Category: Erectile Dysfunction

Viagra Precaution for Pregnancy and Breastfeeding

Viagra Precautions for Pregnancy and Breastfeeding

Viagra (sildenafil) is a medication commonly used to treat erectile dysfunction (ED) in men. It works by increasing blood flow to the penis, helping to achieve and maintain an erection. While Viagra is primarily used by men, there are important considerations and precautions for pregnancy and breastfeeding that should be noted:

Pregnancy

  1. Intended Use:
    • Viagra is not intended for use by women and is typically prescribed for men with erectile dysfunction.
  2. Off-Label Use:
    • Occasionally, sildenafil (the active ingredient in Viagra) may be prescribed off-label for certain conditions in women, such as pulmonary arterial hypertension (PAH). In such cases, the risks and benefits should be carefully considered by the healthcare provider.
  3. Effects on Pregnancy:
    • Animal Studies: Research in animals has not shown significant harm to the fetus when sildenafil is used. However, human studies are limited, and the potential risks are not fully understood.
    • Consult Your Doctor: If a woman is pregnant or planning to become pregnant and is prescribed sildenafil for a condition like PAH, it is crucial to discuss the potential risks and benefits with the healthcare provider.

Breastfeeding

  1. Medication Transfer:
    • There is limited data on whether sildenafil passes into breast milk. However, due to its pharmacological properties, it is possible that some amount could be excreted in human milk.
  2. Potential Risks to the Infant:
    • The effects of sildenafil on a breastfeeding infant are unknown. If it does pass into breast milk, there could be potential risks to the nursing baby.
  3. Consult Healthcare Provider:
    • Women who are breastfeeding should consult their healthcare provider before taking sildenafil. The provider will weigh the benefits of treatment against any potential risks to the infant.

General Recommendations

  1. Avoid Use Without Medical Guidance:
    • Women, whether pregnant or breastfeeding, should not use Viagra (sildenafil) without explicit guidance and prescription from a healthcare provider.
  2. Discuss Alternatives:
    • If sildenafil is deemed necessary for a woman’s health condition, discussing alternative treatments or additional monitoring with a healthcare provider is important.
  3. Monitor for Side Effects:
    • If sildenafil is prescribed, women should be vigilant for any side effects and report them to their healthcare provider immediately.

Key Points

  • Viagra is not intended for use by women and should only be used by men with erectile dysfunction, unless prescribed off-label for a specific condition by a healthcare provider.
  • Pregnant women and breastfeeding mothers should consult their healthcare provider before using sildenafil to understand the potential risks and benefits.
  • Careful consideration and close monitoring are essential when sildenafil is prescribed to women who are pregnant or breastfeeding.

It’s not known if Viagra is safe to take during pregnancy. (But keep in mind that the drug isn’t approved for use in women.)

If you’re sexually active and you or your partner can become pregnant, talk with your doctor about whether you’ll need to use birth control while you’re taking Viagra.

Viagra and pregnancy

Viagra isn’t approved for use in women. And it hasn’t been studied in pregnant women. It’s not known whether this drug is safe to take during pregnancy.

In animal studies, Viagra didn’t cause fetal harm when given to pregnant females. But animal studies don’t always predict what will happen in humans.

If you have questions about the safety of Viagra use during pregnancy, talk with your doctor.

Viagra and breastfeeding

Viagra isn’t approved for use in women. And it hasn’t been studied in women who are breastfeeding. Viagra may pass into breast milk, but it’s not known if this could affect a nursing child.

If you have questions about the safety of using Viagra while breastfeeding, talk with your doctor.

Viagra expiration, storage, and disposal

When you get Viagra from the pharmacy, the pharmacist will add an expiration date to the label on the bottle.

This date is typically 1 year from the date they dispensed the medication.

Viagra 100mg

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good (also called shelf-life) can depend on many factors. These factors include how and where you store the medication.

Viagra tablets should be stored at room temperature between 68oF and 77°F (20oC and 25°C). It should be kept in a tightly sealed container away from light. Avoid storing this medication in areas where it could get damp or wet, such as in bathrooms.

Disposal

If you no longer need to take Viagra and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

Is there a “female Viagra”?

While Viagra isn’t approved for use in women, a drug called Addyi is approved for use in certain women.

Viagra 50mg
Viagra 50mg

Some people refer to Addyi as “female Viagra.”

However, Addyi doesn’t work like Viagra does. Below, we describe the condition Addyi is approved to treat and how the drug works.

If you have questions about using Addyi, talk with your doctor.

What is Addyi?

Addyi is a brand-name prescription drug that’s approved to treat hypoactive sexual desire disorder (HDSS). It’s prescribed for women who haven’t yet gone through menopause. Addyi contains the active drug flibanserin. It’s not known for sure how Addyi works to treat HDSS.

What is HDSS and how does Addyi work to treat it?

With HDSS, you have very low sexual desire that’s troublesome for you. The condition can have various physical or psychological causes.

Unlike Viagra, which improves blood flow to male genitals, Addyi doesn’t work by improving blood flow to female genitals. Instead, Addyi affects the activity of certain neurotransmitters that are involved in sexual desire and arousal. (Neurotransmitters are chemicals found in your brain.)

The neurotransmitters affected by Addyi include dopamine, noradrenaline, and serotonin. But it’s not known for sure how the drug’s action affects sexual function.

How well does Addyi work?

For some women with HDSS, Addyi can improve sexual desire and increase the number of sexually satisfying events. But the drug hasn’t been found to be very effective.

For example, in clinical studies, treatment with Addyi was compared with that of a placebo (no active drug). The number of women whose HDSS was “much improved” or “very much improved” was only about 10% higher in women who took Addyi compared with women who took the placebo.

And keep in mind that it can take up to 8 weeks for Addyi to start working to treat HDSS.

Is Viagra OK for Women ?

Viagra is approved to treat erectile dysfunction (ED) in men. But you may have questions about whether Viagra can be used in women. Or you may be wondering if there’s a drug similar to Viagra that can help women with sexual dysfunction.

Viagra 25mg

Can women take Viagra?

No, Viagra isn’t approved for use in women. And there isn’t enough evidence to show that Viagra works for treating sexual problems in women.

One review of studies showed that current research has conflicting results on how Viagra affects women.

For example, in women with female sexual arousal disorder, the review showed the following findings:

    • In one study, some women who’d gone through menopause were given Viagra. These women had improved arousal, vaginal lubrication, and orgasm when they took the drug.
    • In another study, both women who’d gone through menopause and those who hadn’t were given Viagra. These women reported no significant positive effects from taking the drug.

In men, Viagra improves blood flow to their penis by blocking the action of a chemical called PDE5. This chemical is also found in the vagina and the clitoris of women. So in theory, if a woman takes Viagra, it could increase blood flow to her genitals.

But in reality, there’s less PDE5 in a female’s genitals than there is in a male’s penis. This could explain why Viagra has less of a physical effect in women than it does in men.

And keep in mind that sexual problems in women often have a lot to do with reduced sexual desire and arousal. Viagra is unlikely to address these issues.

viagra for men
viagra for men

Viagra (Sildenafil) is Primarily Prescribed for Men

Viagra (sildenafil) is primarily prescribed for men to treat erectile dysfunction (ED) and is not approved by the U.S. Food and Drug Administration (FDA) for use in women. However, there has been some interest and research into its potential effects and uses in women, particularly for conditions such as female sexual arousal disorder (FSAD). Here’s what is currently understood about Viagra’s use in women:

Research and Potential Uses in Women

  1. Female Sexual Arousal Disorder (FSAD):
    • Some studies have explored the use of sildenafil for FSAD, which involves difficulty with sexual arousal and lubrication. The results have been mixed, and there is no conclusive evidence to support its routine use for this condition.
  2. Pulmonary Arterial Hypertension (PAH):
    • Sildenafil is approved for the treatment of PAH in both men and women under the brand name Revatio. It helps relax blood vessels in the lungs to improve blood flow.

Potential Effects and Considerations

  1. Mechanism of Action:
    • Sildenafil works by increasing blood flow, which can theoretically improve sexual arousal and response. In women, this could potentially enhance blood flow to the genital area, increasing sensitivity and lubrication.
  2. Limited Evidence:
    • Research on the effectiveness and safety of Viagra in women is limited and inconclusive. Some studies have shown minimal improvement in sexual arousal, while others have found no significant benefits.
  3. Side Effects:
    • Women may experience similar side effects to men, including headaches, flushing, nasal congestion, indigestion, and vision changes. Additionally, the impact on female physiology is not fully understood, which could lead to unknown risks.

Current Recommendations

  1. Not FDA-Approved for Women:
    • Viagra is not approved for use in women for sexual dysfunction. The FDA has not sanctioned its use for this purpose due to insufficient evidence of safety and efficacy.
  2. Consult Healthcare Provider:
    • Women interested in exploring treatment options for sexual dysfunction should consult their healthcare provider. There are other medications and therapies specifically studied and approved for women, such as flibanserin (Addyi) for premenopausal women with hypoactive sexual desire disorder (HSDD).
  3. Off-Label Use:
    • In some cases, healthcare providers may consider off-label use of sildenafil for conditions like FSAD, but this should be done with caution and under strict medical supervision.

How Common is ED (Erectile Dysfunction)?

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

What is Erectile Dysfunction?

When a man becomes aroused, the brain releases a neurochemical to increase the size of blood vessels carrying blood to the penis and reduce the size of the vessels that carry it out.

Twin compartments that run the length of the penis, called corpora cavernosa, become flush with blood that is trapped in the shaft.

This causes the penis to stiffen and become erect.

If blood flow to the penis is inhibited or the blood vessels are clogged or constricted, erection cannot be achieved or maintained.

This is one of the primary causes of erectile dysfunction.

Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you’re concerned about erectile dysfunction, talk to your doctor — even if you’re embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

Symptoms of Erectile Dysfunction

Symptoms of ED can include:

  • Erections are hard to get
  • Erections are less rigid
  • Erections are not satisfactory for penetration
  • Erections cannot be maintained during sexual activity or until the man’s orgasm is reached
  • Erections cannot be achieved at all

Men with ED can lose confidence in their sexual ability and their overall sense of self-worth can be negatively affected.

Erectile dysfunction can have a devastating psychological impact for individuals and couples.

Causes of Erectile Dysfunction

In the majority of cases, erectile dysfunction occurs when blood flow to the penis is inhibited either by cardiovascular problems or poor nerve signalling. Healthy arousal engorges the penile tubes (corpora cavernosum) with arterial blood causing it to stiffen and become erect. The engorged corpora occlude the venous outflow of blood, creating a rigid or full erection. Erection dysfunction occurs when there is either poor influx of arterial blood or efflux of venous blood (venous leak).

While both psychological and biological factors can cause erectile dysfunction, in reality the mind and body work together in sexual arousal, so most men have both factors in varying proportions.

Psychological Causes of ED
Men who suffer from clinical depression, anxiety, chronic stress, or who are experiencing challenges in their relationship with their partner, may have erectile difficulties. Some of the medications that treat depression can also contribute to the problem. The inability to perform sexually can cause further anxiety and depression, creating a downward spiral.

Biological Causes of ED
Health conditions or lifestyle choices that affect blood circulation, structural anomalies in the penis, certain neurological conditions, hormonal deficiencies, and medication side effects, can all contribute to erectile dysfunction. The chart below lays out examples of potential biological reasons for a man’s erectile dysfunction.

Risk factors

As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection.

Various risk factors can contribute to erectile dysfunction, including:

  • Medical conditions, particularly diabetes or heart conditions
  • Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction
  • Being overweight, especially if you’re obese
  • Certain medical treatments, such as prostate surgery or radiation treatment for cancer
  • Injuries, particularly if they damage the nerves or arteries that control erections
  • Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions
  • Psychological conditions, such as stress, anxiety or depression
  • Drug and alcohol use, especially if you’re a long-term drug user or heavy drinker

Complications

Complications resulting from erectile dysfunction can include:

  • An unsatisfactory sex life
  • Stress or anxiety
  • Embarrassment or low self-esteem
  • Relationship problems
  • The inability to get your partner pregnant

Prevention of ED

The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example:

    • Work with your doctor to manage diabetes, heart disease or other chronic health conditions.
    • See your doctor for regular checkups and medical screening tests.
    • Stop smoking, limit or avoid alcohol, and don’t use illegal drugs.
    • Exercise regularly.
    • Take steps to reduce stress.
    • Get help for anxiety, depression or other mental health concerns.

Diagnosis of ED

Finding the cause of your ED will help direct your treatment options.

Diagnosing ED starts with your health care provider asking questions about your heart and vascular health and your erection problem. Your provider may also give you a physical exam, order lab tests or refer you to a Urologist.

Health and ED History

Your doctor will ask you questions about your health history and lifestyle. It is of great value to share facts about drugs you take, or if you smoke or how much alcohol you drink. He/she will ask about recent stressors in your life. Speak openly with your doctor, so he/she can help you find the best choices for treatment

What Questions Will the Health Care Provider Ask?

Questions about your health:
      • What prescription drugs, over-the-counter drugs or supplements do you take?
      • Do you use recreational drugs?
      • Do you smoke?
      • How much alcohol do you drink?
      • Have you had surgery or radiation therapy in the pelvic area?
      • Do you have any urinary problems?
      • Do you have other health problems (treated or untreated)?

Questions About ED

Knowing about your history of ED will help your health provider learn if your problems are because of your desire for sex, erection function, ejaculation, or orgasm (climax). Some of these questions may seem private or even embarrassing. However, be assured that your doctor is a professional and your honest answers will help find the cause and best treatment for you.

Questions about your ED symptoms:

    • How long have you had these symptoms? Did they start slowly or all at once?
    • Do you wake up in the morning or during the night with an erection?
    • If you do have erections, how firm are they? Is penetration difficult?
    • Do your erections change at different times, like when going in a partner, during stimulation by mouth, or with masturbation?
    • Do you have problems with sex drive or arousal?
    • Do you have problems with ejaculation or orgasm (climax)?
    • How is this problem changing the way you enjoy sex?
    • Do you have painful with erections, feel a lump or bump in the penis or have penile curvature? These are signs of Peyronie’s Disease which can be treated but calls for an expert in urology to assess and manage.

Questions About Stress and Emotional Health

Your health care provider may ask you questions about depression or anxiety. He or she may ask about problems in your relationship with a partner. Some health care providers may also ask if they may talk to your sex partner.

    • Are you often under a lot of stress, or has something recently upset you?
    • Do you have any anxiety, depression or other mental health issues?
    • Are you taking any drugs for your mental health?
    • How satisfied are you with your sex life? Has there been any changes lately?
    • How is your relationship with your partner? Has there been any changes lately?

Physical Exam

A physical exam checks your total health. Examination focusing on your genitals (penis and testicles) is often done to check for ED. Based on your age and risk factors, the exam may also focus on your heart and blood system: heart, peripheral pulses and blood pressure. Based on your age and family history your doctor may do a rectal exam to check the prostate. These tests are not painful. Most patients do not need a lot of testing before starting treatment.

Lab Tests

Your health care provider may order blood tests and collect a urine sample to look for health problems that cause ED.

Other Tests

Questionnaires are often used by health experts to rate your ability to initiate and keep erections, gauge your satisfaction with sex and help identify any problems with orgasm.

Advanced Erectile Function Tests

For some men with ED, specialized testing may be needed to guide treatment or re-assess you after a treatment fails.

    • Blood work to check Testosterone and other male hormones
    • Blood work to measure blood sugar (Diabetes)
    • Ultrasonography (penile Doppler) to check blood flow
    • A shot into the penis with a vascular stimulant to cause an erection
    • Pelvic x-rays like arteriography, MRI or CT scanning are rarely needed to check ED unless there is history of trauma or cancer
    • Nocturnal penile tumescence (NPT), an overnight test to check for sleep erection

Treatment of ED

The treatment for ED starts with taking care of your heart and vascular health. Your doctor may point out ‘risk factors’ that can be changed or improved.

You may be asked to change certain food habits, stop smoking, increase workouts or stop using drugs or alcohol. You may be offered alternatives to the drugs you take. (Never stop or change prescription drugs without first talking to your health care provider.)

Your health care provider may also suggest treating emotional problems. These could stem from relationship conflicts, life’s stressors, depression or anxiety from past problems with ED (performance anxiety).
The treatments below are available to treat ED directly.

Non-invasive treatments are often tried first. Most of the best-known treatments for ED work well and are safe. Still, it helps to ask your health care provider about side effects that could result from each option:

  • Oral drugs or pills known as phosphodiesterase type-5 inhibitors are most often prescribed in the U.S. for ED (Viagra, Cialis, Levitra, Stendra)
  • Testosterone Therapy (when low testosterone is detected in blood testing)
  • Penile Injections (ICI, intracavernosal Alprostadil)
  • Intraurethral medication (IU, Alprostadil)
  • Vacuum Erection Devices
  • Penile Implants
  • Surgery to bypass penile artery damage for some younger men with a history of severe pelvic trauma. Penile vascular surgery is not recommended for older men with hardened arteries.

Oral Drugs (PDE5 inhibitors)

Drugs known as PDE type-5 inhibitors increase penile blood flow. These are the only oral agents approved in the U.S. by the Food and Drug Administration for the treatment of ED.

    • Viagra ® (sildenafil citrate)
    • Levitra ® (vardenafil HCl)
    • Cialis ® (tadalafil)
    • Stendra ® (avanafil)

For best results, men with ED take these pills about an hour or two before having sex. The drugs require normal nerve function to the penis. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis. Use these drugs as directed. About 7 out of 10 men do well and have better erections. Response rates are lower for Diabetics and cancer patients.

If you are taking nitrates for your heart, you SHOULD NOT take any PDE5 inhibitors. Always speak with your health care provider before using a PDE5 inhibitor to learn how it might affect your health.

Most often, the side effects of PDE5 inhibitors are mild and often last just a short time. The most common side effects are:

    • Headache
    • Stuffy nose
    • Facial flushing
    • Muscle aches
    • Indigestion

In rare cases, the drug Viagra ® can cause blue-green shading to vision that lasts for a short time. In rare cases, the drug Cialis ® can cause or increase back pain or aching muscles in the back. In most cases, the side effects are linked to PDE5 inhibitor effects on other tissues in the body, meaning they are working to increase blood flow to your penis and at the same time impacting other vascular tissues in your body. These are not ‘allergic reactions’.

Testosterone Therapy

In those rare cases where a low sex drive and low blood levels of Testosterone are at fault for ED, Testosterone Therapy may fix normal erections or help when combined with ED drugs (PDE type 5 inhibitors).

Vacuum Erection Device

A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body. A pump at the other end of the tube makes a low-pressure vacuum around the erectile tissue, which results in an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. With proper training, 75 out of 100 men can get a working erection using a vacuum erection device.

Diagram of a Erectile Dysfunction Vacuum
Diagram of a Erectile Dysfunction Vacuum

Diagram of a Erectile Dysfunction Vacuum

Enlarge

Intracavernosal (ICI) and Urethra (IU) Therapies

If oral drugs don’t work, the drug Alprostadil is approved for use in men with ED. This drug comes in two forms, based on how it is to be used: intracavernosal injection (called “ICI”) or through the urethra (called “IU therapy”).

 

Self-Injection Therapy

Alprostadil is injected into the side of penis with a very fine needle. It’s of great value to have the first shot in the doctor’s office before doing this on your own. Self-injection lessons should be given in your doctor’s office by an experienced professional. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment. Many men who do not respond to oral PDE5 inhibitors can be ‘rescued’ with ICI.

ICI Alprostadil may be used as a mixture with two other drugs to treat ED. This combination therapy called “bimix or trimix” is stronger than alprostadil alone and has become standard treatment for ED. Only the Alprostadil ingredient is FDA approved for ED. The amount of each drug used can be changed based on the severity of your ED, by an experienced health professional. You will be trained by your health professional on how to inject, how much to inject and how to safely raise the drug’s dosage if necessary.

ICI therapy often produces a reliable erection, which comes down after 20-30 minutes or with climax. Since the ICI erection is not regulated by your penile nerves, you should not be surprised if the erection lasts after orgasm. The most common side effect of ICI therapy is a prolonged erection. Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office.

Men who have penile erections lasting longer than two to four hours should seek Emergency Room care. Priapism is a prolonged erection, lasting longer than four hours. It is very painful. Failure to undo priapism will lead to permanent penile damage and untreatable ED.

Intraurethral (IU) Therapy

For IU therapy, a tiny medicated pellet of the drug, Alprostadil, is placed in the urethra (the tube that carries urine out of your body). Using the drug this way means you don’t have to give yourself a shot, unfortunately it may not work as well as ICI. Like ICI therapy, IU Alprostadil should be tested in the office, before home usage.

The most common side effects of IU alprostadil are a burning feeling in the penis. If an erection lasts for over four hours, it will need medical attention to make it go down.

Surgical Treatment

The main surgical treatment of ED involves insertion of a penile implant (also called penile prostheses). Because penile vascular surgery is not recommended for aging males who have failed oral PDE5 inhibitors, ICI or IU therapies, implants are the next step for these patients. Although placement of a penile implant is a surgery which carries risks, they have the highest rates of success and satisfaction among ED treatment options.

Penile implants are devices that are placed fully inside your body. They make a stiff penis that lets you have normal sex. This is an excellent choice to improve uninterupted intimacy and makes relations more spontaneous.

There are two types of penile implants.

Semi rigid Implant (Bendable)

The simplest kind of implant is made from two easy-to-bend rods that are most often made of silicone. These silicone rods give the man’s penis the firmness needed for sexual penetration. The implant can be bent downward for peeing or upward for sex.

Inflatable Implant

With an inflatable implant , fluid-filled cylinders are placed lengthwise in the penis. Tubing joins these cylinders to a pump placed inside the scrotum (between the testicles). When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff. Inflatable implants make a normal looking erection and are natural feeling for your partner. Your surgeon may suggest a lubricant for your partner. With the implant, men can control firmness and, sometimes, the size of the erection. Implants allows a couple to be spontaneously intimate. There is generally no change to a man’s feeling or orgasm.