Originally published 11/7/2019
When we posted the blog below in 2019, no one dreamed that a deadly pandemic would soon sweep the world. Even if they had, they probably did not imagine that Viagra (sildenafil) might play a role in saving a woman’s life. That’s exactly what seemed to be the case when a 37-year-old British nurse, Monica Almeida, went into severe respiratory distress in October, 2021 due to SARS CoV-2—and was placed in an induced coma. She emerged from the coma on Dec. 14, thanks to receiving a high dose of Viagra. Ms. Almeida stated, “ ‘It was definitely the Viagra that saved me. Within 48 hours it opened up my airwaves and my lungs started to respond.’ She added, ‘If you think how the drug works, it expands your blood vessels. I have asthma and my air sacks needed a little help.’“[i] Is the little blue pill a miracle drug?
Viagra was originally developed to treat restricted cardiac blood flow but quickly gained fame for its ability to promote erections by relaxing and thus widening blood vessels for greater flow. Could enhanced blood flow benefit people suffering from other conditions? In addition to the study with lower urinary tract symptoms described below, Viagra hos now been tested for prevention or use in the following conditions: Alzheimer’s disease, vascular dementia, damaged skin from radiation treatments (sildenafil formulated as a topical gel), and cancer cell death/tumor shrinkage (lung, stomach, ovarian and prostate cancers). While many of these studies were done in labs with cell samples or animals, it is not surprising that researchers would explore the physical benefits of boosting blood flow.
Viagra may indeed prove to have many applications. However, it’s important to recall that like any drug, there are risks and side effects, and possible harmful interactions with other medications. Always discuss prescriptions with your doctor, and inform him/her of any other drugs you may be taking. That said, when responsibly used for ED or other condition for which it is approved and appropriate, there’s no question that Viagra can save quality of life.
Some folks might say that erectile dysfunction (ED) can lead to a broken heart. On the other hand, in 1989 the physical feeling of a “broken heart” (heart-related chest pain) accidentally led to a treatment for ED. When pharmaceutical giant Pfizer was researching medication for angina, a painful heart condition, their researchers discovered sildenafil, now known by the brand name Viagra.
Today, sildenafil can still be used to ease high blood pressure in lung arteries—a source of chest pain, shortness of breath, tiredness and other symptoms. However, it is most commonly prescribed to treat ED. It works by blocking an enzyme that the body normally uses to “switch off” an erection after orgasm, but that same enzyme can interfere with getting an erection to begin with. The enzyme is called phsophodiesterase-5 (PDE-5). By inhibiting PDE-5, Viagra allows the erection program to proceed.
“The little blue pill” is highly successful
ED, or impotence, means the inability to achieve an erection sufficient for penetration. The percentage of men who experience frequent ED increases with aging. A 1994 landmark study of impotence, The Massachusetts Male Aging Study, reported that about 40% of men have some degree of ED at age 40 but this increases to 70% at age 70. Viagra, or “the little blue pill”, does not cure ED, but rather is used on demand as needed. When taken as directed (about 1 hour before sex) followed by sexual stimulation (it won’t work without it), 94% of men report they are satisfied with it.[ii]
Lower urinary tract symptoms (LUTS)
There’s another male problem that occurs with aging: lower urinary tract symptoms (LUTS). A man’s personal plumbing can wear out in much the same way as household pipes eventually clog or leak. In the majority of cases, male urinary problems are the result of prostate enlargement or inflammation. Symptoms range from mildly inconvenient to annoying to disruptive of one’s quality of life (QoL).
LUTS commonly shows up as either obstruction issues (poor urine stream, difficulty starting, dribbling, incomplete bladder emptying, etc.) or storage issues (increased urgency, needing to urinate more often, leaking, disrupted sleep due to need to urinary, urge incontinence, etc.).
LUTS and ED
LUTS are embarrassing, stressful, and wreak havoc on a man’s dignity as well as his daytime and nighttime lifestyle. It’s no wonder, then, that many men with LUTS also experience ED due to the psychological impact of LUTS. Even ED medication may not work well because of the pressures generated by bladder and prostate difficulties. On the other hand, studies show that when their urinary symptoms are successfully resolved, their sex life also improves. Makes sense, right?
It may come as a surprise, then, to find that a drug that improves ED also appears to improve LUTS. This unexpected finding occurred as the result of scientific curiosity on the part of a team of British researchers. They wondered if treating ED using Viagra would ease urinary symptoms in men who had both problems. Before embarking on their own study, Sairam, et al. (2002)[iii] could find “…no published evidence exploring the relationship between men presenting with ED and their LUTS. In addition, it is unknown if treatment of their ED improves or worsens their LUTS.”
Viagra fixes two problems for the price of one
Thus, the Sairam team designed a study to explore what happens to LUTS when a man’s ET is treated with oral medication. They offered Viagra to 112 men whose main complaint was ED but who also had lower urinary tract symptoms. Both conditions were assessed at baseline using two questionnaires:
- International Index of Erectile Function (IIEF)
- International Prostate Symptom Score (IPSS) including QoL self-assessments
Then, during the study, the participants used Viagra on demand before sexual activity and kept a diary. Their cases were reviewed and the questionnaires administered again at 1 and 3 months.
As expected, the majority of patients (81%) had improved erections when using Viagra, but it was effect on LUTS that came as a surprise. At 3 months, all patients with severe LUTS shifted down to moderate, and 60% of those with moderate LUTS shifted down to mild. The authors wrote:
After treating the ED with sildenafil there was in improvement in the IPSS [urinary function score] which was accompanied by an improvement in the QoL scores. The changes in the IPSS and QoL scores were significantly correlated with the IIEF variables after treatment (at 3 months) suggesting that it was the change in sexual function caused by sildenafil that brought about the improvement in the urinary symptom scores.
This correlation was hypothesized to be the physical effect of the drug on the relaxation of isolated bladder and urethral smooth muscle, as well as modulation of prostatic smooth muscle tone when PDE-5 is blocked. In short, Viagra may not only relax penile tissues allowing the improved blood flow and congestion needed for an erection, but it may also offer smooth muscle relaxant properties in the lower urinary tract. If their theory is correct, Viagra indeed solves two problems for the price of one.
The authors acknowledge that more research is needed, with studies designed to evaluate physiological details not tracked in their observational study. Nonetheless, they “recommend treating patients who present with ED and concomitant LUTS with sildenafil” as long as no co-existing condition bars Viagra use. The pleasure of this small study is the good news it offers men as they age.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Lee, Bruce Y. “Nurse Says Viagra Saved Her From Severe Covid-19 Coronavirus Infection.” Forbes, Jan. 8, 2022. https://www.forbes.com/sites/brucelee/2022/01/08/nurse-says-viagra-saved-her-from-severe-covid-19-coronavirus-infection/
[ii] McMurray JG, Feldman RZ, Auerbach SM, DeRiesthal H et al. Long-term safety and effectiveness of sildenafil citrate in men with erectile dysfunction. Ther Clin Risk Manag. 2007 Dec; 3(6): 975–981.
[iii] Sairam K, Kulinskaya E, McNicholas TA, Boustrad GB, Hanbury DC. Sildenafil influences lower urinary tract symptoms. BJU International. 2002;90:836-39.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
