Physical intimacy and sexual health play an important role in our lives, even as we get older. Sexual activity can lower blood pressure, boost the immune system, relieve pain, aid in heart health, and create an overall sense of well being as it promotes blood circulation and the brain release of feel good chemicals known as endorphins. From a psychological standpoint healthy physical intimacy helps couples bond emotionally, and may even help males live longer, according to studies conducted on men in their 70’s.^[8]

Sexual Health and Aging

By the time a man reaches age 18, testosterone levels that control sexual desire and libido are at their peak. As men age however, many begin to experience difficulty getting and maintaining an erection long enough to participate in sexual intercourse.^[7]

According to the National Institute of Diabetes and Digestive and Kidney Diseases, approximately 30 million men suffer the effects of erectile dysfunction causing limitations on physical intimacy and sexual behavior.^[3]

Drug Treatment for Erectile Dysfunction—How It Works

With the advent of PDE5 inhibitors (chemical compounds developed in the late 1990’s) treatment for erectile dysfunction became widespread, as pharmaceuticals now targeted the core symptom driving erectile dysfunction.

For erection to occur, stimuli promote the release of nitric oxide in the body, causing a chemical chain of events. Guanylyl cyclase is produced which leads to the creation of cyclic guanosine monophosphate (cGMP). This facilitates muscle and arterial relaxation, causing dilation to occur.^[1] PDE5 inhibitors all work the same way, by blocking the PDE5 enzyme that breaks down cyclic guanosine monophosphate, also known as the “erection chemical”. This promotes further production of cGMP so that blood fills the penis long enough for intercourse to occur.^[2]

Sildenafil, Tadalafil, and Vardenafil, A New Line of PDE5’s for Consumers

In 1998, The U.S. Food and Drug Administration approved the chemical compound, sildenafil citrate (marketed as Viagra) for treatment of erectile dysfunction in men. In 2003, vardenafil (sold as Levitra) followed, along with tadalafil, the chemical name for Cialis. In 2008, low-dose, daily use Cialis entered the marketplace as well.^[6]

*It is important to note that PDE5 inhibitors are not aphrodisiacs and require that stimulation for sexual activity be present.

Viagra changed the way many people viewed erectile dysfunction, because treatment for this little talked about condition suddenly became easy and effective. No longer were men forced to endure embarrassing, sometimes invasive methods of treatment through devices or pumps.^[5] Prescription medication was small, portable, and completely discreet.

Viagra, Levitra, or Cialis?—It’s All in the Timing

Though each of the PDE5 inhibitors works essentially the same way, the difference remains in the amount of time each drug must be taken before sex, and the length of time it remains in the body.^[4]

Viagra, Sildenafil in Tablet Form

Users are advised to take Viagra approximately one hour before sexual activity. The effects of the drug generally last 4-5 hours for most individuals.

Dosage—Viagra is dispensed in tablet form and is available in 25 mg, 50 mg, and 100 mg dosages. A 50 or 100 mg dose on an empty stomach, one hour before sexual activity is common.

Side Effects—These include headaches, nasal congestion, and flushing. Allergic reactions include hives, breathing difficulties, facial swelling and inflammation of the throat area. Serious side effects during sex could include, dizziness or nausea, pain, numbness, or tingling in the chest, arms, neck, or jaw. Sudden loss of vision, or hearing, or ringing in the ears is also a serious side effect.

Interactions—The following medications should not be taken with Viagra: PDE5 inhibitors, Nitrates

Warnings—The efficacy of the active ingredient may be delayed or compromised if taken with food (especially fatty foods). Viagra should not be used in individuals with have heart problems occurring within the last 6 months, chest pain, stroke, liver disease, blood pressure problems, dehydration, or medical conditions affecting the penis including, Peyronie’s disease (curvature due to scar tissue), angulation, fibrosis, or priapism (prolonged erection).

Cialis, Treatment That Lasts

Referred to as the “weekend pill”, the effects of Cialis (tadalafil) can last up to 36 hours.

Dosage—Cialis is available in tablet form and is dispensed in 2.5, 5, 10, or 20 mg doses of the active ingredient tadalafil. Cialis should be taken at least 30 minutes before sexual activity.

Side Effects—Side effects of Cialis are not common, but may include: cough, dizziness, headache, upset stomach or heartburn, flushing, nasal congestion, changes in vision, back pain, or loss of hearing.

Interactions—PDE5 Inhibitors/Protease Inhibitors, Alpha Blockers, Nitrates

Warnings—Do not consume more than 5 alcoholic drinks while taking Cialis. Check with a physician before taking Cialis if you have had a heart-related condition in the last 6 months, have kidney disease, liver disease, irregular blood pressure, dehydration, a penis condition such as, angulation, scarring, Peyronie’s disease or priapism, serious eye problems, disorders involving bleeding, or stomach ulcers.

Cialis For Daily Use

This low-dose form of Cialis is taken once a day to help maintain a steady level of tadalafil in the system. This allows for healthy sexual function anytime, without preplanning every sexual event.

Levitra, Fast Acting

Levitra (vardenafil) works in the treatment of erectile dysfunction by relaxing muscles and promoting blood flow to the penis.

Dosage—Levitra is available in 5, 10, and 20 mg doses and should be given in 10 mg doses initially and adjusted up or down depending efficacy and tolerance. The maximum dose of Levitra is 20 mg, one time a day.

Although instructions indicate that Levitra is to be taken one hour prior to sexual activity Levitra may start working within a half-hour.

Side Effects—headache, facial flushing, nasal congestion, nausea, heartburn
dizziness, and back pain.

Interactions—PDE5 Inhibitors, Vardenafil/Protease Inhibitors/CYP3A4 Inhibitors, PDE inhibitors/Riociguat, Nitrates, Alpha Blockers

Warnings—Discuss treatment options with your doctor if you have had heart problems or a stroke in the last 6 months, have irregular blood pressure, or chest pain during sex.

Physical intimacy is an important part of overall health and wellness, yet 70% of men age 70 and above suffer with erectile dysfunction. Sexual activity can promote positive physical, mental, and emotional well being. There’s no reason to live without intimacy any longer when effective prescription treatment is well tolerated and available.