Viagra Alternatives
 The little blue pill that lifted millions of libidos from fizzling to sizzling remains a favorite among men with erectile dysfunction, but local urologists say Viagra's alternatives competitor is gaining popularity.
Less than a year after FDA approval, Cialis has cut into Viagra's market share with the promise of up to a 36-hour window for sexual intercourse.
Many men battling impotence like the idea of an alternative to Viagra, which takes effect quickly but wears off within four or five hours. Cialis takes slightly longer to kick in — about an hour — but boasts a longer-lasting mechanism for erections, said Dr. Jerry Givens with Tri-Lakes Urology Consultants at Skaggs Outpatient Center in Branson.
Cialis triggers a series of biochemical reactions that enables blood to flow to the penis when a man is sexually aroused, Givens explained. "The idea is to maintain or increase blood flow to the penis," he said. "Erections are about large amounts of blood being trapped in the penis." Erectile dysfunction affects the lives of 15 million to 30 million American men and their partners, according to the Mayo Clinic. The inability to obtain or sustain an erection is more common among men 65 or older who have pre-existing medical conditions such as diabetes, prostate complications or high blood pressure.
But couching erectile dysfunction as a problem only older men face is incorrect. Fortunately, Givens said, the trio of ED drugs — Viagra, Cialis and Levitra — have worked well for men of all ages. "I've given it to people in their 30s through 90s," he said. "We'll give it to just about any age."
But the wonder drugs, which cost roughly $10 a pill, may not be as wonderful as some have been led to believe, urologists said.
Like most pharmaceuticals, these drugs — known as PDE-5 inhibitors for the enzyme they block — have side-effects and drawbacks, said Dr. Jeff Johnson with St. John's Urology Clinic. "The drug is not for everybody," he said. ED drugs shouldn't be prescribed for men already on alpha blockers — meds for high blood pressure or an enlarged prostate. That's part of the fine print few men read when they see ads promising to rekindle the sexual flame in their smoldering physical relationship. Of the people who try ED drugs, about 50 percent to 60 percent achieve some degree of success, urologists said. "Most people that won't respond to one won't respond to another," Johnson said. Both Givens and Johnson said they have prescribed all three drugs to patients, but are most comfortable with Viagra, which was approved by the FDA in 1998. Side effects associated with the drugs can include headaches, nasal congestion and a bluish tint to vision. Some Cialis users also experience muscle aches or back pain, Johnson said. For many patients, though, the side effects are worth the payoff, which yields physical, mental and emotional dividends, said social psychologist Tyra Pierce.
"How you function sexually in a relationship is going to have a direct influence on the relationship," said Pierce, who teaches human sexuality at Drury University. "It takes a very strong relationship to make it through that."
After all, Pierce added, the male ego — for all its pride — can be quite fragile. "Some men ... base their whole personality, their whole self-esteem, on their sexual performance and if they can't do it, then yeah, that's a big thing," he said.
Johnson said only 10 percent to 20 percent of men with erectile dysfunction seek medical help, but that the advent of Viagra and its competitors are changing the landscape of what was once taboo.
"I think it's positive that men are realizing it's okay to seek treatment for erectile dysfunction," he said.
Sam Fields 
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