In one sense, we might conclude there is no cause for alarm. The FDA runs what’s called the Postmarketing Reporting program. Doctors and hospitals have a specific legal duty to report all serious side effects caused by drugs after their release into the open market. Thus, the FDA keeps it finger on the pulse of each new drug as it is taken up by increasing numbers of people in the real world. Some will use it sensibly. Others will abuse it. But over time, a pattern of experience will emerge. It may confirm the findings of the initial research on safety that encouraged the FDA to grant a license. Or it may reveal completely unexpected long-term problems that would never appear in the classic clinical trials which do not often last more than one year. As and when this evidence emerges, the FDA will either require a change in the labeling to warn people of the new problems or, in the more serious cases, instruct the manufacturer to withdraw the drug.

This October has seen the release of a new piece of meta-research which consolidates the results of 49 published trials. This reanalysis of the data from multiple studies allows broader patterns to be detected. In this case, the Canadian team confirm the risk of side effects from the use of viagra increases if men take a higher dosage over time. But, because none of the studies has more than a twelve week follow-up, there is no data on whether the level of risk changes if men continue to take the drug. It’s possible that men build up tolerance and the risk of side effects reduces. No-one knows for sure. The obvious explanation for the lack of multiple reports of side effects is that men accept them as part of the price to be paid for restoring sexual activity. So, let’s take the practical view that viagra remains not only effective but also safe for use both in the short- and long-term.

This question was in the spotlight of various media for the past couple of years and there are camps advocating both views on the matter. The general answer is that cycling for long periods of time while sitting on an uncomfortable saddle will likely cause erection problems, especially in mature men. However, there are many factors influencing the result, so it’s not very bright to state that by cycling you will automatically develop ED and have to get a supply of Viagra.

But first of all, people have to understand what ED is. Having erection problems every now and then is not a problem as it happens to all men and it’s completely natural. When speaking of erectile dysfunction or impotence, erection problems should be persistent, manifesting in more than 25% of all sexual encounters when a man can’t achieve an erection suitable for successful sexual activity. That’s when a doctor can say it’s clinical ED. Lack of sexual desire or being unable to orgasm is a whole different story.

Erectile dysfunction can have different causes both of physiological and psychological nature. Physiological causes of ED include damaged nerves, blood vessels and tissue in the penile area. Psychological problems include stress, depression, anxiety and even relationship problems. Still, over 2/3 of all ED cases are linked to other health conditions such as heart diseases, diabetes, smoking, alcoholism, drug abuse and lack of physical activity.

And how cycling can become the cause of ED, you might ask? Riding a bicycle for a long period of time puts a pressure on the tissue, nerves and blood vessels in the perineum, which can result in temporary inability to obtain and maintain an erection. The effects can be aggravated if the saddle is not comfortable and there’s no time for the vessels and tissue to recover after cycling.

Some factors can make the problem even worse and cause serious erection problems. Such things as the time spent cycling, the weight of the person, design of the saddle, weight distribution and how intensively you ride the bicycle can strongly affect your chances of having erection problems. For example, professional race cyclists have an intense style but because the distribute more weight to their feet and pedals rather than the saddle they are less likely to have ED.

If you love cycling but fear developing ED, don’t give up your passion as there are easy ways to avoid erection problems and not make you buy Viagra at all. First of all, make sure to invest money into a good saddle and choose a comfortable design that provides less pressure on your perineum and . When taking a long ride and feeling uncomfortable, take breaks and take some time to stretch your legs and even massage the numbed areas. You can also reduce the pressure on the sensitive areas by leaning forward and distributing more of your weight on the paddles. This way you will not only reduce the risk of having erection problems but will also have better control of your speed when cycling. So don’t give up your passion and enjoy riding for as much as you like because inactivity can also cause erection problems and by cycling you effectively prevent them the best way you can.

Well, at the latest Congress of the European Society for Sexual Medicine (ESSM), the results of the latest clinical trials were reported. Apart from the usual congratulatory news that the drugs continued to prove safe and effective was a new study from Canada which looked at a slightly different question. The assumption has usually been made that the embarrassment factor means most men will delay seeking treatment until the problem has become undeniably serious. This has a benefit in that, when the treatment works, the results are a dramatic return to form, which has an immediate effect in boosting self-confidence. The Canadians speculated there could be clinically significant benefits from taking the pills at an early stage when the erectile dysfunction was only mild. So they designed a fourteen-week trial. The first eight weeks adopted the usual double-blind, randomized, placebo-controlled methodology with 150 men suffering only a minor loss of hardness in the erections. Yet, this was a sufficient loss of hardness to prompt a loss of satisfaction. Hence, the men were seeking treatment. The second six weeks allowed the men to decide which erectile dysfunction medication to take. The researchers then compared the results from both parts of the trial to assess the men’s overall level of satisfaction.

The conclusions are interesting. The majority of men taking viagra in the first part of the study reported a real level of improvement in the hardness of their erections. When the men could decide which of the three major drugs they could take, they all reported even further improvements in their erections. This confirms that the confidence felt by men is improved and their erections become significantly harder when they know which drug they are taking. So, to answer the opening question, the Canadians confirm there is a real clinical benefit from taking the little blue pill sooner rather than later. The quality of erections is definitely improved even though the previous symptoms were mild. So whether it’s the day time or the night time for you, it should be viagra time to be with the one you love.

Curiously, the world is growing old with us. When we were young and living through the fifties, the television was a novelty. Replacing the radio and its world of advertiser-sponsored programs came the future with moving images and all the new ads. They were simple sales pitches, very naive by modern standards. But they got the message across. And what were those messages? Well, for the most part, housewives were told what food to put on our plates, what drinks to offer us. Then came the things to make the household run smoothly and the latest model vehicle to get us from A to B. In between were sometimes disturbing news reports which grew worse as we came into the sixties and the Russians took over Cuba as a missile base on our doorstep. In some senses, it’s actually more relaxing to have the modern coverage of world events. For the most part, our media have forgotten the need to tell us what’s happening outside our shores. It’s more important to package our local politics as the news and give us the messages most important to those controlling the content. The ads have changed as well. The networks have decided the silver-haired crowd has the buying power. We boomers hold what’s left of the purse strings. So we need to know about the adhesive to keep our dentures in place, heat wraps to keep the arthritis pain under control and the latest pills to keep Alzheimer’s away. Oh, and the pills to keep our sex lives going.

Living through the last sixty and more years has been living through a cultural revolution. Who would have thought we would see erectile dysfunction openly discussed on TV with viagra available to treat it. It’s something no-one could have predicted in the buttoned-down fifties when Bob Newhart could so innocently poke fun at the police with a sketch about a nude line-up to identify a flasher. The only thing that we can rely on now is viagra. That gets a rise out of everything still important to us.

All of which brings us to research undertaken in the Ramban Medical Center in Haifa, Israel. The head of research, Dr. Vardi, collected together a group of some twenty brave volunteers, all of whom were suffering from erectile dysfunction. Twice a week over a three year period, the team then administered electric shocks to various parts of each participant’s penis and genitals. The results are out. Fifteen of the twenty have shown significant improvement. The research is justified in the following way. Many men who take the standard pills find their erections perfectly satisfactory. But, when they stop taking the pills, the erections also disappear. There is therefore a need to find a long-term cure. The hypothesis under test is that electricity stimulates blood vessels and improves their ability to dilate and contract. Hence, the reported improvement in erections reported by these participants.

Now before you all dash out and ask the local chapter of the BDSM for electric shocks to your penis, let’s pause. Electricity has been used as a torture for more than one hundred years. Further, there is absolutely no scientific evidence for the proposition that the application of electricity puts new life into the smooth muscle walls in blood vessels. At the very least, the BDSM community itself and everyone playing with vibrating devices would have noticed the beneficial results. Except in the BDSM community where role-playing torture scenes routinely does encourage erections, there is no anecdotal evidence of a link between electricity and erections. While we never want to criticise serious scientific researchers, this particular clinical trial seems strangely perverse, and will require ethical and robust follow-up to see whether the results can be replicated in a statistically significant number of participants. This would be one case in which the majority of men might prefer to be in the placebo-control group where only a pretend shock is administered. For those of you who prefer safe sex to mean the absence of cattle prods and other electrical devices, there does remain the problem of erectile dysfunction. Fortunately, as Dr. Vardi confirmed, there is always viagra which produces an erection in almost all men the first time and every subsequent time it is used. Viagra is better and cheaper than a dominatrix.

Which leads us to the thorny question of the controls over what the advertizers can say about their product. Let’s start with the time of day. Many parents have been distressed that the adverts air on television during the afternoon and early evening when their children are watching. This leads to embarrassing moments as these naturally curious youngsters ask their parents to explain what erections are. As it stands, there are no formal limits on when these adverts can air. It’s for the television stations to make editorial decisions. After all, everyone is in this business for the money so, if you have a vacant slot on a show to sell, you usually take the money from an advertizer no matter what is for sale. That’s capitalism for you. Significantly, all the cost of this pharmaceutical advertizing is tax deductible. So, guess what. All the advertizing dollars get added to the price of the drugs you buy and this adds to the overall cost of healthcare. If the Administration is serious about cutting health costs, all it has to do is ban television advertising and, overnight, the cost of the drugs drops.

So when the television ads air, what exactly do we see and hear. The standard slots vary between 40 and 60 seconds in length. The images are usually of couples doing things together. They may be walking hand-in-hand along a beach, riding bicycles or doing some work in the yard. It’s not considered appropriate to show real people in flagrante delicto. They must be caught in romantic moments suggesting the possibility of sexual activity later - assuming they are not too tired after digging up the yard. But the words list all the side effects and then mention how great viagra is as a treatment for ED. The FDA regulates pharmaceutical ads and requires the content to show “fair balance”. So what you hear is written by lawyers trying to avoid sanctions imposed by the FDA. In other words, “fair balance” means telling the consumer about both the benefits and the risks of each drug. It’s not too alarming to hear you may get a headache if you take viagra. Some of the other drugs, say for treating rheumatism, list fatal side effects. So let’s keep this particular sales pitch simple. Viagra is the best of the ED drugs and it gets great results almost every time.

Against this background, it’s impressive that the Department of Urology at the University of California should have launched a study into whether there’s a difference in the incidence of erectile dysfunction (ED) between the different racial and ethnic groups. For the most part, research in the US never looks for differences between the races. To keep the peace, everyone is assumed to be the same. This university team was brave in tackling a topic that’s sensitive both sexually and culturally. It abstracted the medical data on 80,000 men from the California Men’s Health Study. These men were subdivided into three groups by age: between 45 and 48, 50 and 59, and over 60.

As everyone expected, the incidence of ED grew as the men aged. It affected 13% of men in the first group, 24% in the second and 44% in the third. There was then detailed analysis to discover whether there were differences depending on socioeconomic class and status, lifestyles, other medical conditions, and so on. Again, as expected, the study confirms men are significantly more likely to suffer from ED if they are overweight, drink too much alcohol, smoke and fail to exercise regularly. But what is interesting is that when the data was analyzed by selecting on the different racial groups of white, black, Hispanic and Asian, there was a statistically significant difference. It seems that, taking the white community as the base, Hispanic men are slightly more likely to suffer moderate to severe ED, while black and Asian men are less likely to suffer ED. This is not suggesting that black and Asian men have any kind of immunity. Merely that the results show a different level of ED in their communities.

This leads to an interesting conclusion. The population trends in the US already see a continuing swing likely to make the white group the minority within the next decade in some parts of the country. With the black and Asian groups also less likely to suffer from ED, this may have a slight effect in boosting their birth rates. However, the good news for all the racial and ethnic groups is that viagra was equally effective no matter who took the pills. As anyone who has every had ED since the launch of viagra on to the market can testify, the little blue pills work the first time for more or less everyone who takes it, regardless of race, religion or creed.

So, all you doctors living out there in the boondocks, you must stop prescribing and recommending those pump devices. You know those vacuum tubes that encourage a hard erection when you pump out the air. More effective but painful and less convenient were those injections. Patients always liked the words of encouragement that being injected in the penis was no worse than being slapped by an elastic band on the rebound. And no more of those suppositories. Yes, keeping regular is good for you and, with the right chemicals inside and a lot of belief, there were times when these worked. Then there were all those creams, gels and patches. You know the ones. They were stuffed full of good things like male hormones. And all those other pills offering enhancement. . . Well, you can put all those things away in a drawer, turn the key and forget about them. The ACP has spoken in its voice of thunder. Apart from psychotherapy which can be useful if the cause of the ED is mainly psychological, the best therapy is a PDE5 inhibitor. According to the evidence, about 88% of all men using viagra find their ED is cured on the first use. The well-advertized testosterone gels and creams were no better than the placebos.

The ACP did talk wisely about dosages, indicating that slightly higher dosages yielded the best results. Their advice was also balanced. Yes, there were occasional side effects. Indeed, the committee members called for more research to determine which of the PDE5 inhibitors caused the most problems. But, as it stands, most men preferred a hard erection and were prepared to tolerate the odd runny or blocked-up nose. Why, you might ask, has the ACP decided to talk now. The answer is quite revealing. The US has an ageing population and more men are reaching an age when they may expect problems of ED. In 2025, the ACP estimates there will be more than 300 million men seeking help. This makes the ED market worth billions so they decided to endorse viagra now. Significantly, only one of the authors of this report disclosed funding from the ED manufacturers so that makes this report timely, balanced and reliable.

The reality that men would die young has been displaced. US men can now expect to live to an average age of 76. But most of the scientific evidence suggests that erectile dysfunction grows more common with age. Obviously men of three score and ten years and more will experience the most difficulty - assuming they can find willing partners, of course. All of which brings us to Richard Roden who, at the ripe old age of 71, has just become the oldest man in the UK to father twins. Obviously we should offer congratulations. This gives him a total of twelve children with different mothers. His current wife is only 25 and the happy couple are confidently talking about adding to the family. Ignoring the questions of finance - it’s expensive to bring up children - and the morality of bringing children into the world when you know you have only a few years to live as their parent, let’s all adjust to the new reality. Terry Jones, one of the Monty Python crew, leads an ever increasing pack of men in their late sixties and seventies who are repeating the fatherhood experience.

The men who talk openly about their sex lives usually deny the help of viagra. They put down their continued potency to their healthy lifestyles. They eat modestly, never drink to excess, do not smoke, exercise regularly, and so on. It does not matter whether this is true. They have become the new poster boys for the boomers. They are the living proof there is life after retirement. They are the hope for the future. And if it does turn out that the lifestyle is not as healthy and there are problems, there’s always viagra to make sure the news story comes out right in the end. If this is you, buy viagra and keep your sex life going. More importantly, stop thinking about age. Just be yourself and have fun.

The truth is rather more boring. Like many other chemical substances, if you were unfortunate enough to eat too much of it, it would make you sick. As a side effect of this sickness, men would tend to lose interest in sex. But the idea that a pinch or two of potassium nitrate added into food by willing accomplices among the kitchen staff would induce impotence is pure fiction. In fact, it’s the literal opposite that’s true.

For centuries, saltpeter has been added to food because it’s a preservative. Before the invention of the refrigerator, kitchens routinely salted meat to keep it edible during the long winter months. Today, the traditional cans of corned beef still contain saltpeter — it has always been man’s friend when used in moderation. Saltpeter first emerged in China about 2,000 years ago. Early experiments saw Chinese chemists getting the best and the worst results, depending on your point of view. The compost heaps containing decomposing organic matter were covered and spiked with dung and urine. When the resulting “mess” was filtered and wood ash added, this was wonderful fertilizer and the basis of fireworks for celebrations. Later, of course, it made explosives for war.

Modern science is a wonderful thing (when it works). It has built bigger and better fireworks and developed viagra as a sure-fire cure for erectile dysfunction. With the spread of refrigerators and the use of radiation to extend the shelf-life of food, there is less need for saltpeter. Indeed, because of the threat of urban terrorism, people who buy large quantities of fertilizer are monitored carefully (and that’s no myth). But, of course, when there are not enough explosions in the bedroom, viagra is the first response for the men affected. The performance of this drug is no myth. In every clinical trial and with now more than a decade of practical experience in the real world, viagra has consistently proved itself able to produce erections hard enough for penetration. So even if modern men were to eat saltpeter in their food (no matter who put it there or why), there would always be a remedy to keep men’s libido on high.