Man’s Search for Ultimate Sex: Viagra® Abuse Jeffrey A. Albaugh Susan Kellogg-Spadt n an age when men aspire for “extreme” perfor- mance in all aspects of their lives, sexual per- safe, but encouraged the young man to seek medical formance is no exception. As a result, the drug advice prior to further use. Curiosity about Viagra sildenafil citrate (Viagra®) is being routinely abounds with men wondering about its ability to Iused and abused by men of all ages (who have not improve the quality and rigidity of erections, been diagnosed with erectile dysfunction) to facili- decrease the refractory period after ejaculation, and tate the ultimate sexual experience. Men might use increase libido. Danner (2001) reports that Viagra is this drug to counteract or coincide with other recre- one of the “party drugs” of our times and there are ational drugs, to improve the quality and longevity reports that it is prevalent in British nightclubs and of an already adequate erection, or to shorten the restaurants under the name “poke” (Canadian normal physiologic refractory period between erec- Medical Association, 1998). Widespread Viagra use tions. Although there is no indication or document- is also reported as a trend among gay men in the ed evidence for improved erectile function in party scene (Contemporary Sexuality, 2001; Men’s healthy young men, the use of sildenafil citrate Fitness, 2002). among this population is thought to improve erec- tile longevity and rigidity by these men. Mixing Drugs Man’s search for improved sexual function In recreational use, Viagra is being mixed with would be better served by his learning about the other street drugs such as ecstasy (methylene- arousal response cycle and the type and amount of dioxymethamphetamine), uppers (amphetamines), loveplay that might lead his partner to the greatest crystal methadone, and poppers (amyl nitrate) into level of satisfaction. The arousal response cycle of what is termed a “party cocktail.” Ecstasy is an illic- the male was described by Masters and Johnson it drug (illegal since 1985) used to produce a relaxed (1986) and continues to provide the standard for euphoric state that leaves the user feeling empathet- male sexual response today. There remains a 10 to ic and accepting of themselves and others (Brown 15 minute disparity between the much quicker cli- University, 2001). Amphetamines are uppers used to mactic episode of a male versus the longer time to increase alertness and create an increased energy climax associated with the female. Orgasm and cli- level and euphoric feeling (Winstock, Wolf, & max are not dependent on an erect penis (Masters & Ramsey, 2002). Crystal methadone is used on the Johnson, 1986; Ramage, 1998). Males typically have street to increase libido dramatically (Men’s Fitness, a refractory period after orgasm in which full erec- 2002). Amyl nitrate is a potent vasodilator tradition- tions are unachievable (Masters & Johnson, 1986). ally used for angina pain, but as a street drug is Improved knowledge of these physiologic processes reported to cause aphrodisiac benefits and a rush might lead to improved sexual satisfaction for a feeling caused by an immediate increase in heart male and his partner. rate coupled with a decrease in blood pressure (Dye, 1993). Unprescribed Use of Viagra Drugs like ecstasy can cause erectile dysfunc- In a question and answer column in a men’s tion and Viagra is used to counteract the adverse health magazine, a seemingly healthy 34-year-old effects. Crystal methadone may potentiate libido, man described his immense satisfaction with Viagra while the Viagra may improve stamina in conjunc- and asks if it is harmful (Steig & Jones, 2002). The tion with this party drug. None of these drug combi- responding physician stated that it is remarkably nations have been researched. Of most concern is the mixture of Viagra with amyl nitrate. It has been found to potentiate the vasodilatory effect of Viagra, Jeffrey Albaugh, MS, APRN-BC, CUCNS, is a Clinical a potentiation that can be fatal (World Health Nurse Specialist, Center for Urology, Northwester Memorial Organization, 2001). Hospital, Chicago, IL. There are concerns that “party cocktails” might promote sexual promiscuity and the increased Susan Kellogg-Spadt, PhD, CRNP, is Director, Vulvar and spread of sexually transmitted diseases (CDC & Sexual Medicine, Graduate Hospital, Philadelphia, PA. FDA, 2002). Colfax et al. (2001) report increased UROLOGIC NURSING / February 2003 / Volume 23 Number 1 75 high-risk activities among urban gay and bisexual smell of excess. Retrieved December 6, 2002 from men taking drug cocktails, and cite these behaviors EbscoHost: Health Source – Consumer Edition. Joe Weiders Men’s Fitness. (2002). Viagra abuse on the upswing. as putting them at risk for exposure to HIV. The drug Joe Weiders Men’s Fitness, 18(1), 54. cocktails may contribute to a sexual freedom on the Masters, W., & Johnson, V. (1986). Sex and human loving. Boston: part of the user, which would normally not be acted Little, Brown, & Company upon. Ramage, M. (1998). ABCs of sexual health: Management of sexu- al problems. British Medical Journal, 317(7171), 1509-1512. Steig, B., & Jones, L. (2002). Hard facts. Men’s Health 17(5), 50. The Clinician’s Role in Stopping Winstock, A.R., Wolf, K., & Ramsey, J. (2002). 4-MTA: A new syn- Pharmacologic Abuse thetic drug on the dance scene. Drug and Alcohol Sex education can be an empowering tool to Dependence, 67(2), 111-115. promote improved sexual satisfaction on the part of World Health Organization. (2001). Sildenafil: Not for use with nitrates. World Health Organization Drug Information, both partners. This educative process should 15(2), 81. include sexual anatomy and physiology, normal sex- ual response cycles for the sex of both partners, forms of stimulation that may lead to orgasm, mas- turbation techniques, and the adverse effects of illic- it drugs. Education can be delivered in a matter of fact, yet sensitive manner. Each patient must be evaluated with a history and physical examination to determine the appropriateness of treatment with any medical intervention such as sildenafil citrate. The clinician must assess the person’s or couples’ feelings about the information presented and acknowledge those feelings and emotions. Much of the sex education information may be new and dif- ferent for patients. It is important to falsify the wide- spread belief that all sexual pleasure is derived solely from an erect penis. The goals of sexual intimacy and loveplay should be mutually agreed upon by both part- ners and are highly individualistic. Communication is an essential element to improving sexual intimacy and satisfaction. Partners must be able to dialogue freely about their feelings, pleasure, and dislikes in regards to intimate loveplay. Foreplay may or may not be aimed at pleasuring each other to reach mutual climax. The clinician can play an integral role in educating patients on anatomy and physiology, normal sexual response cycles, alternative methods of pleasuring each other, and opening up communication between partners about intimacy and sex. Conclusion Man will no doubt continue his search for improved sexual performance and greater sexual satisfaction. With the help of clinicians involved in sexual health, man can continue to do so in a safe and responsible manner. • References Brown University. (2001). From MDMA to ecstacy. Brown University Child and Adolescent Behavior Letter, 17(8), 1-2. Canadian Medical Association. (1998). We’re not making this up. Canadian Medical Association Journal, 159(12), 4. Centers for Disease Control/ Food and Drug Administration. (2002). Experts see dangerous trend in use of Viagra with party drugs. Medical Letter on the CDC & FDA. Retrieved December 12, 2002 from EbscoHost Database: Nursing & Allied Health Collection: Comprehensive. Colfax, G.N., Mansergh, G., Guzman, R., Vittinghoff, E., Marks, G., Rader, M., & Buchbinder, S. (2001). Caution about club drugs and Viagra. Journal of Acquired Immune Deficiency Syndromes, 28(4), 373-379. Contemporary Sexuality. (2001). Viagra abuse seen among San Francisco gay party scene. Contemporary Sexuality, 35(11), 8. Danner, V. (2001). Viagra becomes a party drug. Access 15(6), 8. Dye, C. (1993). Amyl/butyl nitrate and nitrous oxide: The sour 76 UROLOGIC NURSING / February 2003 / Volume 23 Number 1.