Why Viagra may not work for you

“For a lot of men, simply swallowing the pill isn’t enough”

By Anand Patel / 19 November 2015

In The Matrix, Morpheus counsels Neo to choose between a blue pill that will allow him to continue living a happy existence, or a red pill that will mean facing a potentially harsher reality. When Viagra first appeared back in 1998 as a drug treatment for erectile dysfunction (ED), it similarly promised an exciting future with a younger, sexually vibrant version of yourself.

Some studies have found 30% don’t get past their first prescription

This was of particular importance given the number of men with the condition. The Massachusetts Male Ageing Study (MMAS) demonstrated 40% of 40-year-old men reported ED, and this figure rose to almost 70% in men aged 70 years. Medical professionals like myself refer to the drug as ‘sildenafil‘ – the active compound in the branded drug Viagra – which relaxes blood vessel walls, increases blood flow to the penis and gives a firmer erection. But sometimes it doesn’t work.

The problem is that in a significant number of men, simply swallowing the pill isn’t enough to result in a firm erection. This is understandably disappointing for patients and has led to a high drop-out rate: some studies have found at least 30% don’t even get past their first prescription. This means many men stop using a potentially very effective drug which has been available on the NHS since last year.

The good news is that in ‘non-responders’, up to 60% can be salvaged with the right counselling. This involves advising on a healthy lifestyle to maximise the chances of the drug working, as well as managing expectations. So it’s worth remembering that sildenafil may restore your vigour, but it won’t turn you into a sex machine. Here’s how to make sure you get the best out of those little blue pills…

How quickly does Viagra work?

Once swallowed, sildenafil takes 30-60 minutes to reach suitable levels in your blood and lasts about eight hours. If you’re turned off by the need to take a tablet just before sex, you could try Cialis (tadalafil) which can be taken daily. It lasts much longer in the body and allows for more spontaneity which is really important to some. However this is only available to selected patients on the NHS; most will need to pay for a private prescription at around £60 per month.

Fine dining + Viagra = a disaster

Wining and dining a sexual partner into bed won’t do you any favours if you’re using sildenafil. Having a substantial meal in your stomach reduces the absorption of the drug in the body. Plus your gut is then focused on digesting food and blood is diverted away from the penis. Eat lightly. As for drinking alcohol – this increases the risk of an adverse reaction and reduces testosterone levels.

How can you tell if a man has taken Viagra?

I call it ‘Smurf sex‘. Taking sildenafil actually makes the world look a bit blue for a man, and he may look rather red from the outside. So if a man is flushed on his face and chest, complains of a headache, nasal congestion or heartburn then these are common side-effects. They are all due to the drug’s effect on dilating blood vessels throughout the body, not just the genitals. And remember it’s a drug used by all ages – 21% of men aged 18-30 have used it, 73.3% more than once.

When Viagra isn’t right for you

If you take nitrates

This is medication which improves blood flow to the heart and is often prescribed for conditions such as angina. If you do need medical attention – and have chest pain after using Viagra – tell the paramedic you used sildenafil so they don’t administer nitrates to treat your heart. Sildenafil and nitrates mixed can cause a catastrophic drop in blood pressure because they activate the same systems, both relaxing muscles which cause blood vessels to open up. Sildenafil is great for your penile blood flow, but together they open all your blood vessels, reducing the pressure of blood going to the brain and the heart. So users can collapse, lose consciousness or have a heart attack.

If you use ‘poppers’ (amyl nitrate)

This is used as a recreational sex aid which is sniffed. It gives a short lived head-rush lasting a couple of minutes, may make orgasms feel more intense and can relax the anal sphincter muscles making anal sex less uncomfortable. Unfortunately, it can cause a drop in blood pressure or give you a bad headache, not ideal when you want to have sex.

If you use recreational drugs

Many of my patients are not aware that cocaine, ecstasy, and other recreational drugs can all cause changes to sexual function, varying from difficulty achieving an erection to very delayed ejaculation times.

If you’re stressed

Any ED drug treatment will work less effectively when you’re stressed, because it cuts down the nerve connection between brain and genitals.

If you have diabetes

Diabetes and other health conditions can damage the nerves to your penis. You need a mix of nerve AND blood vessel activation to get a good erection. So if your diabetes is badly controlled, chances are your nerves are more likely to get damaged and the less chance you could respond well to sildenafil.