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Viagra: Some ups and downs of the little blue pill

The arrival of Viagra (sildenafil citrate) came on the market in 1998 as the first drug to treat impotence. Impotence is the consistent inability among men to achieve and sustain an erection sufficient for sexual intercourse and/or to achieve ejaculation. Like the contraceptive pill in the 1960s it was greeted as a life changer giving men a chance to enjoy more and better sex when they wanted it. Of course it was never going to be that easy and the complications would take a while to emerge. In this blog I will share some thoughts on impotence and Viagra mainly in physiological terms; I will explore further psychological and relational aspects in later blogs.

There are other drugs for erectile dysfunction such as Cialis and Levitra as well as generic versions for example Kamagra. For simplicity I will use the term Viagra to refer to all the different versions.

Key findings from a 2018 survey of 2000 men, carried out by Atomik Research and sponsored by Co-Op Pharmacy, showed 43% of men between 18-60 were suffering from impotence and only 28% of those surveyed had discussed it with a GP. These are worrying figures and we can see why Viagra has been such a success story. Millions of men have taken Viagra apparently without any major incident or serious drawbacks. Although given the reluctance of men to talk to their GPs about sexual problems there may significant numbers who are suffering side effects that impair their sex lives.

Impotence is caused by reduced blood flow to the penis and Viagra works by increasing blood flow. A study of 23,000 men, cited by Pfizer the pharmaceutical company that manufactures Viagra in 2019, claims that 72% – 85% of men taking Viagra (the differences relate to the dosage 25 mg, 50mg and 100 mg) achieved erections hard enough for sex compared to 50% of those men on a placebo. This looks encouraging.

It can take around 15 minutes to one hour for Viagra to bring about an erection suitable for intercourse. On average these effects last 2-3 hours, may be up to 4-5 hours depending on your body’s metabolism. Viagra can help maintain an erection after ejaculation and can reduce the time it takes to achieve another erection following ejaculation. Some men say it can be more difficult to orgasm with Viagra, which may or may not be an advantage for their partners. Pfizer advise Viagra only works when you are sexually aroused, it does not make you feel aroused or cause instant hard-ons. In theory you will not be left with an unwanted erection if you are no longer horny.

A higher dose does not necessarily mean a better hard-on but it is likely to produce more side effects. These can include headaches, flushes, indigestion, abnormal vision, stuffy or runny nose, muscle pain, nausea and dizziness. There are also negative interactions with prescription drugs, over the counter medications and natural supplements. Viagra does not work well following a fatty meal or alcohol, which is tough for those who like to wine and dine as a prelude to sex.

There are men who do not have erectile problems who use Viagra to improve their sexual performance. However the recreational use of Viagra can be dangerous, especially if combined with other recreational drugs as in chem sex; this is an issue because chems can make it difficult to achieve and sustain an erection. Taking Viagra at the same time as recreational drugs such as chems, ecstasy, cocaine, crystal meth, poppers, and speed can produce a range of side effects including serious risks of a fatal drop in blood pressure and/or additional pressure on the heart. There are instances of men taking large doses of Viagra and enduring erections that last many hours. These are often painful and if not treated can damage the penis. In 2013 a Columbian man took a large dose and ended up with an inflamed and gangrenous penis that had to be amputated.

We have to recognise the benefits for men who can buy Viagra without a prescription, however apart from the recreational risks outlined above there are concerns about self-mediation and missing the signs of serious illness. High blood pressure and diabetes are two conditions that diminish the blood flow and therefore impotence can be a symptom. In the US diabetes is the most common cause of erectile dysfunction and impotence can be the first sign of heart disease especially in young men. If left unchecked these conditions can have long term and tragic results.

Viagra has undoubtedly helped many men and couples regain a sex life or find sex more satisfying, however this little blue pill is not always an effective treatment for erectile difficulties. Men who cannot tolerate side effects or for whom Viagra is not medically advised may want to explore other ways of enjoying sex if they are and their partners are able to talk about it. Viagra often reduces spontaneity and mean partners have to plan when to have sex, which again requires talking about it. Openly discussing the impact of impotence on a relationship is not easy; sometimes the conversation never happens. This is where counselling and psychotherapy can help by offering a safe space to have these conversations as individual or as a couple.

 

References-

https://www.atomikresearch.co.uk/case-studies-archive/co-op-pharmacy-erectile-dysfunction-pr-survey/

http://www.tradesexualhealth.com/sexual-health/sex-drugs/viagra.html

TRADE – Free, confidential health advice, information, services and support for the lesbian, gay, bisexual and trans communities of Leicester, Leicestershire and Rutland.

https://www.viagra.com/learning/is-it-right-for-me

Pfizer, 2019

https://www.usrf.org/index.shtml

Urological Science Research Foundation

https://www.independent.co.uk/news/world/americas/man-s-penis-amputated-after-viagra-overdose-8835146.html

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further Reading by Angela Rogers –

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

The Contemporary Consulting Room

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Leaving the Family

Long-term Psychotherapy is all about leaving the family – not literally – but in the psychological sense.

This is a much more complex process than it sounds. Why? Because it takes years of back and forth, and it is a journey which although slow, in my view essential for psychological health.

If you were lucky enough to have had a secure attachment relationship to your main carers – meaning an upbringing with parents who were secure in enough themselves to support your natural development throughout life – even if you experienced challenges or significant losses, you will feel enough security (real security, not an inflated one) in yourself to navigate life’s challenges.

For the rest of us, probably the majority – we will probably need to come to terms with the reality and aftermath of growing up in dysfunctional families, with parents or carers who were at best unskilled, and at worst abusive.

Leaving the family in the psychological sense can result in leaving in the physical sense too – such as choosing to have limited or no contact with an abusive or toxic family member.

This can be a difficult and painful decision to reach because of feelings of guilt, and expectations/ ideas of what a family should look like. For example, in some cultures it is taboo to cut contact with close family members (especially parents). Also, the person who is choosing to not have contact is usually accused of being difficult, making up stories, etc. Putting the blame on one family member (usually a child) is also a way of denying systemic dysfunction within the family.

Status Quo

Being in Psychotherapy can be risky because of what can get uncovered. Ideas about family which were not true, love which wasn’t there, destructive behaviour which was condoned or kept secret, etc. It is often painful to come to terms with reality. However, it is much more painful to live in denial.

Things which are denied or suppressed, remain unaddressed. What remains unaddressed affects us anyway because we can’t make links between our experience (past and present), feelings and behaviour. This is confusing and can cause a lot of unnecessary suffering.

As children we may have tried hard to keep our family together, because we depended on them for survival. And whilst some families are held together by love, compassion and humanity, other family relationships are held together by denial of serious dysfunction and/ or secrecy around abuse. This is not to say that love isn’t possible in dysfunctional families. There are degrees of how much harm dysfunction in families will cause.

Short Cuts

The reality is that there aren’t any short cuts for this type of work. Many people come into psychotherapy having tried to bypass their pain through short-term fixes, and shallow pursuits. Maybe after a string of failed relationships or a life that feels empty. Unaddressed, long-standing issues can also manifest as chronic depression or anxiety.

Of course, there needs to be a certain readiness and willingness for this type of work to take place. Maybe a certain level of maturity even (not usually related to age).

Aims and goals

The destination is unknown because it depends on each unique individual’s circumstances and hoped for outcomes.

The aim could be to finally become an adult in an emotional and psychological sense. This means to take more ownership of one’s feelings, thoughts and decisions. To be more present in one’s body. To have more fulfilling relationships and a more meaningful life.

Who wouldn’t want this?

Sam Jahara is UKCP Registered, CTA, PTSTA and is one of the Brighton & Hove Psychotherapy Co-founders.  She is an experienced Transactional Analysis Psychotherapist. Her special interests include culture, identity, belonging, sustainability and environmental issues. Sam is available at our Lewes and Brighton & Hove Practices.

 

Further reading by Sam Jahara –

Psychotherapy can change your life – but you may not want it to

On rushing towards answers

How do Psychotherapists work with anxiety? Trio of Blogs – Part 3

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Using the body to calm the mind

When we think about psychological difficulties, we often think of these as being purely in the mind.  In some of my other blogs I’ve spoken about the link between mind and body, and this is something I work with a lot in my therapy sessions with clients. 

This is particularly relevant with issues of anxiety; where the fight-flight-freeze system comes into play.  This ancient pathway in our brains allowed us to detect and respond to threats before we even had a conscious awareness of them.  Nowadays of course often the ‘threats’ are more likely to be psychological (fear about a situation for example) rather than a physical threat such as being attacked by a wild bear.  However, our bodies still react in the same way, by preparing our bodies to fight, run, or stand very still and hope the bear doesn’t notice us.  This is why stress and anxiety tends to lead to symptoms such as racing heart, tight muscles and increased breathing rate; all things that would help us to fight, run or stand very still.

We often might think of needing to use our minds (thoughts) to calm ourselves, and certainly in Cognitive Behavioural Therapy this is an important part of learning to manage anxiety.  However, we can also use our bodies to calm our minds.  As well as the messages coming from our brain to our body to say ‘quick, get ready to respond’ our bodies also send messages back to our brains.  So if we can do things with our bodies to calm, that in turn can send messages of calming back to our brains.  A good example of this is breathing:  In flight-fight-freeze mode our brains’ automatic response is to send a message to our bodies to make breathing shallower and faster in order to get oxygen to our muscles to prepare to run, fight or stand really still.  If, however, we over-ride this and purposefully slow our breathing to take deeper, slower breaths, that will send the message to our brain to say ‘it’s ok, we don’t need to be anxious’.  Some people find using a breathing square or star can be helpful.  If you imagine the shape and trace round it in your mind, breathing in as you trace along one side, and out as you trace along the next and so on.

Using progressive muscle relaxation (PMR) is another body based technique that can be really useful.  This involves working through the body from feet to head, tensing and then relaxing different parts in turn.  There are many scripts available online, or even YouTube videos which take you through a PMR exercise.  Again, this helps calm the mind by sending messages from the body back to the brain.  Even just going for a walk can be really useful when we are stressed or anxious.  At times of anxiety or high stress our bodies get flooded with hormones, including adrenaline.  This is what tells the body to prepare to run, fight or stand really still.  All the time high levels of adrenaline are present in our blood we will be in fight-flight-freeze mode.  Adrenaline is used up by our muscles, so doing activities that use our muscles will reduce the amount of adrenaline in our system.  So things like going for a walk are great for reducing adrenaline.

Most people anecdotally have probably found that when we are stressed or anxious going for a walk or taking 10 deep breaths can be useful.  As we can see there is a very real reason for why this can help; our bodies can be used to calm our minds.

Dr Emma Stevens, HCPC Registered, is an experienced Clinical Psychologist. She has an integrative approach drawing on Cognitive Behavioural, Systemic and Psychodynamic models, as well as Attachment Theory. Emma sees individuals primarily for sort-term work. Emma is available at our Lewes Practice.

 

Further reading by Dr Emma Stevens

Emotional Well-being

What is EMDR?

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Why do I do that? A Dramatherapist looks beneath the surface

I am a dramatherapist and I am talking today about one of my favourite subjects. I am going to explain the benefits of working with creativity in the therapy room.

When we are being creative we are using a part of our brain which does not relate to logic or linear time. This part of the brain thinks in pictures, metaphor and symbols. It is representational rather than objective. It endows personal subjectivity to our experience. It is what makes us human and unique. It records and remembers everything that has ever happened to us, every thought, every sensation, every feeling, every hope, every dream. What a storehouse of information waiting to be revealed!

But here’s the thing. Whereas we can easily access the logical part of our brain, so we know to carry an umbrella when it’s raining. We have learned this, it’s logical. Our creative brain thinks in pictures, sensations and emotions. Experiences and memories are recorded and stored in a different way which means they’re not always readily available for us as information because they reside outside of our awareness.

So for example: you’re normally a reasonably polite friendly person, but behind the wheel of your car you rage at other drivers and you don’t know why you do this. This behaviour stems from something in your psyche that is ‘out of your awareness’. So you can’t stop yourself doing it by simply noticing it and trying to change your behaviour. The interesting thing about this type of ‘out of awareness’ behaviour is that we can’t seem to learn from it no matter how hard we try.
This is where the dramatherapist armed with a creative toolkit can help. We know from research that when the mind is engaged in a creative task, the logical mind takes a back seat. It goes off-line and allows us to tap in to the resources that are held ‘out of awareness ‘ and hidden beneath the surface of our everyday experience.

Here we can see why we behave the way we do and where/ how  it originated. We can explore the triggers. In doing this we can actually heal our past experience and recover form it. And that’s what we want from therapy, right?

One way I get my clients to tap in to their ‘out of awareness’ experience, is to use a method called hot-penning. First of all I prepare my client using relaxation techniques to enable a clear focus on the issue at hand. The client then takes pen and paper and writes whatever comes to mind. The rule book is thrown out and the pen is given free reign. The writing need not be logical or sequential, it may be a stream of words, you’re allowed to swear, it does not have to make sense. After a couple of minutes of loosening up the client will generally begin to write meaningful narrative which can be very revealing. Clients are so frequently surprised by their own articulacy and the wisdom that they express. Quite often there will be the ‘a-ha’ moment.

In my experience when the client has insights unprompted by the therapist they are more motivated towards lasting change.

Dramatherapy as a creative therapy can help the client to begin to live more fully ‘in awareness’ and be less affected by ‘out of awareness’ behaviours which formerly tripped them up.

Magdalena Whitehouse is an experienced HCPC Registered Drama Therapist, working with individuals, couples and  groups. Magdalena is available at our Brighton and Hove Practice.

Further reading by Magdalena Whitehouse –
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Interpersonal Therapy (IPT) Explained

When we are feeling depressed it is common to withdraw from those that we are close to, to shut ourselves away, turn down social invitations and generally pull away from friends and family.  By doing this we are refusing the help and support of others, possibly because we feel bad about ourselves or that we have failed in some way, or that we will burden others. Friends and family may feel hurt and rejected by our withdrawal, they may not understand and feel that they are being shut out consequently may start to pull away from us.  We may then interpret this behaviour as confirmation of our view of ourselves as ‘a burden’ or ‘a failure’ consequently perpetuating, and even increasing, our symptoms of depression. Thus a vicious cycle is inadvertently created.

This example illustrates the fundamental concept of IPT – that depression can be understood as a response to current difficulties in relationships and in turn depression can affect our relationships. If a focus on your current relationships makes sense to you then IPT could be the therapy approach for you.

IPT is time limited, usually between 12 and 16 sessions, its structured and is recommended in the NICE Guidelines (National Institute for Health and Care Excellence). NICE is like the NHS Bible and recommended treatments are well researched and evidence based.   

The main focus of treatment is on relationship difficulties and on helping you to identify how you are feeling and behaving in your relationships.  IPT typically focuses on the following relationship problems:

  • Conflict within relationships – this can often be difficulties within a significant relationship where the relationship has become ‘stuck’ in arguments or disagreements  and has become a cause of stress and is having a significant impact on mood.
  • Change in circumstances such as redundancy, breakup of relationship or other life event that has affected how you feel about yourself.  This can include happy changes such as becoming a parent or moving. However significant change can be difficult to adjust to and have an impact on how we feel about ourselves and others.
  • Bereavement – it is natural to grieve for the loss of a loved one however sometimes we don’t seem to be healing from the loss.  We can continue to struggle to adjust to life without that loved person.
  • Isolation – Difficulties in forming and maintaining relationships – this can be due to not feeling close to others or not having many people around.  Not having company or support of others can be stressful and leave us feeling very alone.

During the first few sessions of therapy we will gather information about your difficulty, create a time line of your symptoms and discuss current and past relationships in your life.  Once we have gained a good understanding of the problem and the connected relationship difficulties we will collaboratively agree on which of the 4 areas therapy will focus on.

The benefits that IPT can bring include:  Improvement in relationships, including relating to others and communication, learning to cope with emotions and life changes, problem solving, processing loss and grief, and overall an improvement in mood and psychological distress.

 

Rebecca Mead is an accredited, registered and experienced Psychotherapist offering Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT) to individuals adults.  Rebecca is available at our Brighton and Hove Practice.

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