Caverject

When Jeremy Morse sneaked a little blue Viagra pill from his partner's prescription bottle in 1999, it was curiosity-not medical necessity--that fueled his desire to try the erectile dysfunction drug. "I was thinking it might give me the erection of stone; that's what I was really looking for," says the 33-year-old Phoenix resident.

Morse's experimentation with and expectations of erectile dysfunction medications aren't uncommon, health care providers say. Although Viagra use is widespread among heterosexual men, there's a general sense among medical professionals that gay men are more apt to try or use the drug on a regular basis.

Data from more than 5,000 HIV-negative gay men participating in an HIV vaccine trial seem to bear out this suspicion, says Ken Mayer, medical research director for Boston's Fenway Community Health. When participants were asked in 2002 about drug use during the past six months, 15% to 20% of the men reported taking Viagra.

The reasons gay men turn to erectile dysfunction treatments more readily than their straight peers are numerous and complex, but much of the explanation may be rooted in gay male culture's idolization of youth and sexual prowess, says Tony Mills, an openly gay Los Angeles physician and the 1998 International Mr. Leather titleholder. "There's definitely a heightened importance on sex and casual sexual relationships in gay culture," he says. "And it's very common for part of a gay man's self-esteem to be wrapped up in his sexual performance. When we notice even a slight change in that, it ends up being a very big thing in our minds."

Change does occur. Varying degrees of sexual dysfunction are relatively common as men grow older. Some studies have shown that about 5% of men in their 40s experience symptoms of erectile dysfunction, such as erections that aren't quite as hard or the occasional difficulty in getting aroused, with the percentage climbing significantly as men age. The Viagra Web site claims that half of all men between the ages of 40 and 70 experience at least occasional erectile dysfunction symptoms.

But Stephen E. Goldstone, medical director of the Web sire GayHealth.com, says that while erectile dysfunction among older men is not unusual, gay men already are more likely to be concerned by even rare signs of it--and are more likely to seek treatment. "We go for Botox; we go for plastic surgery," he says. "We don't want to see our erections drop as we grow old either."

However, it's not just middle-aged gay men seeking treatment. Physicians say there also is a sizable demand for the drugs among young gay men, some even in their early 20s or younger. Experimentation drives much of that, as does the desire of recreational drug users to counter the erection-hindering effects of ecstasy, ketamine, and crystal methamphetamine. Yet many young gay men still coming to terms with their sexuality may experience real, if temporary, impotence problems because of their anxiety or nervousness about having sex with another man, Goldstone says: "For these guys, Viagra can certainly lower the anxiety level tremendously by taking away the worry about being able to get an erection, and help them over the proverbial hump, so to speak."

Viagra and Levitra, an erectile dysfunction drug approved by the Food and Drug Administration in August, work by increasing blood flow to the penis. (A third medication, called Cialis, is currently under FDA review.) They're widely prescribed to treat erectile dysfunction caused by smoking, high blood pressure, high cholesterol, diabetes, and other physical ailments--as well as mental health conditions such as depression, stress, and anxiety. The drugs also are commonly used by HIV-positive men experiencing a condition called hypogonadism, which reduces the amount of testosterone in the body, making it difficult to achieve erections.

"For these men, they can be amazingly effective drugs," Mills says.

But men who merely experiment with erectile dysfunction medications are often disappointed with the results, with the spontaneity-killing wait of 30 minutes or more for the medications to kick in, or with such side effects as flushing, headaches, and even blue-tinted vision. "A lot of people also think it's going to improve libido mid the sex drive, but it doesn't," says Mills, 42, who himself occasionally uses Viagra and Levitra. "It really only works on function."

That's precisely what Morse discovered. "As far as enhancing the sex, it didn't do much of anything," he says.

While erectile dysfunction treatments can restore the self-confidence and rejuvenate the sex lives of many gay men, unexpected emotional issues can arise, says Michael Alvear, a gay sex advice columnist and author of the book Men Are Pigs but We Love Bacon. These problems are not uncommon--even among the partners of the men who are taking the medications.

"One of the most interesting letters I've ever gotten was from a gay man whose boyfriend was impotent, got a prescription for Viagra, and schwing, things started happening," Alvear says. "But the boyfriend said he felt, like he was getting 'pill-fucked.' He wanted the experience of turning his partner on, and Viagra actually led to a building resentment because he wasn't getting that experience."

Morse also struggled with those feelings when he discovered flint his partner of 11 years was secretly taking Viagra. "I started wondering if I wasn't good enough or sexy enough," he says. "These stupid little pills became the bane of my existence."

Despite glowing media reports and upbeat advertising campaigns, erectile dysfunction drugs also don't work for everyone. Viagra's Web site acknowledges that the medication is ineffective in about 20% of the men who take it. "Because we've made Viagra seem like the be-all, end-all for sexual dysfunction," Goldstone says, "if it doesn't work for people, they end up being devastated."

Another worry for health providers is that gay men who combine Viagra or Levitra with party drugs may ultimately engage in unprotected sex, possibly even multiple sexual encounters, putting themselves or others at risk for HIV and other sexually transmitted diseases. "You may be so high that you have no real sense of judgment," Goldstone says. "But now you're able to get an erection and just jump in."

This is particularly true for injectible medications like Caverject and Trimix, drugs that are administered as a shot directly into the penis. Although more difficult to obtain without a prescription them pills like Viagra or Levitra, injectible treatments are often sought by recreational drug users who may already be accustomed to injecting themselves or desire the quick-acting and virtually guaranteed effects of the shots, Mills says.

While a boon for men with legitimate ED symptoms who don't respond to Viagra or Levitra, injectible treatments are significantly mare likely to cause a dangerous condition called priapism, in which an erection doesn't go away, resulting in damage to penile tissue. Doctors counsel patients taking Caverject and Trimix on how to treat erections lasting longer than four hours--for example, a double dose of the over-the-counter decongestant Sudafed may help, Mills says--and when to seek emergency room treatment.

But men high on party drugs may not realize a long-lasting erection poses a medical danger until they reach a point where surgery may be the only successful treatment. "And with that comes the risk that there will be long-term problems getting an erection naturally," Mills warns.

Mills, however, believes that in the absence of party-drug usage, ED treatments actually can improve the likelihood of safer sex for many gay men, especially those who lose their erections when they use condoms. "When that does happen, you're stuck--do you risk losing an erection when you try to use a condom, or do you just have sex without it? Viagra can be helpful in making sure you stay hard so you can use condoms," he notes.

Despite the possibility for the medications to be misused, Mills, Goldstone, and Mayer agree that Goldstone says treatments are needed and useful in treating what was once a condition rarely discussed by doctors or patients. All three also are typically willing to give their gay patients samples or limited prescriptions to try the medications if they're experiencing even occasional symptoms of sexual dysfunction.

The key, Mayer says, is to seek the drugs from your health care provider and not get them from friends, in a club, or through the Internet. Talking with your doctor allows physicians to screen patients for possibly dangerous conditions, like diabetes, that may be causing the erectile dysfunction; educate them about the risks and benefits of the drugs; and encourage them to practice satyr sex.

"Then people will have the context to make informed decisions and to use the drugs in an optimal wag for their health," he says.

RELATED ARTICLE: Proceed with caution.

Combining erectile dysfunction drugs with other medications--and even with the recreational substances amyl nitrite or nitrate; commonly called poppers--can result in dangerously low blood pressure and possibly even death, says Ken Mayer, medical research director for Boston's Fenway Community Health. The interaction between erectile dysfunction drugs such as Viagra and Levitra and other medications also can affect the levels of the medications absorbed by your body.

Do not take erectile dysfunction medications if you:

* have a history of low blood pressure;

* have a history of cardiovascular problems;

* are taking nitrate-based drugs, including those to treat certain cardiac conditions; or

* use poppers.

Talk with your doctor before taking ED medications if you:

* are taking protease inhibitors for HIV;

* take alpha blockers to treat high blood pressure or prostate problems;

* are being treated for the eye disease retinitis pigmentosa; or

* are taking certain antibiotics, including erythromycin.

Erectile dysfunction drugs also can cause a rare condition called priapism, in which an erection does not go away, which can cause permanent damage to penis tissue. Seek immediate medical attention if you experience an erection lasting longer than four hours.

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