Importance of seeing a physician before using Viagra

Viagra (Sildenafil) has certainly become a major drug that has helped a large number of impotent males worldwide. And even though the number of prescriptions written for this medication have dropped dramatically since its introduction in March of 1998, the numbers are still staggering and monumental, even before the drug becomes available to the world as a whole. Viagra appears to be very safe even though we have all read about deaths associated with it and realize that these deaths have occurred in patients who probably should not have had the medication due to severe heart disease, that couldn't tolerate normal sexual function, or due to the fact that the patient's were taking the contraindicated nitroglycerin or nitrate medications.

If you exclude this group of patients, the safety record of Viagra has been exceptionally good, and its effectiveness is in the range of 50 to 75%. Many patients consider it to be a drug that should be sold over the counter, and, in fact, many have been able to obtain prescriptions for this drug on-line at various prescriptions web sites without ever seeing, talking to, or being examined by a qualified licensed physician.

Why is it that giving prescriptions for Viagra, either over the counter or on- line, is not good for the health of the impotent male? Firstly, the erectile dysfunction is a symptom of another problem and it is extremely important to make the diagnosis of that other problem since the other problem may have serious sequelae worse than the symptoms of impotence. A full history, medical and sexual, a full physical, and basic blood studies must be done to rule out those disorders that are either easily correctable or treatable which may develop into future problems that are more serious than the problems of erectile dysfunction. For example, a relatively young male 45 to 65 years of age may have erectile dysfunction as his very first symptom of serious underlying coronary artery disease. He may not have chest pain or angina and the only indication of decreased blood flow is the decreased blood flow to the penis. Evaluation may suggest a vascular cause for his impotence and basic cardiac testing including an electrocardiogram or better yet a thallium stress test would indicate asymptomatic heart disease, prevent a future heart attack, and possibly save the life of this patient. Another example would be a male, let's say the same age group, who not only has erectile dysfunction but has poor sexual desire. On obtaining some basic blood studies it is found that his total male hormone level (serum testosterone) is extremely low and subsequent blood tests including a prolactin show high levels of prolactin. Further evaluation determines that he has a brain tumor or a tumor of the pituitary gland which in some situations can be life-threatening as well.

Secondly, Viagra should not be given to any patient who has severe heart disease or is unable to tolerate normal sexual activity. In order to determine this a good history and knowledge of the patient is necessary. Basically the amount of energy necessary to have normal sexual activity (6 calories/second) is equivalent to the ability of climbing one flight of stairs without chest discomfort. This evaluation certainly would be better done in the presence of a qualified physician.

Thirdly, there are approximately 75 drugs of various sorts that contain nitrates, including generic sublingual nitroglycerin and nitrate patches. Many patients are taking nitrate-containing medications and don't even realize it. Only by a careful, compulsive history done by a physician can the drugs be identified. Every drug that a patient takes must be extracted from the patient during the history taking and, if these drugs contain nitrates, either changed to a non-nitrate containing drug or the Viagra must not be given. The combination of Viagra and inorganic nitrates is potentially lethal with a drop in the blood pressure and the possibility of subsequent stroke or heart attack. The fourth deals mostly in the follow-up of the patient since not everybody will get 100% response to Viagra. In those patients who have a poor response the physician will then be able to assist the patient in other more aggressive effective therapies, and in those patients in whom the response is suboptimal, there are many ways of improving the suboptimal results by either changing the method and timing of the Viagra pill or adding in a timely manner other effective medications such as intraurethral Prostaglandin (Muse therapy).

If you have read this article and have reached this point, it is obvious that Viagra is not a drug that can safely be prescribed as an over-the-counter medication or through an on-line web site. Nitrate-containing drugs must be elucidated from the patient, general health conditions must be evaluated, and correctable disorders must be diagnosed and treated. Non-responders should have the opportunity of receiving other more aggressive effective impotence therapy, and suboptimal results can be enhanced with other simple noninvasive techniques and medications. This can only be done by a qualified licensed physician in his office and not by any other means.

Lastly, all patients on Viagra, or treated for impotence should have adequate follow-up therapy on a regular basis, and for many patients this may be the only male health evaluation. Biannual or annual prostate examination, PSA testing, and urinalysis will be done during those visits and prevent other significant male health problems including prostate cancer.