Author: edquestions

Q. Viagra doesn’t seem to be working for me. I started out with one 50-milligram tablet taken an hour before I expected to have sex but was still unable to get an erection strong and long-lasting enough to have intercourse with my partner. What other options are available to me?

A. You can increase your Viagra dose to 100 milligrams to see if the larger dose does the trick. If that also fails to overcome your symptoms of ED, you might find relief with one of the other ED drugs on the market. Although all of these drugs are similar in chemical structure to one another, there is enough variation that one drug may work for one man but be less effective in another. If neither of these solutions works, it’s possible that you will have to try another form of treatment altogether.

Such alternatives include penile injection therapy, which involves the injection of a vasodilating drug directly into the shaft of the penis, or a penile implant. Yet another option is a vacuum erection device, which basically consists of a plastic cylinder that fits over the penis and a pump mechanism to pump all the air out of the cylinder.

As a vacuum is created, blood rushes into the penis, creating an erection. At that point, the plastic cylinder is removed and a constricting band is placed at the base of the penis to keep the blood in place until the sexual activity has been completed.

Q. Over the last year or so, my erectile function has gone downhill rapidly. I’m in a monogamous relationship with a longtime girlfriend, and I’m sure she’s noticed the changes in me, but I’m finding it difficult to discuss the matter with her. Does it make sense for me to man up and confront the elephant in the room?

A. By all means, you should talk to your partner about your erection problems. She almost certainly is as aware as you are of your problems getting and keeping an erection. If you don’t discuss it frankly and explain that it’s not your lack of desire but a physiological problem that’s at the root of your problem, she may mistakenly believe that you no longer find her sexually exciting. Enlisting the help of your intimate partner can also help you fight the problem.

When you are having difficulty getting an erection, she can supply the needed stimulation — manually or orally — to help you achieve as full an erection as possible. If the problem has gone beyond the ability to you and your girlfriend to overcome it, you can both discuss the use of ED drugs and how that might resolve matters.

She’ll need to know that you can’t be quite as spontaneous as you might have been in the past and will need to pop a pill 30 to 60 minutes before you’re able to perform sexually.

Q. I’m in my mid-40s and have always found it easy to get an erection, but lately it seems to take longer to get hard and I tend to go soft quicker than I did in the past. Is this something that’s to be expected at my age? Would Viagra help or should I take some other steps to improve erectile function?

A. The early signs of erectile dysfunction serve as a helpful signal that things will probably get worse unless you take proactive steps to improve your overall health. Eating a healthy diet, such as the so-called Mediterranean diet, can be a good way to start.

Such diets are high in heart-healthy nutrients and fats but lower in refined sugars and grains, as well as the unhealthy fats found in red meats, high-fat dairy foods, lard, and tropical oils, such as coconut and palm oils. If you take action quickly enough, you may be able to regain more normal erectile function without resorting to prescription medications.

Other important lifestyle choices include a regular regimen of physical activity, which can begin slowly with brisk walking and progress to more advanced forms of exercise as you gain strength. If you smoke, stop as soon as you can, and if you don’t smoke, don’t start.

Work with your doctor to manage those underlying ailments such as atherosclerosis and diabetes that can increase the risk of ED. Alcohol is all right in moderation, but drinking in excess can make it difficult or even impossible to get an erection.

If you would prefer the convenience and confidentiality of ordering your drugs online, there is a safe alternative. Secure Medical Inc., based in Tempe, Arizona, operates a network of online drugstores that sell only FDA-approved drugs, all of which are sourced from licensed U.S. pharmacies.

Websites in the Secure Medical network include AccessRx.com, eDrugstore.com, and Viamedic.com. All sell a full range of ED medications, as well as a number of other prescription and OTC drugs.

For those who have a prescription from their doctors, they can fax it or scan and email it along with their order. However, if you don’t have a prescription, each of these websites can arrange a complimentary online consultation with a member of its team of licensed U.S. physicians.

You will be required to complete a questionnaire covering your current symptoms, medical history, and a list of all prescription and OTC drugs you’re now taking. If the doctor concludes that you’re an appropriate candidate for Viagra or another of the prescription drugs these websites offer, he or she will authorize a prescription.

Teva Pharmaceuticals USA is scheduled to introduce its generic formulation of Viagra beginning in December 2017. Likely to follow soon thereafter is a generic version of the drug from Mylan. Under FDA regulations, all generic substitutes for Viagra — or any brand-name drug, for that matter — must contain the same active ingredients as the branded drug.

The offerings from Teva and Mylan will be sold under the generic name sildenafil citrate, as will all generic versions of the drug that may follow.

FDA regulations do not require that a generic drug’s inactive ingredients replicate those in the brand-name drug, but since such ingredients are chemically inert, it has no real effect on the consumer. The primary effect of generic competition for Viagra will be to exert downward price pressure on the brand-name drug, as Pfizer seeks to continue to appeal to some buyers who’d prefer to stick with the original little blue pill.

As more and more generic versions hit the market, competitive pressures will increase, pushing average prices for the drug still lower.

Unless you know the reputation of an online vendor, buying Viagra and other ED drugs online can be a very risky proposition. It’s been estimated that roughly 90 percent of the ED drugs advertised online are counterfeit.

More importantly, many of these drugs contain potentially toxic ingredients, including dry wall material used as filler and printing ink used as a coloring agent. It’s true that some of these drugs have been found to contain the active ingredients in brand-name ED drugs but at levels that are either too low to be effective or so high that they could be dangerous.

Such ingredients are not listed on the drugs’ labels, so the consumer has no way of knowing the amount of active ingredient he may be getting. Unless you know you’re ordering from a trustworthy online supplier, it’s best to avoid buying ED drugs online.