Erectile Dysfunction News

“Viagra May Raise STD Risks in Gay Men”

WEDNESDAY, June 1 (HealthDay News ) — Researchers have called on the federal government to impose new restrictions on Viagra because studies suggest it makes gay men more likely to use illegal drugs, have unprotected sex and become infected with sexually transmitted diseases.

But, a prominent physician said the findings of the researchers, based on a new analysis of 14 studies, don’t prove that Viagra is responsible for changing anyone’s behavior.

“To blame the drug is foolish,” said Dr. Abraham Morgentaler, associate clinical professor of urology at Harvard Medical School. “Just because two things happen to go together — in this case, risky behavior and Viagra — doesn’t mean Viagra caused the risky behavior.”

Since the introduction of Viagra in 1998, health advocates have worried about its impact on the gay community. Viagra and its newer rivals — Cialis and Levitra — are designed to treat men who can’t sustain erections, but they’ve also gained a reputation as basic sexual enhancers.

Researchers at the San Francisco Department of Health examined 14 studies that looked at Viagra use among gay men. Their findings appear in the June 2005 issue of the American Journal of Medicine.

Most of the studies surveyed gay men in San Francisco; many of the studies polled men at sexually transmitted disease clinics. All the studies were published between 1999 and 2004.
Eleven of the studies looked specifically at gay and bisexual men; seven of them reported that 10 percent or more of gay men said they used Viagra.

Five studies reported that gay men who used Viagra were 2 to 5.7 times more likely to have put themselves or their partners at risk by having unprotected sex with a person whose HIV status they either didn’t know or was the opposite of their own.

Studies in San Francisco suggested that Viagra users were 2.5 times more likely to test positive for HIV than other gay men, two times more likely to get diagnosed with a sexually transmitted disease other than HIV, and 3.5 times more likely to have used methamphetamines within the past four weeks.

Viagra “is the only sexual health product that’s associated with increased risk for STDs,” said study co-author Dr. Jeffrey Klausner, director of STD prevention and control services at the San Francisco Department of Health. “Condoms, birth control, emergency contraception — they’ve all been shown not to be associated with increased risk of STDs.”

It’s possible that Viagra increases the risk of STDs by prolonging sexual contact during intercourse, Klausner said. However, Morgentaler, the Harvard urologist, pointed out that Viagra “doesn’t affect how you think or how you reason and make judgments.”

Klausner acknowledged that it’s possible that Viagra users are just risk-takers in general. “But even if it were true that more risky people were more likely to use Viagra, shouldn’t those people be protected as well, and offered education and opportunities to reduce their risk?”

On that front, the study authors are calling on the government to mandate more extensive warning labels to alert consumers that their risk of STD infection may go up if they use Viagra. The authors also want the government to consider making Viagra a controlled substance.
According to Klausner, the latter move would eliminate free samples and make it harder for drug traffickers to sell Viagra.

While the study didn’t look at use of Cialis and Levitra, the government should examine those drugs too, the investigators wrote.

Pfizer Inc., the maker of Viagra, did not respond to a request for comment.

Morgentaler, author of The Viagra Myth: The Surprising Impact on Love and Relationships, opposes further restrictions based on “poor scientific conclusions.”

“Viagra has been a tremendous boon for millions of men,” he said. “The fact that there’s a small population that abuses it should by no means penalize the rest of the population.”

To learn more about erectile dysfunction drugs, see the “Erectile Dysfunction Drug Table”.

Erectile Dysfunction Trouble May Signal Heart Disease

HealthDayNews — May 24, 2005. Many men with erectile dysfunction may face an even tougher health problem: heart disease.

That’s the conclusion of a number of studies presented on May 24, 2005 at the American Urological Association (AUA) annual meeting in San Antonio. All found strong connections between the two conditions.

In one paper, Austrian researchers note a relationship between high blood levels of homocysteine, an amino acid marker for heart disease, and erectile dysfunction.

The researchers found that 20 of the 30 patients with erectile dysfunction they studied also had high homocysteine levels.

“Erectile dysfunction and cardiovascular disease are connected, and homocysteine is a marker for cardiovascular disease,” lead researcher Dr. Ralf Herwig, a consultant at Urology Clinic Innsbruck University Hospital, said at a news conference Tuesday. “Testing of homocysteine may be able to identify patients with the risk of erectile dysfunction.”

“Levels of homocysteine may be a sign of how severe erectile dysfunction is,” he added. “If you have a patient with erectile dysfunction and high homocysteine, then you can treat the patient as an erectile dysfunction patient but send them to a specialist that is looking after the vessels in the heart,” Herwig advised.

Simple dietary changes may also help reduce homocysteine levels. “Nutrition can influence homocysteine levels positively, and substitution with folic acid, in combination with vitamin B6 and B12, can reduce homocysteine levels significantly,” the researchers pointed out in their study. “Further studies have to show if vitamin supplementation can possibly help in therapy of erectile dysfunction.”

In another paper presented at the meeting, Italian researchers sought to pinpoint those specific types of heart disease associated with erectile problems.

Among 162 patients with heart disease, 46 percent had erectile dysfunction, according to researchers at the University Vita-Salute San Raffaele, in Milan. They noted that among the patients with chronic angina, 71 percent experienced erectile dysfunction for a little over a year before being diagnosed with heart disease.

Factors most predictive of erectile dysfunction included being older, prior heart attack and a diagnosis of two to three blocked coronary arteries. Furthermore, patients with a history of heart attack plus erectile dysfunction were at a sixfold increased risk of having several blocked coronary arteries, the researchers noted.

“Erectile dysfunction prevalence differs across subsets of patients with coronary artery disease and is related to extent of coronary artery disease and type of clinical presentation,” the Italian team wrote. “It is high in chronic angina with multi-vessel disease and low in heart attack with one-vessel disease as result of clinical conditions with different atherosclerotic burdens.”

“This isn’t so very new,” Dr. Ira Sharlip, a spokesman for the AUA, told the news conference. “This study shows with advancing coronary disease there is a greater likelihood of erectile dysfunction. That’s been shown before.”

He added, however, “Erectile dysfunction is probably a marker for cardiovascular disease. Patients who have erectile dysfunction should be in the hands of physicians who can evaluate them for coronary disease.”

In a third presentation, investigators from Germany reported that Viagra, the male impotency drug, improved circulation in small blood vessels and also improved vessel function in patients with coronary artery disease. “If endothelial dysfunction is defined as a disease, and if it should be treated, a drug like sildenafil could be used,” said lead researcher Dr. Jai-Wun Park, from the Cardiovascular Institute at the Technical University in Dresden. One erectile dysfunction expert said most of these findings come as no surprise.

“I often start my patients on folate to reduce homocysteine,” noted Dr. Kevin Billups, medical director of the Epicenter for Sexual Health Medicine in Edina, Minn. “We also found that men with erectile dysfunction have higher levels of C-reactive protein [another blood marker for heart disease risk].”

He recommends that patients with erectile problems get checked early for possible cardiovascular disease. “If you have erectile difficulty, and if it persists for three to six months, you really need to go in and get treated not only for your erectile dysfunction, but also get a good basic evaluation of blood pressure, weight, blood,” he said. “Don’t just write erectile dysfunction off as being tired or being stressed,” Billups said. “It’s usually part of a vascular issue. If men would come in when they first experience erectile dysfunction, we would pick up cardiovascular disease at a much earlier clip.”

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