Viagra: Does it Work with Spinal Cord Injury

by Lee Slater

Most people wait till they’re dead before they donate their body to science. Not me. I’ve been a guinea pig all my gimp life. That’s 34 years of experimentation. I’m the only survivor I know of the great 28-year Dantrium study, for instance, and then there was my long search for chemical enlightenment during the ’60s and ’70s. This year, duty called again.

I got a call from Fred, my friend and family doctor. Fred said he had come into some Viagra, the erection medication. He was curious to know if it worked on gimps and wondered if I’d test it for him. How could I turn him down? This is the man who saw me through two near-death experiences. I told him I was up to the challenge.

Viagra–the generic name is sildenafil citrate–works like this: An erection occurs when nitric oxide is released into the smooth muscles of the penis, flooding it with blood. But mother nature saw fit to install a control system. An enzyme inundates the penis after ejaculation, constricting blood vessels and allowing it to become flaccid. The enzyme remains and slows the flow of nitric oxide into the penis until the man is intensely aroused. But age or disability can prevent nitric acid from getting past the enzyme gatekeeper, and that’s where Viagra comes in. It gives the nitric oxide an upper hand over the enzyme, and the rest is whoopee.

In studies released by Pfizer Pharmaceutical, the maker of Viagra, 70 percent of nondisabled men achieved viable erections with the drug. For men with spinal cord injury, however, that figure was only 60 percent. Then there are those 50-plus men who have expired–happily but prematurely–from overexertion while using Viagra. These poor souls failed to heed medical advice to go forth and have sex but not get excited.

Pfizer has claimed that side-effects from Viagra are relatively rare, affecting about 9 percent of all users studied. They include nausea, flushing, nasal congestion, headaches and visual disturbances. However, a later Pfizer study published in the New England Journal of Medicine indicates that 30 percent of users experienced headaches, 27 percent had facial flushing and up to 17 percent had visual changes. This still doesn’t scare away the many users who feel that if it’s a decision between no sex and a headache, then bring on the headache. That’s why they sell aspirin.

But beware of taking Viagra with nitroglycerin or similar drugs. The combination can drop blood pressure to dangerous levels. “If a cardiac patient takes Viagra along with nitrates,” reports Your Health magazine, “it could be the last time he’ll have sex.”

So, into the lab. After assessing the Pfizer product literature, my wife Jo and I giggled as we anticipated our first evening together with Viagra. I popped the pill. By the time Jo got in bed, what to my wondering eyes did appear but a genuine unassisted throbber. It was the first in years that hadn’t been punctured into existence. Pfizer had just become my friend.

I was inspired to continue my research during the months that followed. Like many researchers before me, I’ve had successes and failures. The pill doesn’t always provide me with the kind of results I got the first time, and using it too frequently seems to diminish its effects. It’s the same if I drink too much liquid or eat a large meal before taking the pill. Twice my erection failed to remain at attention, and required a jump start from an injection of Caverject. On the other hand, Viagra is great for surprises. Pop a pill, take a nap, and then call your partner into the bedroom on some ruse. Whip back the covers and amaze her–either with your prodigious display or your oafish behavior.

Spontaneity is a key issue for those who have chosen Viagra. Danny Walden, a C5-6 quad, has been married to Beth for 14 years. He had been using papavarine injections, but has recently had good results with Viagra. According to Beth, Viagra has improved their sex life. “It’s easier for Danny to initiate,” she says. “It’s more spontaneous than the other way.”

“It’s improved our relationship and I believe it will improve it more,” Danny adds. “To me, being close sexually makes it easier to be close emotionally. And sex is supposed to be fun. It’s hard to be fun when you have to drag out the needle. Viagra makes it a helluva lot more fun.”

Dale Santella, a C6 quad from Bradenton, Fla., would love to abandon the needle. He had used an injected combination of papavarine and rigotine for seven years with good results before he tried Viagra. “The first time I tried it, I did 50 mg and it did nothing,” he reports. “My doctor said to take 100 mg. I did and I had better results. But not like an injection.”

As a single male, Dale is still motivated to find an alternative to a needle. “When you’re out and things are going well,” he says, “it’s kind of hard to say, ‘Here, you want to jab these works in me?’”

While spontaneity is nice, the newfound ability of many disabled men to initiate sex without help can have dire effects. Quadriplegics freed from injections are no longer dependent on their spouses for erections. Married men in celibate relationships may suddenly develop a unilateral desire to have sex on a regular basis. A woman who for years has been perfectly happy in a marriage without sex can find living with a newly active libido challenging. Myron Murdoch, national director of the Impotence Institute of America, says that one woman he interviewed was so threatened by Viagra she demanded personal custody of her husband’s pills.

Viagra doesn’t work as well for everyone as it does for me, and it may work better for quads than for paras. Of five paraplegics I interviewed, not one was completely satisfied with the drug. Systems analyst Doug Maurer, a T4-5 para, says he took Viagra on his doctor’s recommendation because it’s less invasive than injections. “Unfortunately,” he says, “it didn’t do much for me. Then he had me try a higher dose, but it didn’t do much either.”

Jason, an L4-5 para who wishes to remain anonymous, was also disappointed. “For about 15 minutes it acts like it’s going to work, and that’s it,” he says.

And Viagra doesn’t appeal to all people. Dan Cassady, a C7 quad from Tampa, Fla., still prefers his injectable erection drugs. “I’ve had fairly good success,” he says, “and once you get over your squeamishness with the needle, you go with what’s working. I don’t see the need for taking the pill over taking the shot.”

But for those it helps, Viagra makes a big difference. “I think sexuality is part of who you are,” says Walden. “It improves my self-esteem to know that part of me is there. We always had a sex life, but I couldn’t have sex like I used to. Now I can.”

And if Viagra doesn’t work for you, don’t despair. It’s only the beginning of a promising new line of drugs. Vasmax, an oral medication to be introduced this spring, mimics the injectable Caverject by dilating penile blood vessels. Other drugs are being researched, and because erectile dysfunction is caused by a variety of disorders, Dr. Harin Padena -Nathan of the Male Clinic in Santa Rosa, Calif., maintains, “We could combine them in a cocktail. Some to work in the brain and some to work locally for the best effect.”

Doug Maurer is receiving just such a tri-mix today, blended as an injectable. Does it work? Well, he has had to go to the hospital twice for priapism. Life is full of little ironies. The only thing interfering with Doug’s sex life right now is that every time he loads up he gets stuck with a gun that won’t go back in its holster. His doctor is titrating the meds and Doug is confident that soon he will have an injectable that knows when to quit.

As for me and M’lady, we are believers. Viagra is good stuff. It works for us most of the time and we always have Caverject for back-up. It’s never given me any side-effects, and it’s brought me back to a proud career in research. My only complaint: Where was this damn stuff 20 years ago?

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