Once solely deemed “an older man’s drug,” Viagra and other erectile dysfunction medications are becoming commonplace in younger men’s lives. But why are these young men relying on this little blue pill when they clearly have no physiological impediment?
It’s been over two decades since Viagra—the little blue pill— came onto the market to change the lives of millions of males. Although its initial intention was to treat angina and high blood pressure, it soon became a hit in the bedroom after showing its ‘magic’ as an erectile dysfunction (ED) drug, especially for older males.
However, in the last few years, more and more young males have been turning to this pharmaceutical solution despite not having age-related ED issues. For some, it’s something new to try and a bit of fun. But when we look into the many personal reasons behind this trend, we can see it’s a lot deeper and emotionally rooted than thought.
So, is Viagra a harmless quick fix, or are young males now relying on these pills too much, creating a wider cause for concern? And what can this tell us about the relationship between the physical and mental health of men?
In the latest installment of our In Conversation podcast, Medical News Today seeks answers to these questions and more while addressing the stigma surrounding male psychosexual health.
Joining this conversation as our guests are Dr. Edward Ratush, board certified psychiatrist and co-founder of telepsychiatry and psychotherapy practice SOHOMD in the United States, Dr. Peter Saddington, an accredited psychotherapist specializing in sexual addiction, counseling, and psychosexual therapy at Relate, and three guests who frankly (but anonymously) shared their personal experience with using Viagra.
You can listen to this episode of our podcast in full below or on your preferred platform.
Editor’s note: This podcast includes commentaries that mention the use of illegal drugs. Medical News Today does not condone or encourage their use.
Viagra’s over-the-counter journey
Initially named compound UK-92,480, sildenafil (sold under the brand name Viagra) was developed to treat hypertension and angina, when reduced blood flow to the heart causes chest pains.
In the 1980s, Pfizer biologists started testing the drug for its anti-angina and anti-hypertensive potential. However, patients soon began reporting other effects the drug had been having on their body. One such effect was improved blood flow to the penis, which gave a boost to their sex lives.
Dr. Ratush said Viagra’s potential as a treatment for erectile dysfunction was discovered serendipitously.
“The history of the pharmacology of these products [t]hat started with Viagra was initially intended for the use of cardiac patients because the hope was that they were going to be able to dilate small cardiac vessels and allow for the heart to have oxygen. [They later] noticed that whether or not it had a cardiac effect, a lot of the men reported having erections that they might not have otherwise had normally because they might have had problems in more than one place with their blood flow,” he said.
In 1998, the FDA approved the drug for use as a first-line oral treatment for erectile dysfunction (ED). For the following years, patients would have to go to their physician to get it prescribed.
In 2018, however, Viagra Connect hit the U.K. market as a consumer-ready over-the-counter version. Within its first year, according to the company, seven million pills were sold in the U.K. About two-thirds of the customers were between the ages of 25 and 54.
Viagra remains prescription-only in the U.S., though.
Dr. Ratush said despite Viagra not being available as an OTC medication, it is easy to get, and people only need to tell their physicians the truth.
“If you have insurance or if you could afford to pay out of pocket to see a physician, then you can get this prescription,” he said.
3 men on their experiences with Viagra
Our first guest said he was 19 and with his first girlfriend when he first tried Viagra.
“[I had] been with my girlfriend for almost a year, but we hadn’t had sex yet. Neither of us had done it before. We were both really into it [b]ut every time that I tried to put it in, my penis would go soft. I quite quickly saw my doctor about it because it was putting a strain on our relationship,” he said.
A few sessions of sex therapy initially failed to produce any improvement.
“I felt so ashamed and useless. I don’t know why my girlfriend stayed with me. It was making her upset. It made her feel like she wasn’t attractive enough. But I knew that there was something wrong with me. I was so anxious about losing my virginity,” he said.
That’s when the doctor reluctantly prescribed him Viagra.
“I got too nervous the first time I took it, so I didn’t feel aroused enough to do it. But after another attempt, we were finally able to have sex. It felt amazing. I was so relieved. And that sort of broke down a barrier,” he recounted.
“For me, Viagra pushed me over this mental wall that I had built up around sex, where nothing else seemed to work.”
— Guest 1
For our second guest ‘R’, who is in his 50s, healthy, and exercises regularly, his first experience with Viagra was when he recently came out of a long-term relationship.
“[L]ast year, I had some anxiety about whether I will be able to keep an erection with some casual partners. And this, in part, was triggered by an experience with a particular casual partner who kind of primed me ahead of our encounter, that, you know, he wants to make sure that there wasn’t going to be a problem,” he said.
Our third guest Scott, who was the only one comfortable enough to use his first name, said he first tried Viagra out of curiosity.
“[The] first time I used Viagra would have been when I was maybe 19 or 20 years old, seven or eight years ago. [It] was on a night out, so I’d actually met a girl. We’d [gone] out clubbing, and I had a lot to drink,” he said.
When a friend offered him a Viagra pill from the few in his wallet, Scott said he decided to try and take one before they went back to the hotel.
One benefit he noticed from taking Viagra was the shortened wait time between getting erections or rounds of intercourse.
“[W]ith Viagra, you don’t need no breaks in between, you can finish and go again straight away. So that’s sort of what it brings to the table. So, if you’re ever trying to sort of impress a lady or on a weekend away, Viagra sort of allows you to go and go again,” said Scott.
The side effects of Viagra
The side effects people most commonly report with Viagra are heartburn, skin flushing, vision changes, and upset stomach.
“I would describe it as quite unpleasant. Maybe 30 minutes after popping the pill, I had a headache, flushing— face was red, heart was racing. It was uncomfortable, and not a feeling that I would associate with sex at all.” said R of his experience.
Most of these effects subside within about five hours as the medication has a metabolic half-life of about 4 hours.
“Mostly, it’s very effective, and [people] don’t have any side effects, but side effects that they can notice, because it’s working throughout the system, [are] palpitations, quite extreme headaches, that sense of feeling really pressured. And so some guys will stop taking it because the side effects are counterproductive,” detailed Dr. Saddington.
“If you’re feeling like you’re gonna have a heart attack, or you’ve got a raging headache, you’re not exactly going to feel sexual or turned on,” he added.
Scott also shared his tale of caution when it comes to mixing different drugs.
“[A] lot of the time when I’ve used [Viagra], I’ve been sort of under the influence of alcohol. [I] have had one side effect where I was partaking in other narcotics [and] experienced really bad heart palpitations. Apart from that, whenever I’ve been sort of semi-sober or just had a few drinks, I’ve never had any side effects at all.”
Q&A: Addressing common misconceptions
There are many misconceptions people have about erections, Viagra, its similars such as Cialis and Levitra, and their effects on the body. Here are a few of the most popular ones:
How do drugs like Viagra work?
The active compound of Viagra is sildenafil citrate. This chemical helps nitric oxide, which helps blood vessels widen, bind to receptors that relax helicine arteries in the penis. This results in increased blood flow to the soft tissue, which causes an erection if the individual is sexually aroused.
Will Viagra give me a hard-on out of nowhere?
Despite popular belief that viagra can cause erections like aphrodisiacs or increase one’s sex drive, the drug only works when someone’s already aroused. so without sexual excitation, the drug won’t take effect, giving the individual some level of control over it.
Can you get addicted to Viagra?
There is nothing in Viagra pharmaceutically that could make someone physically dependent on it and cause withdrawal symptoms. However, the assurance it gives, coupled with increasing use and higher doses, can be psychologically addictive for some people.
How long should an erection last with and without Viagra?
Ask any male in your life, and more often than not, most will believe that an erection should last a longer time than what is considered average. Data shows that the average duration of an erection is around 6.5 minutes for males aged 18 to 30 years, and 4.3 minutes for those older than 51 years.
Viagra not only extends this time but can also make it easier to get successive erections.
According to data, an erection’s duration can, on average, extend to about 33 minutes one hour after taking viagra. Eight hours after taking the drug, this time frame drops to about 23 minutes, and to 16 minutes 12 hours after initially taking the drug.
However, the effects may vary for many people and may start subsiding about 4 hours after taking it.
Why are young men using Viagra?
Both our experts and our guests said that Viagra use in younger males wasn’t physically rooted but was seen as “more of a help” about performance anxiety and a psychological boost.
“Even amongst men who had a successful pharmacological effect, ie, they were able to achieve and maintain an erection for said activity, more than half of them stop using the product within a few months. And that clearly indicates that there was a psychological component that was never being addressed,” explained Dr. Ratush.
Dr. Saddington agreed.
He said young men “are using Viagra as a way of reassurance. [T]hey can get erections at other times, but they get anxious, particularly in new situations, new relationships, or if they’re going out casually, that they’re using Viagra as a backup really, because they’re anxious something might go wrong.”
However, relying on Viagra for peace of mind can become problematic, said Dr. Ratush.
“It’s so tempting to use a pharmaceutical as a crutch when it is as effective as it is, and with limited downside[s] as it has— flushing headaches, low blood pressure, and maybe a little bit of racing heart rate,” he told MNT.
The mainstreaming of ‘chem sex’
Dr. Ratush and Dr. Saddington said they have come across men taking Viagra, especially when taking alcohol and other drugs, either the boost the sexual experience or out of fear that an erection will be less likely.
Dr. Saddington said this is referred to as “chem sex”:
“[Q]uite often it’s associated with cocaine or ketamine, [w]here they’re feeling that by taking [Viagra], it’s enhancing their sexual experience. So the sexual experience that they’re looking for is associated with drug taking as well. So, it becomes a very recognized pattern that they’re getting into.”
He said he’ll often see or hear men having a weekend of taking many of these drugs and being sexual with either the same person or many people.
Casual sex and Viagra
Dr. Saddington said it was more common for young men to take Viagra for casual sexual encounters rather than long-term committed relationships.
“It’s quite often associated with the idea that in a relationship where they’ve got a commitment, and they’re feeling more confident, they don’t worry so much about performance, the erection becomes much more sustainable,” he said.
R said he thought it was this very “nature of being in a more casual thing with people” that made it hard to maintain an erection.
“[Because it was casual], if I did have a problem, then I wouldn’t be able to negotiate [or] say, ‘well, today’s not the day, let’s do something else’. Those options and avenues didn’t feel like they were open to me,” he said, highlighting the lack of communication and openness in that relationship dynamic.
“[Having a harder time having and keeping an erection is] a natural thing that happens when [a] relationship breaks up, or [they’re] trying to have more casual relationships or start a relationship, performance anxiety starts creeping— the urgency, a sense that they will be judged or blamed if they don’t get an erection.”
— Dr. Peter Saddington
Communication can solve many problems
Dr. Ratush likened Viagra to workout supplements and said that men, in general, were open to trying such things. However, such a pharmaceutical solution, he said, has made people push the root causes under the carpet.
“The unfortunate part is that people moved away from actual ‘talk therapy’ as a way of addressing their sexual issues,” he said.
“[I]f there was communication with [their] partner, the fear about performance anxiety might not be there. So, before [taking] a medication like this, therapists [sh]ould be working with men and their partners to create a way of communicating to one another so that they could feel as comfortable as possible in their lovemaking.”
— Dr. Edward Ratush
Dr. Ratush said that not talking and being transparent with a partner can have a wider negative impact on psychosexual well-being and increase dependency on medications such as Viagra.
“In a way, what’s happening over time is we create a bigger and bigger rift between men and their partners about the communication involved in this dynamic,” he said.
R agreed. He said taking Viagra wasn’t a cure for his anxiety about keeping an erection.
“[I] got into a long-term relationship with someone at the beginning of this year. And being in that relationship enables me to negotiate actually, if I don’t feel like it’s going to be the day for performance, then there are other options available to us that result in still having a good time,” he said.
“[Many people] struggle to share what they’re really experiencing or talking about if they’ve got problems, how to resolve them sexually. I think there’s a taboo about being able to talk about sex and to explain how to get your needs met or how to talk about things if they’re going wrong. That’s why therapy can be so effective because it allows them the chance to talk about it.”
— Dr. Peter Saddington
Erections and men’s self-perception
The pressure to perform and the lack of communication risks creating bigger relationship problems.
“What it tells me most is that there’s a big divide amongst heterosexual couples, between men and women in what they understand about one another. [B]ecause clearly, there’s much that men can still learn about themselves sexually, and how they function and how to optimize their own physiology and functionality,” said Dr. Ratush.
“[The] idea that not only do I have to understand myself, but then translate it to someone who doesn’t have similar parts, and similar experiences, is, I think, a really daunting task,” he said, adding that some men do not even want to be seen by their partners when they are flaccid.
“[They like to only enter the arena when they’re fully ready for performance, so to speak,” he said.
“[For men] it’s so much easier to just perform well than to be able to explain why something that is happening is contributing to your anxiety. Because one of the things that Viagra and Cialis do beyond erectile functionality is they impact things like early ejaculation problems as well. So there’s more to it than just the erections.”
— Dr. Edward Ratush
Behind younger adults seeking to use Viagra, according to our experts, could also be social media and porn as influencing factors. However, it all boils down to sex education.
‘[I]’d certainly say that for a lot of young men, their sex education comes from porn. So if it’s based on seeing men, [that] are performing in a very virile way, [that] appear to be able to have sex when they want to, in whatever position [f]or a long period of time, [and] if they’re judging themselves against that, they’re not going to be able to behave or act sexually in the same way. So there’s going to be a lot of anxiety about [that],” said Dr. Saddington.
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