Source: Anchorage Daily News
Date: 20 April 2004

Young men experiment with Viagra


By Helena Olivero

ATLANTA - Hundreds of patients asking Dr. Scott Parry for Viagra at his Atlanta clinic are young, healthy and virile.

They don't suffer from diabetes, hypertension or any other medical cause of impotence.

Some complain about performance anxiety. Others say that their marriage is in need of a spark. Partygoers are looking for something to offset the effects of alcohol.

They're part of a new wave of men in their 20s, 30s and 40s who look nothing like Viagra's first spokesman five years ago: former presidential candidate Bob Dole, who famously used the term "erectile dysfunction," or ED. Instead, they mirror the drug manufacturer's new spokesman, home-run slugger Rafael Palmeiro, who has used Viagra but is reported to have said he didn't need it.

"Mr. Blue" - a slang term for the drug - has exploded into a multibillion-dollar industry, with nine Viagra tablets dispensed every second around the globe.

Men with ED aren't the only ones fueling the business. Curious men and others looking for that edge in the bedroom can buy the pills from a doctor, off the Internet or around Atlanta nightclubs, sealed in tiny zip-top bags.

"Some young men will come in for a cold or pain in the leg and say, 'By the way, I was wondering about this Viagra, and my wife and I have been having some problems,' or 'I could use something to build my confidence,'" said Dr. Shangbo Guan, a specialist in internal medicine who is seeing an increase in the number of younger men asking for Viagra.

Experts say that some of these men suffer from unrealistic expectations about performance or are masking more deep-rooted problems, such as relationship conflict, poor self-image or drug addiction.

"There seems to be growing interest in having a 24/7 erection and performing sexually without looking at the context or meaning," said Dr. Gail Wyatt, a sex therapist, professor of psychiatry at UCLA and the author of No More Clueless Sex.

At other times it is even more superficial: Men simply want to be impressed with how they function.

"Everybody has insecurity, and here's this one thing they take and they can feel they have this power and they look good," said Virginia Erhardt, a sex therapist.

Viagra manufacturer Pfizer and other companies selling impotence drugs vehemently deny targeting healthy men and say the drugs are intended only for men with ED.

With as many as 30 million American men suffering from at least partial ED, according to the National Institutes of Health, there is no need to go outside that pool of potential customers, the drug-makers say. They estimate that only one in every 10 men with ED seeks treatment.

The incidence of ED increases with age, and it is unclear how many men under 40 have it. Government and private sector estimates of the number of 40-year-old men suffering from ED range from 5percent to 39 percent. Men 40 and younger account for at least 8 percent of the prescriptions for Viagra, according to Pfizer. No age breakdown is available for Levitra or Cialis, a newcomer to the market already dubbed "the weekender," because it can stay in the bloodstream for 36 hours. Unregulated Internet sales are not tracked.

But all three drug companies say that young, healthy users represent a small slice of the business - even "peripheral," according to Pfizer spokesman Daniel Watts.

Doctors and people on the party circuit argue that they are seeing anecdotal evidence to the contrary. While most who use the drugs need them, there's clearly interest among growing numbers to see if they can find thrill in a pill.

Guan said that only about 10 percent of the men asking him for ED medication appear not to need it, but the buzz about the pills is getting around, and he's seeing it in his office.

There's a reason the impotence drugs are intended only for men who clearly need them. While considered relatively safe, the trio of impotence drugs can lead to serious complications when taken with nitrates, often used to control chest pain, and other medications. Possible side effects include flushing, muscle aches and even bluish vision. Urologists warn that some men who don't need the medication might develop a psychological dependency. And the long-term effects are still unknown.

Use of the drugs by men without ED also seems completely unnecessary. The drugs work by increasing blood flow to the penis, allowing for an erection if stimulated. It is not a hormone or an aphrodisiac.

"You should never take any medication that's not necessary," said Dr. Deena Davis, a urologist at St. Joseph's Hospital in Atlanta. "Men think they will have this great erection, but if you are fine without it, there is no reason to take it.... I think some men look at it like a miracle pill, and then there"s word of mouth about this buddy who lasted 20 days."

With impotence pills easily available through the Internet, Parry, a primary-care physician, typically grants requests for them so he can supervise their use and educate his patients about the risks. He is also afraid some men may not use a condom if denied a prescription for Viagra.

"In an era of safe sex, the condom takes away some of the sensation, and if you want to encourage safe sex, Viagra can help that," Parry explained.

Some doctors also worry that the new Cialis may be particularly attractive to young party revelers because it stays in the bloodstream for so long. "You take it at lunch on Friday and you are good all weekend," said Dr. Bruce Stein, an Atlanta urologist.

A Cialis spokeswoman, however, explained that the long-acting drug is meant to let couples "take advantage of the romantic moment as it happens and have less time pressure."

Some doctors also say that mixing impotence drugs with mind-altering drugs, such as Ecstasy or crystal methamphetamine, is on the rise - and a potentially deadly combination. Wyatt, the UCLA sex therapist, said that Viagra has become a staple at popular "rave" parties in the gay community, known as "circuit parties."

"If you are in party mode and if everything is sped up, you may not take time to talk about sexually transmitted diseases," Wyatt said.

In fact, a study of 844 men at a San Francisco STD clinic found that Viagra users had had an average of 5.4 sexual partners during the past two months, compared with 3.5 partners for non-Viagra users. The study also found that more than half the men using Viagra had obtained it through a friend, not a doctor.

Pfizer spokesman Watts said that Viagra is not to blame.

"This is not about Viagra," he said. "It is about individuals taking responsibility for their actions - practicing safe sex and taking appropriate actions."

Many experts blame highly sexualized images in magazines, pornography and such TV shows as Sex and the City for giving young men the impression that women desire marathon sex.

"Sex is everywhere," said Davis, the St. Joseph's Hospital urologist. "Men see sex and sexual performance as part of the definition of what a great catch a guy is.... I think this is fed to them by the outside world for the most part. Not their partners."

Relationship gurus say that many of the roots of impotence are psychological and need not medication but counseling, or at least a different mind-set. They recommend drug-free solutions: tenderness, love and communication.

"Women don't want a minute-and-a-half, but they sure don't want four hours," said Erhardt, the Atlanta sex therapist. "Most women would like four hours of lovemaking that includes hugging and kissing and cuddling - but four hours of intercourse? Give me a break."

Wyatt said that many men are developing a warped - and casual - view of sex.

"Viagra is not the way to a good sex life," she said. "The way to a good sex life is to make a friend of the person you're with ... and look at sex as an added ingredient."

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