Myths & Facts About the Little Blue Pill After Prostate Cancer

Next to the introduction of the birth control pill in the 1960s, nothing has had a greater impact on men and women’s sex lives than phosphodiesterase-5 inhibitors (PDE5 inhibitors)—a group of oral medications better known by their brand names: Viagra, Cialis and Levitra.

It all began by accident with a potent “little blue pill”—Viagra. Originally developed by Pfizer Laboratories as a cardiovascular drug designed to help lower blood pressure, Viagra took on a whole new life when researchers learned people who participated in clinical trials for the drug didn’t want to return samples because of a very seductive side effect—erections that were harder, firmer and lasted longer. Researchers identified sildenafil as Viagra’s “magic” active ingredient, and the rest is history. It wasn’t long before other drug manufacturers came out with their own formulations—namely Cialis (with tadalafil) and Levitra (with vardenafil).

While there is no dispute that these oral medications have helped many men who suffer from erectile dysfunction caused by natural aging and a variety of health factors—including recovery from prostate cancer—there are some myths and misconceptions about PDE5 inhibitors that should be cleared up.

“The most common misconception is the belief that a man only needs to pop a pill to get an instant erection, but that isn’t how PDE5 inhibitors work,” says David Shepherd, M.D., a board-certified urologist with USMD Prostate Cancer Center. “They have to be absorbed into the bloodstream, which takes about an hour. And they all require certain conditions in order to be effective. PDE5 inhibitors correct a very specific physiological condition.”

Here’s how PDE5 inhibitors work: When a man is aroused, nerves trigger a chemical reaction that creates an erection. A messenger nucleotide—cyclic guanosine monophosphate (cGMP)—signals smooth muscle cells that line blood vessels in the penis to relax so blood can engorge the penis. But the body also produces PDE5, an enzyme that attacks cGMP. When there is too much PDE5 and not enough cGMP, blood flow to the penis is restricted. PDE5 inhibitors work by blocking the enzyme so cGMP can do its job. Taken about an hour before anticipated intimacy, a PDE5 inhibitor will produce an erection— provided other conditions are right, too.

“In order for Viagra, Cialis and Levitra to work, a man must be sexually stimulated to trigger the chemical chain of events and the cavernosal nerves that signal the penis during an erection must be intact and functioning,” Dr. Shepherd says. “So in cases where a man has undergone a prostatectomy or other prostate cancer treatment in which the nerves were not spared, PDE5 inhibitors will not produce an erection.”

Even when the cavernosal nerves are left intact, sometimes they can be temporarily paralyzed if they suffered from a lack of oxygen during a procedure. That’s why it is very important to begin erectile rehab as soon as possible following cancer treatment. During rehab, PDE5 inhibitors may not produce erections until these nerves have healed, but they do help promote good blood flow and oxygenation to the penis during the healing process. Don’t become discouraged if you are two or three months post a nerve-sparing procedure and find that Vigara, Cialis or Levitra are not helping you achieve an erection. Your nerves may just need a little more time to heal so the PDE5 inhibitors can produce an erection.

When physiological conditions are right, PDE5 inhibitors should be taken approximately thirty minutes to one hour before anticipated stimulation and intercourse. Side effects—although mild and temporary—can include facial flushing, headache, and blurry or “blue-tinted” vision. Viagra, Cialis and Levitra are not prescribed for men taking nitrate medications because a chemical interaction between the two can cause a dangerous drop in blood pressure. Keep in mind, too, that PDE5 inhibitors do not increase a man’s libido, and they do not protect against HIV or other sexually transmitted diseases.
PDE5 inhibitors are designed to help millions of men overcome erectile dysfunction—including men who may temporarily experience erectile dysfunction following nerve-sparing treatments for prostate cancer. If you or a loved one have been diagnosed with prostate cancer or are recovering from treatment and have questions about the use of PDE5 inhibitors for erectile rehab, talk with one of our board-certified urologists.

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