How Viagra, Levitra, and Cialis Work

In this article, I’ll be talking to you about how the drugs Viagra, Levitra, and Cialis work. I want to start off by talking a little bit about what conditions can affect erectile function. And basically, there are several overall health issues that can impact erectile function and cause men to have erectile dysfunction, and by the way, we have a separate video about erectile function in general, but today I will be talking only about the drugs. One of the things that can affect erectile function is increased high blood pressure. It’s important to see your health provider for this because once you bring your blood pressure back down to a normal level, the erectile function might improve. Another thing is diabetes – sometimes men who have had diabetes for several years notice that they get erectile dysfunction, and sometimes actually some people are diagnosed with diabetes because they have had maybe poor erections for a while. Heart disease, anything that can affect blood circulation in your body can affect your erections as well. That also includes high cholesterol, being overweight can certainly affect your erections, and sometimes losing weight can improve erectile function. Surgery – men who’ve had, for instance, prostate surgery, sometimes have erectile problems after the surgery, even though most surgeons try not to cut any nerves when they do the surgery. There are quite a few medications that can also have a sexual side effect of causing erectile problems. So if this happens, if you notice if you’ve been switched to a different medication or you’ve maybe started on a medication and you notice sexual side effects, be sure to let your physician know so that they can either change the dose or maybe switch you over to a different kind of medication. Stress and depression can affect erectile function, and – very important – drinking. Too much alcohol depressed the nervous system and it can affect erectile function. What some people don’t know is that smoking tightens the blood vessels in your body and it can also affect erectile function.

I’d like to show you a model – this is a model of the penis – in order to explain how erections happen and how the drugs Viagra, Levitra and Cialis work. So this is a penis, and it has these two white elements here – they’re not white in reality – they are like sponges, and they’re called the cavernous bodies. And up here we have the blood vessel that goes into the penis. Basically, the blood rushes into the penis and fills up these sponges, and down here we have the urethra – this is where the urine comes through, all the way out to the tip. So basically what happens when a man has an erection is the blood rushes in through the blood vessel and into the sponges, fills up the sponges – and that’s what an erection is. It’s simply a blood-filled penis. And the outflow, the blood vessels go back out of the penis, they tighten up by a membrane that goes around the penis, so the blood is really trapped in the penis for a while, making it stiff and hard – and that’s an erection. So the way Viagra works – I’m saying Viagra, all of them work in exactly the same way – Viagra, Levitra, and Cialis all work exactly the same way, and that is by inhibiting a substance called nitric oxide. So when a man gets aroused, when blood rushes to the penis and fills it up, and it’s not very healthy to have an erection for a long time, so our bodies are designed in a way that this blood supply will go away after a while, because it’s not healthy to have an erection for a long time. In fact, it’s called priapism if a man has an erection for several hours, and that can be dangerous – he usually will end up in the emergency room. And it doesn’t happen very often, but it’s something that’s called priapism and so basically it’s not healthy to have an erection for a long time. Basically, because the blood is stuck in the penis, there’s no circulation. We need fresh blood to the penis, in and out again. So it’s not healthy to have an erection for a long time. So the body makes sure that as soon as a man has an erection, after a while it will be broken down, and the blood flow has to go away again for the erection to go away. So basically what the drugs Viagra, Levitra and Cialis do – they are called PDE5 inhibitors. And they inhibit an enzyme that’s called phosphodiesterase. This is getting very complicated, and I’m trying to keep it simple, but basically, these drugs inhibit the breakdown and inhibit the effect that blood is again rushing out of the penis. So they trap the blood in the penis for a little bit longer than the body normally would allow it. So that’s really what the drugs do – they keep the erection longer than your body would normally keep it. One thing that’s important, a lot of people don’t realize that drugs don’t really change your desire. You need to have a desire for sex, or you need to be sexually aroused – they don’t turn you on, all they do is they help you with the blood flow. They increase the blood flow that is already there to a certain extent, they just make it more powerful. I always give this example to my clients, I tell them if they take one of these pills and go out and mow the lawn, nothing is going to happen – you need sexual stimulation, and then your blood will start flowing into the penis and then the drug will make sure that this blood flow is enhanced and that it will stay around a little longer than it normally would. The different pills come in different dosages – Viagra comes in 25, 50, and 100 milligrams. The Levitra comes in four different dosages – 2.5 milligrams, 5, 10, and 20. The usual starting point is 10 milligrams. Cialis comes in 5, 10, or 20 milligrams. But what’s important here is you need to see a health provider get a prescription for these drugs. Do not get them on the internet, do not accept them from friends – it’s very important that you have a physical checkup with this because it’s important that your physician or nurse practitioner has to tell you what dosage you should start out with and it’s important to have a physical exam.

Viagra takes about one hour to work – Levitra works a little bit faster, and Cialis actually works over a longer time period. It works up to 36 hours, and it’s sometimes called the “weekend pill.” So it will stay in your system for 36 hours and it’s not as restrictive as Levitra and Viagra. So you can benefit throughout a longer period from Cialis. It’s very popular in Europe. The one thing that’s always very important to remember is not to eat any fatty foods. Don’t have a big meal just when you take this medication, because it’s going to be harder for your body to absorb it. Just have a light meal, certainly don’t eat any fatty, greasy food because it will decrease the absorption. Also, don’t drink – try to drink very little or no alcohol with it, because alcohol really has an opposing effect – it’s not very good for your erections to have too much alcohol.

I actually usually recommend for the men that I see in my office, when they try Viagra or Levitra or Cialis for the first time, I say just try it on your own first – see how it works. And the one thing that is very very important to tell them is that it doesn’t always work well right away – sometimes you need to try and take it several times. Don’t take several in one day, but try again later – try a few days later, try on a different occasion if they don’t work very well for the first time. It’s not unusual for this to happen, and you need to give it several tries, and a lot of people don’t realize that if it doesn’t work after the first time they think “well that’s it, it just doesn’t work for me.” But that’s not true – I always tell them try it on your own first – try masturbating. See if it feels different, if it works for you. Also, one thing they can see in that situation is whether they have any side effects. Some of the possible side effects are headache – and this is true for all of these medications – headache is sometimes a side effect; flushing – having body parts flush, just get red – that’s increased blood flow in other body parts, and not just in your penis; upset stomach; dry mouth; stuffy or runny nose; dizziness; increased heartbeat; and sometimes it can actually affect vision, your eyesight. And again I can not emphasize enough how important it is to go and see your health provider. Don’t just get these pills from someone else – it’s very important to have a checkup. And actually, there are some conditions where you can die from taking these pills – if you, for instance, are taking heart medication that contain nitrates. It’s very, very dangerous to take Viagra or Levitra or Cialis in this situation, because what happens is those pills will make the heart medication much more powerful than it’s supposed to be, and it can actually kill people. That’s what happened in the beginning when Viagra came out in, I think it was ’98, some people died, and it was because they were not aware that it was dangerous to take nitrates at the same time as taking Viagra. Most people know better nowadays, but I want to emphasize that it’s extremely important to be aware of that.

Also, something called “poppers” – those illegal sniffing drugs that contain nitrites also. And again it’s the same thing – Viagra, Levitra, and Cialis will make this effect even more powerful, and it can get dangerous.

Also if you take alpha-blockers – those are sometimes prescribed for prostate conditions, or maybe high blood pressure, and that can interfere with Viagra, Levitra and Cialis and cause blood pressure to drop to dangerous levels. So those conditions are very important. And if you get these pills, it’s all written out in detail in the information that comes with these pills and I’m sure that your physician or nurse practitioner will go over this with you as well. Another thing to be careful about, and that your health provider will look at, is if you’ve had any heart attack, any stroke, or any kind of life-threatening arrhythmia, increased heartbeat, over the last six months, you shouldn’t take Viagra. Patients that either have very low blood pressure or very high – hypertension it’s called – they are also not good candidates for Viagra and Levitra and Cialis. And then again if you’ve had any heart problems like cardiac failure or coronary artery disease, or if you have problems with your liver or your kidneys, it will make it harder for your body to get rid of this medication. Again it’s something that your health provider will ask you, and if this is the case you might not be a candidate for this medication. Also stomach ulcers – same thing. And then a few people have a condition called retinitis pigmentosa. It’s a genetic eye disease, and those individuals that have this condition also should not take any of these medications.

Finally, I want to finish off by just reminding you, sometimes men who have maybe not had erections for a long time and take these pills, maybe they haven’t had an erection for years, and haven’t had intercourse for a long time. Be considerate of your partner, because this is a completely new situation. Let’s say if it’s a female partner, she may not have had intercourse for years, or for a long time, and she may need some time to get back into the mood. So I just want to have you think about it and be very considerate of your partner in this situation. And one thing I always say is you know, take the time – after you take the pill you need to wait before it works anyway, so just spend some time on your partner and be considerate of your partner.

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