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May 29, 2002 — Once again, Viagra comes to the rescue.

A new study shows that Viagra in combination with Paxil helps premature ejaculators who have not improved with standard treatment.

If a man can work up the nerve to talk to his doctor about premature ejaculation, the doctor may refer him to a psychiatrist or a sex therapist, or may prescribe one of several possible medications including Paxil, an antidepressant, or a lidocaine numbing ointment that is rubbed on the head of the penis before sex.

The study, presented this week at the annual meeting of the American Urological Association in Orlando, Fla., looked at 138 premature ejaculators who started out using a numbing ointment. Thirty-eight were satisfied with that treatment. The remaining 100 started taking Paxil, and 42 of them were satisfied with that, leaving 58 who took Paxil with Viagra.

Over the course of three months, the men took one dose of Paxil seven hours before sex and one dose of Viagra one hour before sex. They noted how long they were able to have sexual intercourse, from the moment they entered a partner’s vagina to the moment they ejaculated. In the beginning, they were able to sustain intercourse for less than one minute to three minutes.

They also rated their performance on a scale. At first they ejaculated too soon from “half of the time” to “almost always.”

By the end of the study, 56 of the 58 men were able to have intercourse for more than three minutes most of the time.

It’s well known that Paxil has sexual side effects, including delayed ejaculation. But Viagra? There can be several explanations for this, says study author Juza Chen, MD, of the Tel Aviv Sourasky Medical Center in Israel.

One possibility is that Viagra acts on the part of the brain that controls ejaculation. This function involves the chemical nitric oxide. Too much nitric oxide inhibits ejaculation. Viagra increases the amount of nitric oxide in the body, which is how it helps men get erections. Juza says there is some scientific evidence that Viagra increases the amount of nitric oxide in the brain, although that is not certain.

“Another possibility could be a decrease of sensitivity in the [head of the penis],” Juza says.

Arnold Melman, MD, head of the urology department at the Montefiore Medical Center in New York City, says he doubts that has anything to do with it. “What evidence is there?” he says. “Do you think when you have a hard erection you’re less sensitive?”

Viagra may have had a psychological effect, too: With a firmer erection, they had more confidence, so they had more control. Melman says he thinks that is a more likely explanation. “I’m sure that’s true,” he says. “Much of the reason for premature ejaculation is psychological, not physical.”

Juza says more research is needed to learn about using Viagra as a treatment for premature ejaculation. He plans to study the effects of Viagra alone compared with a placebo, and Viagra alone compared with Paxil alone.

“I think it’s a good concept,” Melman says. Read more…

People seem to want and need to be close to others. As we grow older, many
of us also want to continue an active, satisfying sex life. But the aging
process may cause some changes.

What Are Normal Changes?

Normal aging brings physical changes in both men and women. These changes
sometimes affect one’s ability to have and enjoy sex with another person. Some
women enjoy sex more as they grow older. After menopause or a hysterectomy,
they may no longer fear an unwanted pregnancy. They may feel freer to enjoy
sex.

Some women do not think things like gray hair and wrinkles make them less
attractive to their sexual partner. But if a woman believes that looking young
or being able to give birth makes her more feminine, she may begin to worry
about how desirable she is no matter what her age is. That might make sex less
enjoyable for her.

A woman may notice changes in her vagina. As she ages, her vagina shortens
and narrows. The walls become thinner and also a little stiffer. These changes
do not mean she can’t enjoy having sex. However, most women will also have less
vaginal lubrication. This could affect sexual pleasure.

As men get older, impotence becomes more common. Impotence is the loss of
ability to have and keep an erection hard enough for sexual intercourse. By age
65, about 15 to 25% of men have this problem at least one out of every four
times they are having sex. This may happen in men with heart disease, high
blood pressure, or diabetes-either because of the disease or the medicines used
to treat it.

A man may find it takes longer to get an erection. His erection may not be
as firm or as large as it used to be. The amount of ejaculate may be smaller.
The loss of erection after orgasm may happen more quickly, or it may take
longer before an erection is again possible. Some men may find they need more
foreplay. Read more…

angina-a type of chest pain-that happens when there is
not enough blood flowing to the heart. To improve blood flow to the heart,
nitroglycerin opens up (dilates) the arteries in the heart (coronary arteries), which improves symptoms and
reduces how hard the heart has to work.

Nitroglycerin comes in a quick-acting tablet or spray form, or as
a long-acting pill. The quick-acting pill or spray forms are used under the
tongue (sublingually). Your health professional will prescribe the right amount
for you; do not use another person’s nitroglycerin. Read more…

Thought about leading a healthier lifestyle but haven’t gotten
around to doing it? Here’s a possible incentive: Experts say people who are
mentally and physically fit are more likely to have good sex lives.

“If you feel good about yourself, you are in a better
position to feel good about relationships, including your sex life,” says
Karen Zager, PhD, a psychologist in private practice in New York City.

“When one is not feeling well, and is exhausted, it can
certainly have a negative impact on the quality of one’s sex life,” says
Saralyn Mark, MD, a senior medical adviser at the Office on Women’s Health.

This may all seem intuitive, yet many people find the road to a
fitter mind and body to be bumpy, especially if it involves losing weight,
starting an exercise program, reducing stress, or getting enough sleep.

One big reward, though, is to look and feel better — arguably
a plus for good romantic and sensual activities.

Eat Right

While there is no proven connection between a balanced diet and
bedroom performance, a poor diet can cause health problems that can possibly
interfere with sex.

Studies show animals that get too few calories tend to have
weakened immune systems, says John Allred, PhD, professor emeritus of nutrition
at Ohio State University. He says illness can be a big hurdle for pleasurable
intercourse.

“If you have heart disease, then you might be taking
medication that would inhibit sexual activity, or you might be afraid to have a
heart attack,” says Allred. “If you have the flu, a high fever, or just
don’t feel good … any of these things would be a turn-off.”

Mark Kantor, PhD, associate professor of nutrition and food
science at the University of Maryland, agrees, saying, “You will feel sexy
if you look and feel good.”

A way to do that is to eat an overall balanced diet and to
exercise each day. The two go hand-in-hand, says Kantor, as demonstrated by
today’s obesity problem, in which people eat too much food and aren’t active
enough.

Move That Body

Being physically active can be a natural Viagra boost,
according to the American Council on Exercise (ACE), which recommends 20 to 30
minutes of moderate exertion a day.

“Men and women who exercise regularly are going to have
increased levels of desire,” says Cedric Bryant, PhD, ACE’s chief exercise
physiologist. “They’re going to have enhanced confidence, enhanced ability
to achieve orgasm, and greater sexual satisfaction.”

If that isn’t motivation enough to work out, consider this:
Researchers have found that there is a correlation between waist size and a
man’s odds of having erectile dysfunction (ED). The larger the man’s waist
size, the greater his chance of having ED (because of a higher risk of
underlying cardiovascular disease).

Need more positive reinforcement? Studies show that regular,
moderate exercise can have a positive benefit on major sexual problems, such as
ED in men and low libido in both men and women.

It only makes sense, say experts, since ED is often caused by
poor blood flow to the penis, and exercise can improve the body’s ability to
pump and circulate blood throughout the body.

The same can be true for the ladies. In one University of Texas
at Austin study, physically active women who watched an X-rated film had a 169%
greater blood flow to the vagina compared with when they were inactive.

And there’s more good news. Mark says exercise can promote the
body’s release of hormones important for sexual arousal, increase aerobic
capacity and muscle strength, and boost self-body image — all definite
benefits for between-the-sheets play. Read more…

April 1, 2001 — Move over, Viagra: A team of researchers has found that an experimental form of gene therapy can restore over-the-hill male rats to the sexual potency — as measured by their ability to have erections — of studly young rats just a third their age. The therapy was described at the annual Experimental Biology meeting in Orlando, Fla.

Although the therapy is far from being ready for prime time in humans, it has potential as a long-acting treatment that could help to restore youthful vigor to men with erectile dysfunction, report Trinity Bivalacqua and colleagues from Tulane University in New Orleans and Johns Hopkins University in Baltimore.

In their study, the researchers injected into the penises of aged rats a cold virus modified to carry a gene that helps blood vessels in the penis to expand and fill with blood, one of the key steps necessary to creating and sustaining an erection.

“We looked at the physiology, asking is this going to help these animals get better erections, which it did,” Bivalacqua, a medical student at Tulane University, tells WebMD.

Erections are controlled by a complex series of events involving nerves and the signals they carry, as well as hormones and other substances that control the expansion of blood vessels, so it’s not surprising that any one of several defects or disruptions of one of the mechanisms involved in sexual performance in men can result in erectile dysfunction.

One method for treating erectile dysfunction has been through direct injection into the penis of substances that stimulate the release of chemicals within the penis that control the relaxation of smooth muscle. When smooth muscles surrounding the blood vessels in the penis relax, they allow more blood to enter, thereby causing an erection. Drugs like Viagra work by interfering with an enzyme that would otherwise prevent relaxation of smooth muscle.

Unfortunately, penile injections and Viagra are one-shot deals and need to be repeated every time a man with erectile dysfunction wishes to have sexual intercourse.

To see whether they could create a longer-lasting treatment for erectile dysfunction, Bivalacqua and colleagues injected into the penises of aged male rats a harmless cold virus, called an adenovirus, that had been modified to carry a gene for an important neurotransmitter, or chemical messenger, involved in erections.

Five days after the injections, the rats underwent nerve stimulation to simulate a normal erection, and their responses were compared with those of other rats one-third their age. The researchers found that older animals that received the adenovirus had erectile responses comparable to those of young rats. In contrast, older rats injected with a different gene not associated with erectile function had no significant improvements in function.

The researchers also found evidence that the virus continued to be present in penile tissue for up to 30 days, suggesting that the therapy, if found to be safe and effective in humans, could be delivered once a month rather than before every episode of sexual intercourse — no doubt a welcome prospect to men who are squeamish about the idea of penile injections.

But a urologist who studies gene therapy for erectile dysfunction tells WebMD that there are several drawbacks to using adenoviruses as carriers for genes.

“As a strategy in humans, I think adenovirus has some drawbacks in that it’s inflammatory, and usually repeated doses will cause [an immune system reaction]. I think we need to keep trying different genes, and we also need to start looking at long-term strategies for gene expression, because these are [temporary] and won’t be permanently incorporated into the penis,” says Hunter Wessells, MD, associate professor of urology at the University of Washington School of Medicine in Seattle.

Craig F. Donatucci, MD, a urologist who specializes in research and treatment of erectile dysfunction at Duke University Medical Center in Chapel Hill, N.C., tells WebMD that “conceptually it makes sense, because you fix the problem, but then you have the issue about the dangers of [adenoviruses].”

Donatucci points to the 1999 death of a patient at the University of Pennsylvania who was undergoing experimental gene therapy with an adenovirus for correcting a lifelong metabolic disorder. “If you’re talking just about erectile failure, what’s your safety level? Where do you set that?” he asks. “From a general philosophical viewpoint, it’s very attractive to think of gene therapy in the future, putting in some form of gene therapy, but realistically, it’s a long way from happening.” Read more…

As a psychologist who has counseled heart patients for more than thirty
years, Wayne Sotile, PhD, knows exactly how much they worry about sex after a
heart attack.

And if theyre not anxious, believe me, their partners anxious, he
says.

Couples worry about triggering a second heart attack, or even that a patient
could die in the bedroom. But Sotile and cardiologists tell WebMD that
sex isnt nearly as risky as many patients believe. With a touch of
reassurance, heart patients can once again enjoy sex after a heart attack.

Why Fear Sex After a Heart Attack?

While fears of another heart attack or dying are common, patients have also
told Sotile that theyre afraid of traumatizing their partner if they die
during sex. As director of psychological services for the Wake Forest
University Healthy Exercise and Lifestyle Programs, Sotile is also a special
consultant in behavioral health for the Center for Cardiovascular Health at
Carolinas Medical Center in Charlotte, North Carolina.

Female patients have told Nieca Goldberg, MD, a cardiologist and chief of
Womens Cardiac Care at Lenox Hill Hospital in New York City, about concerns
about increased heart rate and sweating during sex after a heart attack. They
fear triggering heart attack symptoms.

According to Goldberg, depression also sidelines many patients, especially
women.

Women have higher rates of depression after their heart attacks, she
says.

Men are also prone to problems that cause them to put sex on the back
burner. Randal Thomas, MD, a preventive cardiologist and director of the
Cardiovascular Health Clinic at the Mayo Clinic, says, A persons life is
essentially thrown upside-down. They see their frailty and how close they came
to dying, and it can lead to a lot of psychological issues and need for
recuperation.

Some patients give up sex after a heart attack, and theyre too embarrassed
to talk to their doctor about it. Goldberg encourages you to bring
up the subject if your doctor doesnt.

Your doctor should talk to you about sex. With all the high-tech procedures
that we do for people to get them back into the community, I also think that we
have to ensure them a high quality of life, and sexual activity is part of
that.

When Can You Resume Sex After a Heart Attack?

Most people can safely resume sexual activity a couple of weeks after a
heart attack, if they have no serious complications, cardiologists say.

In fact, the chance of another heart attack during sex is so low that its
not worth worrying about, says James E. Muller, MD, a researcher who published
a 2000 study, Triggering of Cardiac Events by Sexual Activity, in the
American Journal of Cardiology.

The absolute risk is very low and should not be a consideration for those
with stable coronary disease, he says.

Sex is generally physical activity, and some doctors have even said its
the equivalent of walking up a flight of steps, Goldberg says. Its not as
vigorous an activity as some people perceive.

Patients may not even need an exercise stress test first to check how much
physical activity their heart can handle according to Thomas. In general,
patients can resume sex after a heart attack if they are able to walk a couple
of flights of stairs, if theyre able to walk on a treadmill, or do
moderate-intensity activity without any chest discomfort or without any severe
shortness of breath, says Thomas.

Sex after a heart attack is safe even after successful bypass surgery or
angioplasty in which stents are placed inside arteries to keep them open,
according to Goldberg. However, bypass patients may need additional time to
recover from their surgical wounds.

Certain high-risk patients do need to be more cautious, however. If theyve
developed complications from a heart attack–for example, heart failure or
dangerous heart rhythms that make them prone to heart attack, cardiac arrest,
or faintingthey may need additional treatment. Until these treatments work to
reduce their cardiac risk, they should ask their doctor when it will be safe to
resume sexual activity. Read more…

May 5, 2003 (New Orleans) — Depression takes all the joy out of life, even the joy of sex. Fortunately for many people, many symptoms of depression diminish once they begin treatment with antidepressant drugs such as Prozac. But for many women, when the depression leaves the sexual dysfunction remains, says H. George Nurnberg, MD, professor of psychiatry at the University of New Mexico.

For these women, he says that Viagra can change their lives.

In fact, he tells WebMD that Viagra is just as good at reversing antidepressant-related sexual dysfunction in women as it is in reversing similar symptoms in men.

And he presented his evidence at the 51st annual clinical meeting of the American College of Obstetricians and Gynecologists.

Nurnberg, who has already published a study in the Journal of the American Medical Association about the efficacy of Viagra in men who have sexual dysfunction associated with treatment for depression, says that 84% of women in his study had a return of sexual enjoyment after treatment with Viagra.

The study enrolled 42 women who had no history of sexual dysfunction before treatment for depression. All of the women were treated with one of the SSRI type of antidepressants such as Prozac or Zoloft, which often have sexual dysfunction as a side effect. All the women were “no longer depressed after being treated with those drugs for six to eight weeks,” he says. But all the women “reported sexual dysfunction related to the [SSRI] treatment.”

The women are randomly selected to take either Viagra or dummy pills for eight weeks. Neither the women nor the doctors knew which pills the women were getting.

Nurnberg and his colleagues assessed response using a standard psychiatric test designed to measure sexual function. The test, called the Clinical Global Impression-Sexual Function or CGI-SF, scores responses about arousal or sexual satisfaction, using a 1 to 7 rating system, with lower scores indicating better functioning.

At the end of the study, “84% of women had a score of 2 or less,” he says. Moreover, he says that Viagra can be given at the same time as the antidepressant, which might make women “less likely to discontinue antidepressant treatment, which is a real problem since only about 20% of women are willing to stick with a full course of antidepressant therapy.” He says that often this reluctance to stay the course with treatment is related to the sexual dysfunction side effect.

Gerald F. Joseph Jr., MD, medical director of women’s services at St. John’s Health System in Springfield, Mo., tells WebMD that Nurnberg’s results are interesting but he is not entirely sold on Viagra. He says, for example, that “placebo effect is very powerful in studies of sexual dysfunction, and I’m not sure these findings are not really just a placebo effect.”

Joseph, who wasn’t involved in the study, says that as a surgeon he thinks the only way that Viagra could work in women is if the women have sexual dysfunction that is “associated with an abnormality in the erectile tissue present in the genitals. Otherwise, it just doesn’t make sense.”

Read more…

May 22, 2007 — Medications commonly used to treat erection problems in men
may also relieve the bothersome urinary symptoms associated with an enlarged
prostate gland, researchers say.

Studies on the topic were presented this week at the annual meeting of the
American Urological Association in Anaheim, Calif.

“Before, we looked at these two conditions as two different
diseases,” says Kevin McVary, MD, professor of urology at Northwestern
University Feinberg School of Medicine in Chicago, who moderated a press
briefing.

But in the past three or four years, he says, the thinking among urologists
has changed.

Sexual performance in men seems to decline as their prostate enlargement
becomes more severe, experts have begun to notice. Doctors also notice
that men with milder prostate problems often have less erectile dysfunction
(ED) than do those with moderate or severely enlarged prostates and urinary
symptoms.

“These two diseases — erectile dysfunction and the lower urinary tract
symptoms associated with benign prostatic hyperplasia — are probably
linked,” McVary says.

Conditions Increase With Age

Prostate problems and ED problems both tend to increase with age. About 31%
of men aged 50 to 59 have an enlarged prostate (also known as benign prostatic
hyperplasia or BPH); 44% of those 70 and older have an enlarged prostate,
according to the National Institutes of Health. As the gland enlarges, it
constricts the urine-carrying tube called the urethra, making it difficult to
empty the bladder.

Common symptoms of BPH include weak urine stream, leaking or dribbling,
feeling that the bladder hasn’t emptied completely after voiding, and more
frequent urination.

Medications are prescribed to relieve the symptoms. Some medications work by
relaxing the muscles at the neck of the bladder and prostate; others inhibit a
hormone that contributes to the growth of the gland.

Erectile dysfunction, defined as an inability to get or keep an erection, is
experienced by 20% to 46% of men aged 40 to 69, according to the NIH.
Medications to treat erection problems help increase blood flow to the penis
when a man is sexually stimulated.

Cialis Study

A once-a-day dose of Cialis helped men with erectile dysfunction and
moderate to severe urinary tract symptoms due to an enlarged prostate improve
sexual functioning, says Marc Gittelman, MD, a urologist in Aventura, Fla., and
a study researcher.

Of the 281 men who enrolled in the study, “81% were sexually active, and
they were in their low 60s,” he says. All had moderate to severely enlarged
prostates and urinary problems; 68% of the sexually active men had a medical
history of erectile dysfunction. Gittelman’s team assigned about half to take
placebo and half to take Cialis.

At the end of 12 weeks, men who took Cialis — first 5 milligrams a day and
then up to 20 milligrams — had significantly higher scores on a standard index
of erectile function, he says.

He especially wanted to see if they were as likely to do well if their
urinary problems were severe as opposed to moderate. “They are equally
statistically likely to respond to a dose of Cialis,” he says.

The study was funded by Lilly, which is the maker of Cialis.

In another study, 223 men aged 45 to 64 who had urinary symptoms due to an
enlarged prostate were assigned either to a group given 10 milligrams of
Levitra twice daily for eight weeks or a placebo for the same time period.

Compared with placebo, treatment with the ED drug significantly improved the
men’s quality-of- life scores and their reports of urinary obstruction and
irritation, says Boris Schlenker, MD, a urologist at
Ludwig-Maxmillians-Universitaet Hospital in Munich, Germany, who presented the
data. Erectile function improved in those who took the ED drug.

“Levitra is a promising new drug for men with lower urinary tract
symptoms, but we need long-term data on how it might affect the progression of
the disease,” he says.

The Viagra Study

In a third study, McVary assigned 369 men aged 45 and up who had both
erectile dysfunction and lower urinary tract symptoms to take either 50
milligrams of Viagra every night, 50 milligrams of Viagra an hour before
planned sexual activity, or to take a placebo. The dose increased to 100
milligrams after two weeks.

When he evaluated their erectile function and urinary symptoms, he found 73%
of the men with severe symptoms improved to having mild or moderate symptoms at
the end of the study.

“The changes in prostate symptom scores were dramatic,” he says.
“They compete with alpha blockers.” Alpha blockers are one type of drug
commonly prescribed to treat urinary symptoms associated with an enlarged
prostate. The more severe the urinary symptoms, the greater the
relief, he says.

The study was funded by Pfizer, which is the maker of Viagra.

“This really is cutting-edge,” says Gittelman.

The experts aren’t sure if the ED drugs will eventually supplement or
replace drugs used for urinary problems associated with an enlarged prostate,
or if new formulations might be developed to deal with both conditions.

Some men on the ED drugs did report side effects, says Schlenker, with the
most common in his study being headache.

It’s not known exactly why the ED drugs also help the urinary symptoms,
McVary says. By increasing blood flow to the pelvic area, the ED drugs may help
relax the bladder enough to relieve the urinary problems. Read more…

Nov. 14, 2001 — Viagra has helped thousands of impotent men restore their sex lives. But for men with chronic heart failure and impotence, the “little blue pill” may not be an option. Many of these men take nitrates for heart failure, which can prove deadly if combined with Viagra. But there may be an alternative. Researchers have found that a regimen of regular bike riding can improve overall health, as well as sexual function, in men with chronic heart failure.

“We found that exercise can act as a medical therapy to improve both sexual function and overall quality of life in these patients,” says study leader Romualdo Belardinelli, MD, director of the Lancisi Heart Institute in Ancona, Italy, in a news release.

Belardinelli team looked at about 60 men, average age 57, with stable, chronic heart failure but no prostate problems. About half of them were taking nitrates. The researchers randomly split the men into two groups. One followed an eight-week regimen of supervised stationary bicycling three times per week; the other maintained their normal lifestyles. All the men continued on whatever drugs they’d been taking. They completed questionnaires on quality of life and sexual activity and underwent fitness and overall health testing before and after the study.

At the end of the study, tests revealed improvements in the cardiovascular systems and overall health of the exercise group but not the control group. Peak oxygen uptake had improved 18%, and blood vessels were responding more appropriately. What’s more, these objective improvements correlated with self-reported improvements in quality of life and sexual function.

“We found significant improvement … among patients who were cycling,” says Belardinelli. He suggests that the exercise may boost health by causing positive changes in the cells (called the endothelium) that line the blood vessel walls. These changes would mean more oxygen-rich blood is reaching all parts of the body, including the penis. Read more…

May 31, 2000 — A new study shows that Viagra appears to be safe even for
some men with severe heart disease, as long as they are not taking
nitroglycerine or similar drugs for their conditions.

Reports of heart attacks in several men who had used Viagra had led
researchers to worry that the drug might pose a special risk to those with
heart problems such as angina (chest pain). But the study, published in
TheNew England Journal of Medicine, shows that the usual dose of
Viagra causes no damaging changes to the heart’s circulation in men with
coronary artery disease (CAD).

Lead author Howard C. Herrmann, MD, tells WebMD that his findings
“should provide reassurance about the safety of Viagra for patients who
take it, for urologists who prescribe it to treat erectile dysfunction, and for
cardiologists, who probably don’t ask about erectile dysfunction as often as
they should.” Herrmann is professor of medicine and director of
interventional cardiology at the University of Pennsylvania Medical Center in
Philadelphia.

Herrmann and colleagues measured Viagra’s effect on blood flow to the heart
and lungs in 14 men with severe coronary artery disease. CAD is a major cause
of angina and heart attacks. For the study, men had to stop taking
nitrate-containing drugs such as nitroglycerin, which is often used to treat
angina.

All of the men in the study had CAD so severe that at least one of the major
arteries supplying the heart with blood had closed up by 70 percent or more.
The study was supported by Pfizer, the maker of Viagra.

Herrmann reports that careful examination of the blood flow within the
arteries showed that Viagra had essentially no effect on blood flow to the
heart or lungs, or on the heart’s ability to pump blood.

“Our data support the consensus position of the American College of
Cardiology and the American Heart Association that Viagra is safe for patients
with stable coronary artery disease who are not taking medications containing
nitrates,” Herrmann writes.

Rohit R. Arora, MD, who reported one of the first cases of heart attack in a
patient who had taken Viagra, tells WebMD that this “well-done, meticulous,
and focused” study provides useful information about Viagra’s effects on
the heart’s circulatory system, but he would like to see more direct
information about heart attacks in men taking the drug. Ahora, who is director
of critical cardiac care services at Columbia-Presbyterian Medical Center in
New York, was not involved in the study.

Herrmann says the safety of Viagra has not been studied in patients who have
unstable angina, who have had a recent heart attack, or who have severe high or
low blood pressure.

People who have not previously had even moderate exercise (including sexual
activity) or who are taking more than one drug for high blood pressure should
be cautious when beginning Viagra, Herrmann says. He recommends that those who
have not been exercising regularly have a stress test, since sexual activity
itself carries a small increased risk of heart attack. He also recommends that
those with high blood pressure take their first dose of Viagra in a doctor’s
office, where the effect on their blood pressure can be checked
immediately.

Vital Information:

• According to new research, taking Viagra does not cause damaging changes to
  the heart among some men with coronary artery disease, as long as they are not
  on nitrate-containing medications.
• The study found no changes in blood flow to the heart or lungs after
  heart-disease patients took Viagra.
• Patients who never exercise or those on more than one medication for high
  blood pressure should be carefully screened before taking Viagra.

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