My old high-school classmate Fred, for example, confided that he’d tried Viagra to celebrate his fortieth birthday and couldn’t believe what a difference it had made when he and his girlfriend had sex that night. Yet despite having had a wonderful night of lovemaking, Fred announced, “I won’t lake it again.”
“Why not!” I asked,
“It’s too hard to live up to!” he said, and we both laughed at his unintentional pun. Then Fred grew serious. “I don’t want to be in a situation,” he said. “where my girlfriend comes to expect that my penis will be completely firm on command, It would be too much pressure for me. I’m okay the way I am, and I don’t want to feel that I need to take a pill in order to make love.”
I thought this was an eminently sensible response. Creating an artificial new level ot erectile performance is not the best way to sustain an authentic relationship. Fred wanted to be accepted for who he was, without any drug enhancement. But as we shall see, this kind of mature altitude is by no means universal among perfectly healthy man in teir quest for sexual prowess.

The ability to have a really firm erection is important to men, especially those who are not yet in a committed relationship and hope to impress a partner with their sexual prowess. Women sometimes laugh at what they see as the simplicity of men. “Why do guys think sex is all about the penis.’” they ask. For men, sexual performance corresponds with self-esteem, and with the typical male focus, on the penis, greater hardness and rigidity translates into greater performance.
The Viagra Myth plays easily into this mind-set because the word on the street is that Viagra does indeed make a normal erection even firmer. As a physician, I am reluctant to prescribe Viagra to anyone who doesn’t truly need it to erectile dysfunction, but I have had many patients and even friends with normal elections who have shared their Viagra stories with me.

What about men who do not have a true erection problem? Just like the young students at Harvard Medical School who ask me what Viagra can do for them, many men who don’t have any actual problems wirh normal potency have also wondered whether Viagra might turbocharge their penis, transforming them into the sexual superstar of their fantasies.

Here is another element ol the Viagra Myth has pervaded our culture! many young men, nervous or insecure about their sexual prowess and performance, assume that having a guaranteed superhard penis is the ultimate path to happiness. Is this true! Does Viagra actually increase rigidity for men without erection problems! And does an extra-hard penis really reward the man who already functions normally, even if this requires a drug to help him accomplish such a goal? Or is this another Faustian bargain with i profound but hidden cost to pay further down the road?

Sildenafil citrate has been evaluated clinically and experimentally with each of these endpoint measurements . Initial studies using the GAQ in more than 3000 patients with a variety of etiologies of ED in I1 double-blind , placebo-con- trolled , flexible-dose studies at week 12 demonstrated that placebo improved erections by 22 % compared with sildenafil at 76 %. When querying patients about successful attempts at intercourse , this same group of patients answered 26 % of the questions positively with placebo compared with 66 % with silde- nafil . In reviewing four randomized , double-blind , placebo-controlled , fixed- dose studies of 12-24 weeks duration , a placebo response was demonstrated in the group of patients queried about improvement in their erections with GAQ . In this group , 24 % had positive placebo response , 63 % responded positively to 25 mg of sildenafil , 74 % to 50 mg , and 82 % to 100 mg . When observing patients of various ages , similar efficacies were demonstrated . In these studies , 24 % of patients who were younger than 60 years of age respond- ed to placebo compared with 78 % of those of the same age in the sildenafil group ( P < . 0001 ); 18 % of patients responded to placebo compared with 69 % to sildenafil ( P < . 0001 ).

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The clinical efficacy of erectogenic agents can be measured with a variety of instruments . The most common instrument is the global efficacy assessment question ( GAQ ), which asks patients ” Did the treatment that you used for your erections improve your erections during the time of therapy “. Although this is an important endpoint measure , it is not as rigorous as some other measures . However , it is the standard measurement for most clinical studies of erectile function agents . Other endpoints include a measurement of the percent of suc- cessful attempts at intercourse and a measurement of the International Index of Erectile Function ( LIEF ) with changes in the erectile function domain score from baseline to study completion . Using this score , values less than 10 sug- gest severe ED and values higher than 26 suggest normal erectile function . Other methods used for measurement include sexual encounter profile ques- tions ( SEP ). The SEP-2 asks , ” Were you able to insert your penis into your partner ‘ s vagina ” and the SEP-3 asks , ” Did your erections last long enough to have successful intercourse ?”