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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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A few questions to ask if you are having relationship difficulties

When do you think these difficulties started?

It is important to recognise when things began to change. On the other hand you might realise that to some extent it has always been like this but it is only now that you recognise that.

Think back to the time when things began to change what else was happening around that time?

Life events make different demands on different people and individuals respond differently to the same events, often we don’t realise the impact this can have on how we feel as a couple. These events might include a new baby especially a first baby; changes at work, losing a job or being promoted; a house move to an unfamiliar area; children leaving home; serious illness, caring for elderly or sick relatives or the death of a parent.

How have these events changed how you and your partner spend time together and/or communicate with each other?

Most couples, consciously or not, have regular ways that they show their care for and communicate with each other. These may part of daily life, a cup of tea in bed in the morning, a lift to the station, a chat in the bathroom. These small rituals are important in keeping the relationship ‘oiled’ and for both partners to feel reassured and affirmed.

How did you meet and get together and what was it that first attracted you to each other?

Look back to what was happening for each of you when you met and think about your expectations of each other. You might have imagined each other would bring new opportunities or offer something that was missing in the other. Maybe one of you seemed warm, expressive and sociable when the other was feeling low or lonely or maybe one of you helped the other sort out practical problems or manage a difficulty at work; perhaps you saw each other as very funny, clever or sexy. One of you might have recently been left or left a relationship and have had high hopes that this one would be very different.

 

These questions begin to reveal the underlying hopes, dreams and expectations in a relationship. These may have been unrealistic at the start or they can become fixed and out of date. Thinking about disappointment is painful and it is easy to blame the other person for failing to live up to expectations or for changing, “You used to be thoughtful and sensitive!” “You used to care about me!” Life events make an impact and the picture keeps changing. Things that seemed important have drifted into the background, something new is brightly lit in the foreground and you can sense things emerging at the edges.

As a couple it is important to be responsive to life and what it brings for each of you, to give yourselves opportunities to reimagine what you want to create together as a couple.

 

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

 

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The Contemporary Consulting Room

Following on from the post featuring Andrew Robinson’s photographs of the rooms at Brighton and Hove Psychotherapy, I want to think about the objects in the room in which therapy takes place.

“Both room and house are psychological diagrams that guide writers and poets in their analysis of intimacy.” (Bachelard, 1958/1994:38). This implies we have a tacit (a felt but not easy to express in words) understanding of the psychology of physical space. I suggest that the surroundings in which therapy happens are part of the therapy.

In contemporary psychotherapy there is a concern about the blurring of the boundary between the personal and professional. In the psychodynamic model if the therapist’s life comes too much into focus the client’s therapeutic potential can be compromised. It is a commonly held belief that therapy should ideally happen in a neutrally private room. However we would want to avoid any resemblance to anything cold, clinical or cell like. Freud is well known for his iconic rug covered couch and his large collection of figures that stood like a group of silent watchers in his consulting room.

A positive approach to the objects and disclosure can provide opportunities for working things through. Let’s think about books on display in the consulting room. A collection of psychotherapy books could be reassuring, showing that the therapist is well informed and takes their professional development seriously. If a client shows an interest in a particular book it can open up an area for exploration.

The impact of objects in the room can become important when a counsellor moves or there is a change in the room. Lapworth describes how when he introduced a sculpture into his consulting room, a client re-saw the room and noticed the books that had been in the room all along. When her attention was drawn to the books by the arrival of a new object, they resonated with her father and she talked about him for the first time (Lapworth, 2012:8).

Field notes the need for counsellors to take transitional objects with them, for example a rug on the floor. When she moved her consulting room a client was relieved to see the rug reappear in the new room. “We came to understand that it was symbolic of my perception of him: that I accepted him as he was; in his words ‘scruffy, imperfect, colourful and well travelled!’ ” (Field, 2007:174).

Therapists can use objects and images to support themselves in their work. A small sculpture or photograph with personal associations or special memories can help a therapist keep an open mind and feel connected with their own resources. Clients can sooth themselves through difficult times by finding reassurance when looking at familiar elements in the room.

 

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

References

Bachelard, G. (1958/1994) The Poetics of Space.

Field, R. (2007) Working from home in independent practice.

Lapworth, P. (2011) Tales from the Therapy Room.

 

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Men, Sex and Aging in Relationships

I have previously written about women and the menopause, I am now turning my attention to men, sex and aging in a heterosexual context.

Research indicates sexual activity declines with age however as we see older people being portrayed as healthy, attractive and vigorous, we are more likely to acknowledge this age group as sexually attractive and therefore potentially sexually active.

In psychosexual terms feeling healthy, feeling good about your body and being reasonably fit are factors in feeling sexually attractive and of course these are likely to make a partner more responsive. Whilst the recognition of desire, lust and libido in the later stages of life must be a positive shift it may hide some of the struggles that older men are facing in the bedroom.

There are inevitable physiological effects of age on erectile function. Age UK says that 40% of men over 60 experience erectile problems. Erectile tissue becomes less elastic over time, testosterone levels are reduced, blood flow to the penis decreases. Apart from achieving an erection, difficulties in maintaining it, ejaculating too quickly or not being able to climax at all are common problems.

Sexual problems are frequent amongst older adults. In one study about 25% of older adults with a sexual problem said they avoided sex as a consequence. There are links between poor health and lack of sexual activity. In the same study the most common reason cited for a lack of sexual activity was the man’s ill health. Examples included drinking alcohol to excess, smoking, stress and a lack of exercise and conditions like high blood pressure, type 2 diabetes and heart disease.

Sexual problems are infrequently discussed with doctors and communication about sexual problems can be poor. Apart from the fact that sexual problems may be symptoms of an underlying physical condition, undiagnosed and undiscussed sexual problems may lead to depression and social withdrawal.

The kinds of problems that do not get discussed include concerns about medication for other conditions that impair men’s sexual performance, as well as drugs to improve sexual performance that have unpleasant side effects such as headaches and indigestion. Men might choose to stop taking medication if they feel they will have better sex without it and they may give up taking medication to improve their sex lives if they cannot tolerate the side effects.

In 2015 prostate cancer accounted for 13% of all cancers in the UK. The survival rate has been improving over the last 40 years but survivors can be left with lasting changes to their sense of themselves as sexual beings. One of the treatments is hormone therapy, which effects the production of testosterone and reduces the desire to have sex. Men put on weight more easily and can develop man boobs and they may find themselves crying more often. It is no wonder that a man might ask himself, “Am I still a man?”

In a relationship the impact of an older man’s difficulties on achieving and sustaining an erection will depend on their partner’s own experience of sex and aging. A man with a younger partner may feel he is letting his partner down. A couple may feel safer distancing themselves from each other and avoiding even affectionate physical contact in case it leads to unsuccessful sex. Men with partners no longer interested in sex may feel shameful about masturbating using pornography or fantasising about other women.

We do not readily talk about sex, it makes us feel very vulnerable. Seeking support and sharing feelings in counselling and psychotherapy can be a step to rebuilding a sense of self and sexual confidence and the start to thinking about new ways of relating.

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

 

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A Couple State of Mind  

This is the first in a series of blog posts about couples therapy.  In this post I want to talk about what Mary Morgan from Tavistock Relationships calls a ‘couple state of mind’.

Why if our partner is ‘right’ for us don’t they understand us completely? There are limits to how much we can ever fully understand or know another person. As we move from away from the early stages of being in love or infatuation it can be disappointing when our partner doesn’t live up to our expectations, ‘You aren’t the person I married!” or “You’ve changed since we first met.”. What we mean is “You haven’t become the partner I imagined you would be.”

When we become a couple we are two separate people with our own ideas of what it means to be a couple and what each of us should be prepared to offer and can expect to receive. These ideas are likely to be based on how we experienced our parents’ or carers’ relating to each other, as well as the community and culture we grew up in. As a couple we will inevitably be sharing psychic space as well as physical space, the tension between wanting to be held and close and wanting our own space and freedom can be challenging.

At times we might find our sense of our self and our reality is threatened by our partner’s version of what is happening. For example, we might feel our frequent phone calls and texts show how attentive and caring we are but our partner may feel overwhelmed and claustrophobic. One of us may feel it is important to regularly spend time apart to not become tired of each other, but this might make our partner might feel rejected and isolated. These polarised positions highlight the difficulties of holding two perspectives on what it means to be in a couple relationship.

Couples coming to therapy often do not have a sense of themselves as a couple. Thinking about what your relationship needs is not the same as thinking about what you need. This may sound obvious but it is easy to lose sight of when you are finding life is a struggle. One role for the couples therapist is to help partners contain or tolerate their differences long enough to create a shared space to think, a couple state of mind. A couple state of mind can be understood as a third perspective, a position which gives a couple a chance to step back, look at their relationship and explore what they could hope for and create together.

Couples therapy also gives each of us the chance to see our partner relating to the therapist, showing ways that two people can think together in a close and trusting way. Seeing someone as familiar as your partner connecting with another person can be surprising, they can be revealed in a different light. The therapist offers a safe and supportive environment where a couple can think together and explore a couple state of mind, to see if they can continue to develop as individuals whilst enjoying the closeness and intimacy of being a couple.

Morgan, M. (2018) A Couple State of Mind: Psychoanalysis of Couples and the Tavistock Relationships Model. London. Routledge.

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

 

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