Show There ire no ocher significant tide effects of which I am aware Some men viexperience temporary bluish-gree- n sion but this does not appear to have any serious ocular consequences at least in the short term There are other minor symptoms —such as transient final flushing headache and occasional stomach upset— but nothing important or persistent Viagra takes anywhere from 20 minutes to one hour to work Recent reports of several deaths of men taking Viagra are being investigated Such news is always of concern but the numbers (30 among 2 million at this writing) are not impressive since 83 of prescriptions written far Viagra are for men between the ages of 30 and 70 many of whom have other serious problems such as heart disease diabetes and hypertension The victims may have been unaware of the warning about the concomitant use of Viagra and coronary-dilato- r drugs or perhaps they ignored it In my own practice I have found Viagra to be more effec- tive than any other chemical treatment for impotence However it not infrequently has been disappointing Viagra works best in men who always have had some erection but not enough to permit penetration In them it enhances the quality and hardness of the erection Men without any prior semblance of an erection as is apt to occur in the presence of severe vascular damage (so that too little blood can enter the penis) and those who have psychogenic impotence are the least likely to benefit from Viagra If Viagra does not work for you for whatever reasoa here are some other options to consider VACUUM PUMPS An acrylic cylinder is placed over the flaccid penis and attached to a pump Squeezing the pump handle a few times creates a vacuum that draws air out of the cylinder and sucks blood into the penis causing it to become erect The major drawback to the vacuum device is that it's not terribly romantic to long-standi- ng stand there pumping up your penis while your partner watches and wails (A vacuum pump costs $300 to $400) PENILE INJECTIONS Several drugs — such as papaverine phentolamine and prostaglandin E i— can produce an erection by relaxing the smooth muscle in the penis so that blood can flow into it But all of these drugs need to be injected into the penis Alprostadil gel (marketed as Muse) is a soft pellet you insert into the urethra with a plastic applicator Muse sex doesn't come cheap Each use will set you back $20 to $22 (manufacturer's suggested price) Some men have told me that this drug hurts them more than the injections da PENILE IMPLANTS AND OTHEN SURGERY If you have severe vascular disease or suffered an injury to the interior of the penis you will not respond to any of the procedures or drugs described above In that case a surgeon can implant a device in the penis that will make it erect or re construct damaged arteries within the penis or repair the varicose veins within it that are responsible far the “ventxrs leak" (the rapid exit of the blood from that organ) Surgery has its problems even in the best of hands Infection is not uncommon and the proslheses themselves sometimes break down and need to be removed in another operation Gist is SIOlOOO to SISjOOO or more OTHER TREATMENT APPROACHES Several medications and herbs ranging from Spanish Fly to ginseng are touted for the treatment of impotence There's no documentation that any of them work For a while yohimbine (derived from the bark of the yohimbd tree in Africa) was in vogue but recent reports concerning its efficacy are conflicting Dopamine a natural substance produced by the brain and trazodone a tranquilizer also have been said to help Agents such as Prozac that increase the concentration of serotonin in the brain may be effective when depression is the cause of the impotence But this and related drugs also can cause the problem PROMISING TREATMENTS ON THE HORIZON An oral preparation of phentolamine (Vfcsomax) now administered only by injection is awaiting FDA approval and probably will he available sooa h takes 13 to 30 mimnes to work but is expected to be effective in only 30 to 40 of cases A sublingual form of apo-morphi- that dissolves under the tongue and acts directly on the area of the brain that triggers erections may be marketed in a year or twa h is said to be 70 effective in men with psychologically caused impotence E |