While it was once shrouded in secrecy, erectile dysfunction (ED), is now at the forefront, thanks to high-profile media advertisements for Viagra and Cialis.
VIAGRA® (sildenafil citrate) and CIALIS® (tadalafil) are both phosphodiesterase-5 (PDE5) inhibitors, a class of drugs which ironically were originally developed to treat angina. PDE5 inhibitors have been shown to lower blood pressure which can be a factor in erectile dysfunction. Now they are considered the first- and second-line ED treatment options that are safe to take with cardio function/heart conditions.
Despite the active exposure on TV, I find my patients still have many questions. Here are the five most common ones asked in my office:
#1. Are Viagra and Cialis safe if you have heart disease?
Viagra can safely be taken by people with heart disease, but not if you are taking a nitrate drug for chest pain because both nitrates and Viagra could lower blood pressure.
If you are on nitroglycerin and you occasionally want to take Viagra to enhance your sexual experience, it is best to consult your doctor to explore scheduling options for both drugs. Like Viagra, Cialis is safe if you have heart disease.
The major difference between Cialis and Viagra is that Cialis can last up to 36 hours while Viagra is generally effective for up to four.
#2. Is ED a sign of heart disease?
Heart disease and erectile dysfunction are connected. Interestingly enough, though not surprising, erectile dysfunction can be an early warning sign of heart disease. There are many causes for ED. Among the causes is heart disease as well as age. As we age, our testosterone levels naturally decrease which can contribute to the incidence of ED in an older population.
#3. Can medications cause ED?
Medications are prescribed to address medical issues. In the process, they can create unexpected side effects. Both over-the-counter and prescription drugs can cause ED including diuretics, anti-depressants, antihistamines, chemotherapy and muscle relaxants as well as ace inhibitors and beta blockers which are often prescribed for congestive heart failure. And that is the shortlist.
If you are experiencing ED, and you think there may be a link to your medication, consult your healthcare professional first. It is highly recommended that you not stop taking your medications on your own. Often your physician can suggest an alternative to try which may address the primary issue and without the side effect of erectile dysfunction.
While you may think a glass of wine may relax you and help with ED, research has found that alcohol as well as smoking and recreational drugs can be triggers for ED and should be avoided if you are experiencing ED.
#4. Are stress and ED related?
Sometimes it is all in your head, meaning the root cause of the ED is in your brain. Depression and anxiety are signs of unhealthy distress which can affect how your brain sends messages to your body. Instead of your body releasing testosterone, it releases cortisol which has the opposite effect, causing you to have difficulty achieving an erection. Long term chronic stress can be a cause of ‘low T’ a topic openly mentioned in TV ads.
Which brings me to the last and most common question.
#5. Are over-the-counter testosterone supplements safe?
Like Viagra and Cialis, the ads promoting the benefits of over-the-counter testosterone supplements are all over the media. If you are experiencing symptoms of ED, you may be tempted to head to the pharmacy and buy a bottle of whatever supplement the ad or celebrity is recommending.
My advice: Before you head over to your local pharmacy to buy an OTC supplement to enhance your bedroom experience, make an appointment with your healthcare professional. Typically there is little evidence to demonstrate the effectiveness of most testosterone OTC supplements and research has indicated there may be negative consequences from the over-the-counter version.
When in doubt, have a heart-to-heart conversation with your cardiologist. Your every body part will thank you.
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