Real Talks: Erectile Dysfunction Medications

HIM: Have I mentioned here before that, during my first marriage, I wasn’t completely faithful?

HER: I think we’ve hinted at it.

HIM: Okay, well, let me spell it out: during my 26 year sex-starved marriage I had two affairs, both lasting about 18 months. Now, this isn’t an article about affairs (which we’ve talk about elsewhere), but they play a role in the subject I want to explore.

HER: Baby, didn’t we just talk about starting our articles with more clarity and impact? This is terrible so far. What exactly do you want to discuss?

HIM: Alright, I want to talk about erectile dysfunction (ED) medications like Viagra and Cialis.HER: That’s better. So what do these drugs have to do with affairs?

HIM: Well, for me the story starts in December 2002. Eighteen years into my first marriage, at the age of 41, I decided I wanted to connect with a flesh-and-blood human being, a real person who actually liked sex. My ex-wife was not that person, and trying to get by on pornography wasn’t cutting it anymore (we had a very challenging son, so leaving would have been cruel). Through the magic of the internet, I found a woman in similar circumstances to mine. After a few chaste meet-ups at bars, we found ourselves at the point where it was clear that the next get-together would be sexual. We arranged to meet at a Holiday Inn motel (the classic venue for a suburban affair, don’t you think?) located mid-way between both of our homes.

Three days before that fateful tryst, my wife initiated sex, something she rarely did. However, unlike every other time we had sex, my cock did not respond. I couldn’t get an erection and I panicked. Not because my ex-wife might be disappointed, but because of the impending encounter with the new woman.

HER: If I put on my amateur psychologist hat, I would say it was a clear case of nerves. After so much time and anticipation, finally making that connection with someone who could appreciate you sexually must have caused you to put enormous pressure on yourself. And let’s not gloss over the impact guilt can have on a cock.

HIM: I know, the psychological dimension appears obvious now, but at the time I thought my body was failing me, totally coincidentally, and at the worst moment imaginable.

HER: So, what did you do?

HIM: I had seen ads for a Men’s Sexual Health Clinic so I called first thing the next morning to make an appointment. After much undignified pleading, they managed to fit me in the next day. I filled out a bunch of forms, underwent several humiliations (verbal and physical), and walked out with a prescription for Viagra in my pocket.

HER: Wait, so after one single failure to perform — the first of your life — you panicked and ran to a doctor for drugs?  You made it a medical issue when it was probably a very understandable case of nerves. If it truly was anxiety, which seems obvious, all you needed to do was wait until you became relaxed enough for things to work.

HIM: With women, as with everything else in my life, I’ve always thought my job was to be as close to perfect as possible, in every way, with no special accommodations required. I could never imagine saying to a woman ‘I might have a problem with erections the first few times’. I would rather have shot myself (not in the face, of course, but in the fleshy part of the leg, say). And yes, I know now that most women would probably find that endearingly frank, but I did not have that perspective at the time.

HER: There’s that sexual insecurity rearing its ugly head again. So, did the Viagra work for you?

HIM: Yes it did, almost magically. And immediately, I became convinced that I could never have sex again without it. Not consciously, but subconsciously. It was like a bleak epiphany: an erection, which previously seemed like the most dependable of natural occurences, revealed itself to be a deeply mysterious involuntary reflex. So I started using it every time before sex, which turned out to be fine for the affair, but not so good in the context of my marriage.

HER: I thought you had no struggles with your ex.

HIM: That was true, until I decided I couldn’t have sex without pharmacological assistance. That change ushered in a whole new problem: since Viagra takes about forty five minutes to start working, I would need to be able to make a short-term prediction about when I would be having sex. For example, I would have to take the pill at 6:15 pm if I figured I would be having sex between 7:00 and 11:00 pm.

Now, that’s no problem in an affair, where you always know precisely when you’ll be having sex because of all the planning required. The challenge was the weird sexual dynamic of my previous marriage. I literally had no idea when she might want it (and  trust me, we only ever did it when she decided she wanted it). I could easily think things looked promising early in the evening, only to see her mood take a hard left turn an hour later.

When it came on the market a year later, I switched to Cialis. This new pill still required a 45 minute head start, but its effects hung around for a leisurely 36 hours. (I don’t know why anyone would still use Viagra, by the way, since the product is clearly inferior by several orders of magnitude). Dishearteningly, starting Cialis led to the sad discovery that I couldn’t even predict within a day and a half when my first wife might want sex! Finally, I had to go to the daily version so that the chemical was always in my bloodstream to ensure that I was ready…whenever.

HER: Alright, but when I came along, you knew pretty early on that I was up for just about anything, anytime. That must have been good news for your cock.

HIM: Yes — too much good news, as it turned out. You were the most amazing woman I had ever met, so now I felt a whole new level of pressure. Sure enough, I struggled a little bit to get fully hard the first two times we were together and that plunged me into into full panic mode.

HER: But your physiological capabilities were already being bolstered by Cialis 24 hours a day. What could be the problem?

HIM: As it turns out, ED medications don’t produce automatic erections. You have to be turned on for them to work, and for some reason, now that I was with the sexiest woman I had ever been lucky enough to see naked, I wasn’t feeling turned on. Fortunately, the pharmaceutical industry had come to the rescue with a new vulnerability for men to freak out over: low testosterone. Maybe that was my problem! I went to see an endocrinologist and, sure enough, my T level was low enough to justify a prescription for Androgel. I started rubbing the stuff on my arms and torso daily as prescribed and the very next time we were together I felt a noticeable surge of lust and stamina. New problem, new solution.

I was concerned about one thing, however. I had read that many men experience an initial boost from supplementing their natural testosterone level, but that the effect frequently disappears after some weeks. That’s because the sudden appearance of exogenous (artificial) testosterone in the bloodstream makes the pituitary gland think that it must have been making too much of the stuff, so it trims production of endogenous (natural) testosterone. You end up right back where you started. That’s the real reason I started our sex spreadsheet in 2012. I wanted to scientifically record my daily dosage along with our sexual activity to see what correlations might emerge.

I am experimental by nature, so I began to tinker with my dosage and record the results. Over time, I found that if I raised and lowered the dosage based on how I was feeling (within the guidelines prescribed by the specialist) my pituitary gland never seemed to settle in at a reduced level of production. At least, that’s how it felt subjectively. So basically, that’s been my daily regimen ever since: 5 mg of Cialis plus a fluctuating dose of Androgel.

HER: This whole thing seems pretty crazy to me. If you read about men who truly struggle, it’s because they have circulation problems, are diabetics, obese, smokers, heavy drinkers, or are in advanced age. None of those things apply to you – you have the cardiovascular health of a twenty year old! It seems so obviously mental. Didn’t any of those doctors ever say, ‘hold on, let’s not jump to a pharmaceutical solution here. Let’s examine the psychological side?’  How irresponsible!

HIM: You have to understand, I always do a lot of research when I’m looking to resolve an issue. When I had that first erection problem back in 2002, it was perfectly timed with the drop off in performance that large numbers of men experience in their early forties. It seemed purely biological. When I found myself struggling early in my relationship with you, I travelled to the Cleveland Clinic in Ohio to consult with a psychologist, a urologist and an endocrinologist. I know, it sounds like the beginning of a Monty Python skit, but these people were serious professionals, and I walked away from that day fully convinced that my blood chemistry was the culprit.

HER: Well, you have to admit that the problem still hasn’t been completely resolved. We’ve seen very clear evidence since we started swinging that, even with these two drugs in your system, you still struggle in new sexual situations. It takes you time to feel comfortable enough to perform well. I’m not a doctor, but it seems so obvious to me that the problem is performance anxiety.

HIM: I actually agree with you – sort of. It seems logically compelling. Yet I’ve tried to drop the Cialis twice, and the same thing happened both times. At first it seems like everything is fine, and around day three I feel like I don’t need it any more. I feel convinced, and very positive, with a new set of expectations. Then, a day or two later, suddenly things just stop working. I’m fooling around with you and I can’t get past the starting line. It’s as if my body is mockingly saying ‘you really thought you could just resolve this thing with the power of positive thinking?’

So it seems like I’m stuck here. I don’t really know if the dependence is physical or mental, but it is a fact, and facts must be dealt with, not wished away. Which I don’t mind, because at least we’re able to have lots and lots of sex, and, as far as I know, there are no long term health issues associated with either drug.

HER: I think you’re giving up too easily. We should do an experiment. Wean yourself off of one of the two drugs for a month and allow your body to readjust your chemical levels. Don’t give up after one or two failures. It’s bound to take some time, and I can be patient. Try not to panic or obsess over it; there are always toys for me and other ways to have fun for you. Then, if you find you can perform without it, try dropping the other one. You can pop a regular Cialis before we meet up with new people to give you a boost of confidence if you need it. But you’re spending more than a thousand dollars a year on these things, and who knows what kind of damage the combination could potentially do to you long term? I think it’s worth a try.

HIM: Well, I’m always up for an experiment. Especially if you wear a sexy lab coat, and sexy glasses.

HER: And maybe hold a sexy clipboard, with a sexy pencil behind my sexy ear? Sure, whatever it takes.

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Four years — and several experiments — after this article was written, Liam has not been able to free himself from his real (or imagined) dependence on performance enhancing drugs.