Dr. Steven Lamm
'The Virility Solution' and restoring sexual potency
(CNN) -- This is the transcript from a recent moderated chat with Dr, Steven Lamm, co-author of "The Virility Solution: Everything You Need to Know About the Medically Proven Potency Pill That Can Restore and Enhance Male Sexuality."
QUESTION: Dr. Lamm, what do you think are the social implications of a drug that can restore potency?
DR. LAMM: I think that the social implications are enormous. The reason that Viagra has received so much attention is that I think Viagra will give couples the opportunity to re-establish a relationship that was harmed by a medical problem.
I think that for a while the drug may throw some couples out of sync. When we start re-empowering a man who has not been sexually potent -- it may make a gap. Sex will have to be re-introduced into some relationships. In some cases, women may have their own sexual issues and problems to deal with.
QUESTION: Does the drug cure impotency that is psychologically based?
DR. LAMM: We don't really talk in terms of cure. However, Viagra can help some psychogenic men (men who have performance anxiety).
QUESTION: Is the potency pill dangerous for older men to take?
DR. LAMM: There are always side effects. The most serious interaction is when Viagra is taken with some nitrates. Sex itself may pose a problem for older men. I think that probably some men with underlying heart diseases should not be candidates for Viagra. The risk of a heart attack for a healthy 50-year-old men is two per million, but that number goes up to 30 per million for the man with cardiovascular problems.
QUESTION: Some health insurance providers cover the cost of Viagra, while female contraception generally is not covered. Any thoughts?
DR. LAMM: I think this is a real socio-economic issue that bothers a lot of people. I clearly would support insurance companies paying for Viagra and birth control pills, when medically necessary. I don't think it is a double standard, because in the long run women will take advantage of Viagra as well!
QUESTION: Dr Lamm, I understand some couples are asking for Viagra for their honeymoons. The implication is that Viagra may work as an aphrodisiac. Will it benefit an already healthy, sexually active male?
DR. LAMM: Clearly, there is a tremendous curiosity about this drug. The reality is that it is very unlikely to make any change in a healthy male. Anyway, If you cannot enjoy your honeymoon -- you have a serious problem!
QUESTION: Dr Lamm, you state there are 30 million American men who experience impotency ... will Viagra help all 30 million?
DR. LAMM: No. Thirty million impotent men is a low number. What we are seeing is a big dissatisfaction with sexual performance all over the world. There is a world-wide preoccupation with sexual performance, and Viagra can only help about 60 to 70 percent of these men. 100 million men, worldwide, are actually impotent. Alternative treatments are not usually acceptable to some men. Other methods tend to be invasive. So, 30 to 40 percent of all men can not be helped by Viagra, and will have to use other alternatives. There are also several new solutions forthcoming. If you follow a regimen of healthy eating and exercise -- and no smoking -- you may not ever have a problem at all. Many men are not aware that every day behaviors affect sexual performance.
QUESTION: Does one need physical stimulation, or will Viagra work when mental and/or emotion stimulation occurs?
DR. LAMM: Viagra is a facilitator of erections. That means that Viagra requires one to participate in an intimate relationship the old fashioned way. Without that it will not work. That is the beauty of it -- there is no artificial aspect to it. The partners feels that they are not being robbed of their responsibility in the relationship.
QUESTION: There is a debate going on here in Tennessee as to whether Medicaid should pay for Viagra. What do you think about this?
DR. LAMM: Once again, I donŐt think this drug should be given to only wealthy people. Everybody deserves a good sex life! Again, the government is working on laws that will ensure all people have access to this drug.
QUESTION: There is a medicine which is injected into the penis which will bring forth an erection lasting much, much longer than that achieved by most without medication. Will Viagra extend the length of an erection?
DR. LAMM: Extending the duration of an erection is somewhat harmful. If you prolong an erection for more than an hour or an hour-and-a-half it is very dangerous. There are men that can sustain an erection longer with Viagra, but once an ejaculation happens -- the erection fades slowly. Second erections may be helped with Viagra.
QUESTION: Dr. Lamm, are we not obsessed with sex beyond reality?
DR. LAMM: Yes. There is no question that sex is a major preoccupation -- not only in America --- but the world. It just shows you how important sexual functioning is to a man. It deals with the core of his being.
QUESTION: Is it proven yet whether Viagra works because it is a phosphodiesterase inhibitor?
DR. LAMM: Yes. It is a type 5 phosphodiesterase inhibitor.
QUESTION: Is extending an erection naturally (i.e. without Viagra or any other drug) beyond an hour-and-a-half dangerous as well?
DR. LAMM: Yes. The condition is referred to as a priapism. It is a condition associated with certain diseases -- most specifically sickle cell. If the erection is truly prolonged ... lasting more than an hour-and-a-half ... contact your physician. The danger is that you may deny the penile tissue oxygen, therefore injuring the penis.
QUESTION: Can Viagra have any effect on patients who have had orchoechtomies due to cancer?
DR. LAMM: Yes. If they have had their testicles removed then they have a loss of testosterone. You can try Viagra in this instance.
QUESTION: Why did Pfizer seek the advice and counsel of the Vatican before it marketed the drug?
DR. LAMM: I think they were very sensitive to the potential religious concerns about sexuality, family and promiscuity. Pfizer wanted the Vatican to know that the primary purpose of the drug is to restore function to an impaired man. Also, they wanted to impress upon the public that this drug will enhance a marriage relationship.
QUESTION: Percentage-wise, how many men can Viagra help?
DR. LAMM: 60 to 70 percent of the men worldwide.
QUESTION: What other kinds of drugs are on the horizon for this indication?
DR. LAMM: The one that I am most familiar with is Basomax. It is another drug that dilates blood vessels, and it looks like it might be approved in the next 10 months. It is a much milder drug. It may have an interesting use in women as well. It is being tested for women to see if it can improve lubrication and arousal. Apormorphine -- another drug that works in the central nervous system -- looks promising. Also, more Viagra-like drugs are coming down the pike as well, and some topical medications that will be as effective as the injections. Whether we ever have drugs that are aphrodisiacs -- I don't know. I think it is important to stress that Viagra is not an aphrodisiac.
QUESTION: Shouldn't this really be viewed as a luxury medicine ... a bit like plastic surgery or breast implants?
DR. LAMM: I think that in some ways this is a quality-of-life drug. So, I can understand how someone might equate this with plastic surgery. Usually, sexual disfunction centers around some physical problem. People deserve a quality of life, and this is a factor.
QUESTION: Are there other vasodilators besides organonitrates which lead to precipitous and hazardous drops in blood pressure with Viagra?
DR. LAMM: The only one that we know of right now are the nitrates. I think as we continue to use Viagra -- we will find other drug interactions. As we do with all new drugs, we will learn as we go. It is a tedious process to get a drug approved, and sometimes you cannot anticipate problems in such small test groups. I am very hopeful for Viagra, but like any other drug we really don't know for several years what the long-term implications are for the drug.
QUESTION: Is there a danger of Viagra being abused, and when it will be in Canada?
DR. LAMM: I think it will be available in Canada in ten months. The drug is not an aphrodisiac, so it should not enhance performance in a normal man.
QUESTION: Are there any side effects to Viagra?
DR. LAMM: The primary side effects include : headaches, light-headedness, and upset stomach. It is important to emphasize that you have to work on your relationship. The pill is not the magic answer. Also, we should be careful not to blame the deterioration of a relationship on the pill. Preserving a relationship because a male is impotent does not seem like a healthy relationship.
QUESTION: Dr Lamm, you are speaking in terms of enhancing an already existing loving relationship, but we have already heard of a man leaving his partner, seeking new sexual conquests ...
DR. LAMM: If we restored vision to a man, and he was dissatisfied with what he saw, would we blame the people who restored his eyesight? We have to work on the health of relationships. There will be men who feel empowered by Viagra, and urge their partner to perform at a higher rate. I suggest that before couples start on Viagra -- couples discuss the value of sex in their lives. You have to be prepared for a change in your relationship. This is a couple decision. Couples should communicate before running out to get this drug.
QUESTION: the story of how clinicians discovered Pfizer's heart medication's unintended effect is a good one ... can you tell it?
DR. LAMM: Viagra was being studied as a drug to treat heart disease. The patients reported no benefit to the heart ... but they had an interesting little side effect ... This happened in 1992 and 1994.
QUESTION: Dr. Lamm, just for clarification, do you believe that just because a male is impotent, there can be no healthy relationship? Or that all "healthy" relationships revolve around sex?
DR. LAMM: I think that there can be very healthy relationships despite a manŐs impotency. The decision to treat a man's impotency is based on a man's dissatisfaction with his life. Of course, there are many intimate loving couple that do not have sex.
QUESTION: Dr Lamm, perhaps marriage counseling should be included with a prescription for Viagra ...
DR. LAMM: I think that for many couples counseling is very important. But not all couples need that. Viagra, for some couples, is just restoring a sex life that dissipated.
QUESTION: Is there the potential for women to ultimately resent Viagra?
DR. LAMM: Absolutely. The women who's partner has been enhanced by the drug ... and the relationship is now out of sync ... may resent the drug. It is not the drug you should be examining, it is the relationship.
QUESTION: Dr. Lamm, why does Viagra have to be a prescription drug? Is it so dangerous? Why not sell it over the counter? Many men are embarrassed and won't go to a doctor and ask for a prescription.
DR. LAMM: At the present time it is a prescription because of the risk of using the drug with other health problems like heart disease or diabetes. We find that men are not as timid to go to the doctor as we once thought. Men are shameless when it comes to getting this back!
QUESTION: Dr. Lamm, shouldn't communication between couples take precedence even if the male is considering using Viagra?
DR. LAMM: The evaluation of a relationship is very complex, and a physician may not be qualified. Certainly the physician should raise questions about the relationship. This drug will not help a relationship that is suffering on other ground. It will help many more couples than it will break them apart.
QUESTION: Dr Lamm, isn't there a double standard regarding Viagra? After all, no one would say that breast implants could undermine a marriage, but somehow Viagra could.
DR. LAMM: I think that the tremendous interest in this drug is somehow based on the idea that we are challenging the balance of power in a relationship. We have to recognize that we say this is a male issue, yet there are many women who are dissatisfied with the sexual performance of their partner.
This drug acts like a magnifying glass for relationships. I appreciate this opportunity to chat with you all. Thank you and goodnight!
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