With the introduction of drugs for erectile dysfunction came much more discussion of the subject. CLAIRE O'CONNELLreports
HAPPY BIRTHDAY, Viagra. The diamond-shaped blue pill turns 10 this Thursday, marking a decade of Federal Drugs Administration (FDA) approval in the US.
Since Pfizer launched the erection-enhancing drug in 1998, Viagra has entered the popular lexicon and become one of the most successful prescription medications in the world: around 35 million men in more than 120 countries have taken 1.8 billion pills.
The drug's use in erectile dysfunction, which can affect men of any age, now generates an annual global sales revenue for Pfizer of $1 billion (€648 million), and it is estimated that worldwide an average of six Viagra pills are taken every second.
But its lucrative application was discovered only by accident. "It was originally a hypertensive drug for bringing your blood pressure down, and it did that by opening up the blood vessels," explains Ian Banks, author of The Man Manual and professor of European men's health at Leeds Metropolitan University.
"They found absolutely by accident that it actually works on the penis. It wasn't a very good drug for the cardiac applications so they didn't pursue a licence for that, just for erectile dysfunction."
Viagra suddenly offered a convenient alternative to previous methods of dealing with erectile dysfunction, including vacuum pumps, surgical implants or injections directly into the penis. "Those would certainly makes your eyes water," says Banks.
The medication's commercial success is down to its satisfied customers, he adds. "It's an amazing drug," he says of Viagra's active ingredient, sildenafil citrate, which is made in Pfizer's Ringaskiddy plant.
"There has not been one recorded death due to Viagra. There has been death where someone has taken Viagra and nitrates [ such as certain angina medication] with it but even then, those numbers are very small. So it's probably the safest drug that has been produced for a long time," he says.
Similar drugs, such as Cialis and Levitra, have since followed "Pfizer's riser" into the market and enjoyed success. "There's not a lot of difference between them," says Banks, who helped launch Viagra in Europe. However, he notes some regional variation in preference. "In Australia, virtually all the prescriptions are for Cialis, in the UK they are mostly for Viagra."
The upshot of having such highly publicised drugs for overcoming erectile dysfunction is greater openness about discussing the condition and related illness, which Banks welcomes.
"Because it was in the press so much, it has allowed men to be able to talk about a much broader raft of conditions than they used to do and that's really valuable," he says.
Talking to a health professional about erectile dysfunction, which can have physical and psychological input, is important, because it can be an indicator of underlying diabetes or a heart condition, explains Banks.
He believes that we will one day see Viagra available from pharmacists without prescription, thanks to its safety profile. "There aren't that many people who shouldn't take it. It should be sold across the counter, and I am absolutely convinced that will happen," he says.
However, erection-enhancing drugs going off prescription could have its downsides, such as increased misuse, and missing out on important medical check-ups. "If it was made over-the-counter I would have concerns about recreational use and about underlying conditions being missed," says Dr Mel Bates, spokesman for the Irish College of General Practitioners (ICGP).
Side effects of these drugs are thankfully rare, but he argues that being under the care of a healthcare professional provides an additional safety net. Before prescribing a medication for erectile dysfunction, he would check for possible physical sources of the problem, such as diabetes, a heart condition or the side effect of a medication the patient is already taking.
Bates also believes that erection-enhancing medications can help overcome the performance anxiety that can underlie erectile dysfunction.
"Nothing succeeds like success and nothing fails like failure. If someone has had an unsuccessful episode, the next time they are sexually active their focus is on it not happening again, so instead of enjoying the moment they will focus on this, which will turn everything off," he says.
"It's a genuine problem, it's upsetting for them and [ these drugs] can help them."