with MS are in younger age groups than those in which major problems have occurred, it is likely that the difficulties will be found to be fewer amongst most men with MS.

    Other help available

    Even if the nerve pathways from the brain to the penis are damaged in the middle or upper parts of the spinal cord, the pathways in the lower part of the spinal cord may still be intact. If this is the case, stimulating your penis directly, most helpfully with a vibrator, could result in an erection. You could also induce an erection by placing the (non-erect) penis in your partner’s well-lubricated vagina – with your partner sitting astride you. However, it is important that this is undertaken carefully, for if sensation levels are low, your penis might be damaged by being folded over, without this problem or any subsequent injury, being realized at the time.
    There are a range of devices used in treating men’s erectile problems, although many of them are now being replaced with Viagra or other related drugs, because they are less intrusive and more effective.

    Vacuum pumps
    The least intrusive of these options is the vacuum pump, which should be available to you on prescription. A tube is placed over the flaccid penis, sealed at the bottom round the base of the penis, and air is pumped out either manually or by a battery-operated pump. This causes blood to enter the penis and for it to become erect. A band is then slipped from the bottom of the pump around the bottom of the penis, the pump removed and the penis then stays erect with the blood trapped inside. It is important not to keep the band round the base of the penis for longer than 30 minutes, and the placing of the band round the bottom of the penis may require some dexterity.

    Injections, prostheses and aids
    Other more intrusive forms of erectile assistance include penile injections that relax the smooth muscle normally inhibiting blood flow into the penis, thus allowing an erection; or penile prostheses that can be inserted surgically that allow an erection to take place with various forms of mechanical assistance.
    There are a wide range of issues and concerns relating to the use of penile injections and prostheses, and both require an exceedingly well- organized and planned approach to sexual activity, and intercourse in particular, which some have found difficult to reconcile with anticipated emotions and feelings. If Viagra, Cialis or Levitra are not available, then you should seek a referral from your GP or neurologist to a physician specializing in these other techniques.
    There are also a number of artificial aids that do not require medical consultation or prescription, and these may include latex or similar penises, some of which are hollow and can incorporate a flaccid penis. Vibrators and other aids in the form of a penis are also available in sex shops or by mail order.

  • Sexual relationships: Problems for women

    In general women’s sexual problems are cantered on a lack of desire, arousal and orgasm. Lack of desire is the chief complaint among women. A woman’s lack of sexual interest is often tied to her relationship with her partner. It can also be triggered by family concerns, illness or death, financial or job worries, childcare responsibilities, managing a career and children, previous or current physical and emotional abuse, fatigue and depression – as well as by the MS itself. Thus the issue is often trying to deal with a range of factors in managing sexual problems. Nonetheless there is a particular set of problems that may occur as a result of the Multiple Sclerosis, particularly cantered on arousal, and subsequent problems of lubrication.
    The process of sexual arousal is similar in women to that in men: in women the engorgement of the sexual organs (the clitoris and the inner and outer labia round the vagina), and lubrication by internal secretions, occur. For many women such a process is not just an aid to sexual intercourse, but also a considerable aid to sexual pleasure. In MS nervous system control of the process of engorgement is likely to fail – parallel to the process of erection in men. Furthermore, sensations in the breast and genital area may be also affected.
    The usual – and it must be said – still relatively common view in such circumstances is that artificial lubrication, through the use of a lubricant such as K-Y Jelly, is sufficient to deal with problems such as vaginal dryness but, whilst such lubrication can help sexual intercourse, it may well not deal with the complex range of other issues that surround sexual arousal and fulfilment in women.

    Exercises for women

    Although there are several possible causes of your loss of sexual drive, and thus several possible approaches to managing the difficulty, as far as some of the physical components are concerned, the female orgasm involves – amongst other things – the contraction of several sets of muscles around the vagina. There is increasing evidence that exercising these muscles can assist in providing the conditions for better sexual responsiveness. Relevant exercises involve periodically squeezing and then releasing the pubococcygeus muscle – the one that starts and stops urination in mid flow – several times a day if possible. This can help tone the muscles, and possibly enhance vaginal sensations, which may help responsiveness.
    If you have no partner, or indeed wish to attempt to do something yourself to enhance your sexual life, then there are a range of things you might try, including the use of fantasy, or sexually explicit books or magazines, and physical exploration of yourself. Some women use vibrators to provide additional physical stimulation. Although it is difficult to create sexual sensations to order, using one or other of these might help you to regain some of your libido – even if this requires more imagination than usual! Remember that some women without MS do not have perfect and completely satisfying sexual lives!

    Viagra, Cialis and Levitra for women

    In principle, these drugs could help to enhance sexual pleasure by promoting the engorgement of the clitoris and the inner and outer labia. Until relatively recently, although there are reports of individual women who have found Viagra helpful, there have been few systematic studies of women’s sexual response using the drug, and none in relation to women with Multiple Sclerosis. Women may feel that this again shows very particular gender priorities in the testing of such drugs.
    However, although a number of studies show that women tend to report more sexual problems then men, there is less evidence that a drug such as Viagra will assist with many of their problems. By and large, the major problems for many women are concerned with desire and arousal, rather than with the engorgement of their sexual organs alone. In particular, as it has been graphically put, often ‘the most important sex organ for women is between the ears, not in the genitals’. Thus it is not at all clear that many women as might be expected will be helped by the physical effects of such drugs alone, although it is important to note, for some women with MS in particular, the local genital effects of such a drug might be beneficial when there are difficulties, for example, with lubrication. Nonetheless many drug companies over the last two years or so have begun the development and testing of drugs, which potentially may have a range of effects on women’s sexual desire, in addition to similar effects to those of Viagra.