THE WORLD WILL ALWAYS WELCOME LOVERS

Victor Bloom MD

As time goes by.... As time goes by men tend to lose their amorous desires and responsivity. Many men accept this waning of physical desire with grace and equanimity, but many others despair and mourn the loss, seeking all kinds of help, from experienced 'sex workers' to various vitamin supplements and herbal remedies. As in the case of appetite suppressants, most of these potency pills have not worked. Ginseng has been sold as an aphrodisiac for years, but few rave about its effectiveness. In the orient, powdered rhinoscerous horn is said to inspire potency, so much so that the poaching of that rare and powerful animal has threatened their extinction. Shark fin has also be touted to restore potency, and finally, the male hormone, testosterone has been used to regain potency. Testosterone, however, is known to facilitate the growth of prostate cancer, so it must be used only with great caution.

For a long time it was accepted as a depressing fact of old age that potency declines with age. Now impotence is called, 'erectile dysfunction'. The field of psychiatry used to be convinced that the symptom of impotence is basically psychological. And so the remedy was psychotherapy and psychoanalysis. Freud had an explanation for it---unconscious, unresolved conflicts, stemming from childhood. On one level, society is blamed for putting excess restrictions on the sex drive, and on another level, the drive is said to be inhibited by the unresolved Oedipus complex. It is true that psychotherapy and analysis helped many men get comfortable with their sexuality, but some patients were refractory; that is, in spite of all kinds of insight, the erectile dysfunction continued.

In recent years urologists, rather than psychiatrists have been diagnosing and treating impotence. These treatments have included surgical implants and an injection. These are rather drastic procedures that most symptomatic men say, 'no thanks' and live with their loss of youthful ardor and performance. It is as if Mother Nature herself said, 'that's enough' of that!

But just as pharmaceutical research has come up with the present effective third generation anti-depressives, the SSRI's, which inhibit the breakdown of serotonin in the brain, alleviating the many symptoms on the spectrum of depression, a serendipitous discovery from Pfizer has made use of another specific inhibitory process. You might well ask, how can an inhibitor result in a more excitable organ? That is a good question and I will try to explain.

The physiologic mechanism of erection involves the release of nitrous oxide (interestingly abbreviated as NO) in the corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing an inflow of blood.

The new drug, Viagra, does not relax the smooth muscle directly; rather it enhances the effect of NO by inhibiting phosophodiesterase type 5 (PDE5), which is responsible for the degradation of cGMP in the corpus cavernosum.

Now all this might seem like a mouthful, but the general principle of the anti-depressives and the potency pill is to block the breakdown of a potent substance, and so the blood levels increase instead of decrease. We are in effect fooling the body, which wants to get rid of the healthy substance, in the one case serotonin in the brain, and in the other, nitrous oxide in the lower regions.

Another important fact about Viagra is that it does not work in the absence of sexual stimulation, and so a man is not in danger of prolonged, painful erection, called priapism. It may be that Viagra will also restore libido to those taking medications in which a reduction of the sexual drive and feeling is a side effect.

The media has reported that there never has been such a rush on a new pill in the history of pharmacy. Pfizer stock has been zooming. These facts point to a longstanding rejection of the 'growing-old-gracefully' theory. Most men would prefer to be sexually active than live on fond memories. Both men and women who are along in years tend to view nostalgically the romances of their youth, the rapture, bliss and ecstasy of the loving embrace.

"Man must have his mate,

That no one can deny.

The world will always welcome lovers,

As time goes by."

The rush to Viagra is synergized by the fact that early reports and clinical studies have found it effective in as much as 80% of cases, and there were no serious side effects. If Viagra maintains its promise, its being readily available may incite a second, male sexual revolution, the first being for women, The Pill, in the Sixties.

Potency is considered 'macho' and many men who are impotent feel less of a man, stirring deep-seated feelings of inadequacy. Tens of millions of older men are going to be trying this new medicine and time will tell whether increased activity is good or bad for the heart. The poets, dreamers and clinicians sing the praises of lovemaking for overall health and vitality. It remains to be seen whether the male pill will catch on, but we know there are many more healthy old people than before, so the probability is great.

On the other hand, the pills are selling from $7 to $10 a pop.

_____________________________________________________________

Dr. Bloom is Clinical Associate Professor of Psychiatry, Wayne State University School of Medicine. He is a Diplomate of the American Board of Psychiatry and Neurology and Life Fellow of the American Psychiatric Association. He is a member of the American Academy of Psychoanalysis and corresponding editor of their quarterly journal, Academy Forum. He welcomes comments and questions at his e-mail address: vbloom@comcast.net.