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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.