Men's Sexual Health Section

Treatment's impotence lets men down

Viagra has changed a lot of lives for the better but drug failure leaves some men feeling blue

By Henry Peters

Men who take sildenafil (Viagra) without achieving an erection may suffer worse depression and lower self-esteem than if they'd never tried it, according to a British study into the psychological effects of treatment. This may give pause to physicians who prescribe the drug without adequate patient counselling.

The research, published in the British Medical Journal, is the first study to ask how men react to treatment failure with the famous erectile dysfunction (ED) drug.

Research into the mental health effects of sexual dysfunction in men is quite rare. The condition was believed to be mostly a mental problem until quite recently, so the bulk of previous psychological research went into hunting the mental obstacles to proper sexual function.

All that changed with the discovery that ED may just be a blood flow problem and Viagra held the cure. It spurred a flood of new patients to seek help after hearing of the pill through the media. Treatment failures weren't mentioned, despite being common, while episodes of priapism grabbed headlines, despite being extremely rare. The public soon came to see it as a wonder drug. Pfizer, the drug's manufacturer, may have had a pang of conscience about its heavy marketing, because it was they who funded this latest study. For that they deserve credit.

British researchers contacted patients from a men's health clinic until they had secured consent from 20 men who had achieved erection with the drug and 20 who hadn't. They began by exploring the psychological impact of ED itself. Dispensing with validated questionnaires, they chose a refreshingly unscientific approach of free-ranging interviews. The result is plenty of anecdote and valuable insight but very few hard figures.

Twenty-eight of the 40 men had first heard of Viagra through the media. Their initial expectations of the drug were almost universally high. As one put it: "I had very high expectations but that, I suppose, is down to the media and the old stories about people taking one who can't get rid of a hard-on for god knows how many hours."

When the drug worked, the psychological effect was actually surprisingly reminiscent of a scene from a Viagra advertisement: "I could have thrown open the window, shouted 'Eureka'. . . and beat my chest like an ape-man," said one patient.

When it didn't, the effect could be devastating: "I thought, 'Well this is my last chance,' and then they don't work. They're supposed to work on 80-year-olds and they're not even working on me... I felt my last chance had gone."

Nineteen of 20 men in whom the drug failed reported severe disappointment. "Although it's now known that with help and advice, the patient can often succeed eventually," say the authors, "a proportion were so disappointed that they did not try again."

"The media have had a major effect on expectations of the effects of sildenafil," they add, "and in retrospect, less sensational reporting would have lowered those expectations to the patients' benefit."