Viagra – how does the blue pill improve your erection ?

When the little blue pills called Viagra were introduced to the market in 1998, it was really breaking news. At last, there was a medicine that could help men with an erection that was too weak for a satisfying intercourse. Not all men, but many.

When I give talks and lectures about sex, I almost always get the question: ”How does Viagra make erection stronger? Does it work for women too?”

I’ll answer the second question first: No, Viagra has no effect on women. It does not make them more sexually aroused or give them more fantastic orgasms. (Well, maybe if their male partners use it).

With men, it’s something else. To understand how Viagra works, you have to know a little about how erection is produced and sustained. The mechanics is quite simple. Imagine that you want to fill a balloon with water: You hold the balloon to the faucet and let the water run. The balloon will fill and get bigger and firmer. If the water runs fast the balloon fills quickly, but if there is a lot of limescale in the pipes, the water flow will be slow and it takes ages to fill the balloon. If there is a small hole somewhere in the balloon, it will never get filled.

The erection mechanics is about the same. The penis has two elongated, spongious structures resembling balloons. They are small and soft when they are empty, but become elongated and firm when filled. When something excites the man and makes him want sex, the blood vessels leading to the penis open and the structures fill with blood. If the erection mechanism works the way it should, his penis gets elongated and stiff – that’s the erection.

But it is also important that the blood stays in the spongious structures long enough to enable the man to have an orgasm. So the blood vessels leading blood from the penis must stay closed. Otherwise, the man will lose his erection too early.

Viagra only works if the man wants to have sex

Even if the mechanics seems simple, a lot of things have to function. First, the man must want to have sex. Desire is crucial to get the process started. Desire makes the brain send signals down to the blood vessels in the pelvis to produce something called NO ( although in this situation, YES would have been more appropriate). NO makes the vessels open, provided they are elastic and can change their diameter. And as the vessels must not close again too early, NO is produced until the man has had his orgasm. The stiffness itself helps to keep the blood in the penis by pressing the vessels together. So will a good strong bulk of pelvic floor muscles.

So what exactly does Viagra do? It keeps the production of NO in the vessels going, so they can stay filled and the erection holds until the man has orgasmed.

But even if Viagra helps a lot of men, it is no miracle cure. It doesn’t work if the man has lost his desire for sex. If the blood vessels have lost their elasticity and are stiff and narrowed by arteriosclerosis, they fill too slowly and there won’t be much erection. It the pelvic floor muscles are too weak, they can’t keep the blood in the penis and the erection will wane off too quickly.

So, to keep your ability to get an erection, or regain what you have had: do pelvic floor exercises and avoid arteriosclerosis. The remedy is lifestyle, again and again…

Can pink pills cure her lack of sexual desire?

My dog Emma is in heat these days. She dreams about puppies and prepares a nest for them in her basket. Male dogs come galloping up to our house, tails high, owners behind them, short of breath and carrying an empty leash. Emma will mate at once, given the chance. She wants to, and she doesn’t care who the partner is, as long as he’s male. When she is not in heat, she sneers at any dog getting too curious of her behind. She does not want to mate. It’s simple.

Marianne and Svend are a couple a little over 50. Marianne’s desire for sex has disappeared completely. She never thinks of sex, has no sexual fantasies, no sudden nice feelings of warmth and heaviness in her pelvis. She and Svend have tried so many things: They have talked about what she likes and what usually turns her on, they have gone on a lover’s weekend, bought toys, watched porn. Nothing has helped. Svend doesn’t try to get close to her so much anymore and the good talks they used to have a getting more rare. Marianne is worried and sad. It’s not simple at all.

People have expectations about desire. They especially expect it to be there, ready to supply experiences, relaxation, wellness, intimacy, and happiness… Lust and a good sex life are seen as necessary ingredients in a good life.

Desire comes from many things

Words, pictures, touch, smell, thoughts and imaginations. What turns us on and how quickly and easily it happens has in part to do with where we are in life. Stress and busyness, disease, breast feeding, oral contraceptives, a partner who’s not as new and exciting as s/he used to be, pain – these are all desire killers. During puberty, when the libido hormone testosterone is high, the sex drive is intense and powerful. During old age spontaneous lust may have disappeared and can only be enticed forward by stimulation and fantasies.

Lack of desire is a widespread problem, with a negative impact on the lives of women and couples all over the world. Hence a great deal of money is at stake for a company who can bring a desire boosting pill on the market. The U.S. Food and Drug Administration has now approved Addyi (flibanserin), the first product ever to get an official stamp as a preparation strengthening sexual desire. It’s so far only tested on women prior to menopause. It’s been called “Pink Viagra” or Viagra for women, which is misleading. Viagra (for men) only works if the man already wants to have sex. Addyi is for those who have no desire for sex.

Small effect, many side effects

Dosage is one pill every day, and if you don’t have any noticeable effect after 8 weeks, you should stop the treatment. The pill can have side effects. It can make you dizzy, sleepy and nauseated. The risk is greatest if you drink alcohol, so during treatment with Addyi, you should not drink alcohol at all. A new kind of Antabus, actually. And the effect is not something that will make you see stars and fireworks. The women in treatment get a handful more sexual thoughts and fantasies, but only 10% of the women think their sex lives get better. On average, they have satisfying sex once or twice more every second month. If that makes it worth the trouble (and the side effects) taking Addyi probably depends on how often you have sex in the first place. And so far, Addyi is only approved for women who have not yet gone through menopause.

So Addyi is no miracle. Maybe it’s not at all better for Marianne than other ways of improving desire. I will come back to that later.

He still desires her. But her desire is gone.

The 60-year-old woman came to my office with her husband. She wanted to have a gynecological checkup. It had been very unpleasant last time she saw a gynecologist – her vagina was very dry and tender.

I asked if that was a problem for their sex life. Yes, it was, she answered. Actually, they did not have sex at all. It was impossible, even if they used a lubricant. She looked straight at me and answered in a matter-of-fact, direct way. She didn’t look at her husband, but he looked at her, concerned, mumbling that it had worked out well earlier, also after her menopause. She didn’t comment on that.

When I examined her it was obvious that her vagina was very dry and irritated. But that was not all. She squeezed her pelvic muscles so hard that it was impossible to do a gynecological examination and visualize the vaginal mucosa, the lining of the vaginal walls. There was just too little space. If she squeezed around her vagina like that when they were trying to have intercourse, it certainly wasn’t possible for him to enter her. And I think the reason with her seeing me was to tell the husband that they could not have sex.

Her sex life was over, but what about his?

When I told her what I had found, she actually seemed content. As I had just given her an alibi to finally drop all ideas about having sex. She clearly didn’t want that anymore. But he did. He asked a bit timidly if there wasn’t anything to do, lubricants, medicine? And yes, there was, so I gave her a prescription of vaginal estradiol tablets, the best remedy against postmenopausal vaginal dryness. But I don’t think she will pick them up at the pharmacy. She has decided that her sex life is over.

Then what about her marriage? I don’t know anything about that. Maybe they had lots of other ways of being intimate than sex. But it was clear that her husband was unhappy with the situation. What about his desire? Will he satisfy himself by masturbating in front of the computer late at night, or will he find another woman, a mistress? That is a dangerous solution. Has she thought that through?

Of course you should not have sex if you don’t want to. And it certainly can be a problem, when the parts in a relation differ a lot with regard to desire. But marriage is about willingness to compromise, more often than not. And desire can be turned on, if you allow it. How – that’s something you must talk about.

Sex after 50? You’re still young at that age!

That people over 50 are enjoying sex is hardly hot news anymore. But what’s it like when you get a lot older?

Do people over 80 have sex at all? Yes, they do. And it’s not even a few youthful exceptions. British researchers have interviewed 7000 men and women over 50 about their sex life, about how often and in what way they have sex, and about their thoughts and worries about the future. The survey showed that 60 % of people between 70 and 79 and 37 % of people over 80 were sexually active in one way or the other. As people get older, intercourse becomes less common. Instead, kissing, cuddling and masturbation takes its place.

The reason for not being sexually active anymore was usually that people had lost their partner. It was especially true for women over 80. If you become chronically ill – get diabetes, high blood pressure or another cardiovascular disease, joint pains or asthma, the disease often also impairs your sex life. This risk is greatest for men. Older women’s sex life is hampered by a dry, sore and sensitive vagina, men’s by erection problems. And both sexes feel that their desire for sex diminishes with age.

Women generally don’t worry as much as men if their desire wanes and sex is given up altogether. For the oldest, it does not seem to matter at all. But it’s important to both women and men that they agree with their partner about how often and in what way to have sex. Otherwise, at least one of the parties will be frustrated. The one who wants more sex will feel unsatisfied, and the one who wants less taken advantage of.

What to do? Well, there’s only one solution. Talk about it!