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The Little Blue Pill ... Plus Other Impotence Options


Their sex drive might hold steady, but as men get older, their erection is less likely to always rise to the occasion when called upon.

More than half of all men over 40 — an estimated 30 million American men — suffer to some extent from erectile dysfunction (ED), the consistent or recurrent inability to get or keep a penile erection sufficient for sexual intercourse. To determine whether you suffer from ED, see Sexual Health Inventory for Men.

The Food and Drug Administration has approved three drugs to bring on an erection when a man is sexually stimulated: Viagra, Levitra and Cialis.

Three in Stiff Competition

Viagra (generic name sildenafil) made its sexual splash in 1998 and has become popularly known as the "little blue pill." The first-ever erectile dysfunction drug and its 2003-approved competitor Levitra (vardenafil) take effect in about 30 minutes and can last about four and five hours, respectively.

A pill for impotence is a dream-come-true for so many men, says Irwin Goldstein, professor of urology and gynecology at Boston University School of Medicine's Institute for Sexual Medicine. "Through the millennia it has been man's dream: take a pill and get a better erection."

Cialis (tadalafil), approved like Levitra in 2003, stays in the bloodstream much longer than the others, between 24 and 36 hours. The makers call its longer-lasting effects a major advantage, touting the spontaneity factor that its shorter-window competitors don't allow.

Right for You?

Clinical studies have shown Viagra, Levitra and Cialis to be similar in effectiveness — about 75 percent of men can expect to be helped, by one estimate, though the drugs often fail to help those whose impotence is caused by prostatectomy surgery to remove all or part of their prostate. Viagra absorption may be slowed by consumption of food, especially fatty food.

Before taking any of these drugs, men should tell their doctor about:

  • Allergies to any drugs
  • Any medical conditions they have and medications they are taking, including prescription, nonprescription and dietary supplements. One drug of particular concern is nitroglycerin or a long-acting nitrate for angina (chest pain), which can cause dangerously low blood pressure in combination with Viagra or Levitra
  • Plans to have dental or any other kind of surgery

It's possible that all or none of these three options will work for a particular man. Side effects aren't common but can include headache, upset stomach, flushing, nasal congestion, back pain in the case of Cialis, and blue color-distorted vision from Viagra. Call your doctor for severe or long-lasting forms of these symptoms, or if you experience rash, painful erection, prolonged erection, fainting, chest pain, or itching or burning during urination.

The popular conception that Viagra-type drugs cause heart attack is not supported by the evidence. Older men suffering from impotence, though, may be susceptible to heart attack from physical activity — including sexual activity — that causes extra strain on the body.