ED Treatment

How Does Viagra® Work?

April 6, 2022

The little blue pill is universally recognized these days. Since its inception, Viagra® (sildenafil) has been used by millions of men around the world as an effective, safe, oral treatment for erectile dysfunction. It was the first approved, and it remains the most popular of the ED medications approved by regulators.

Viagra was developed in the 1990s and first approved by the FDA on March 27th, 1998, a hallmark moment in the treatment of erectile dysfunction (ED).

To understand how Viagra works, it's helpful to be aware of its historical context in treating ED, what it was originally developed for, and how erections get started in the body. It can also help you understand why Viagra works so well, and even why Viagra isn't right for everyone.

The Historical Treatment of Erectile Dysfunction

While Erectile dysfunction (ED) has gone "mainstream", this inherently male issue is nothing new.

ED has been around for centuries. From the ancient Greeks to early Mesopotamia, ancient men have been dealing with ED throughout history. 

But our understanding of ED has changed dramatically, and how we treat it too––for the better. Much like how historical medicine saw bloodletting as an effective treatment for headaches, the treatment of ED had its fair share of unproven and misguided treatments and causes, too. 

Prior to modern medicine, erectile dysfunction treatment took many shapes and forms....and oftentimes very odd means. Among the many bunk approaches to treating ED in ancient medicine were:

  • consuming the genitalia of animals
  • injecting hormones from animals
  • self-injecting semen into the bloodstream
  • even putting animal testicles inside your own body

Thankfully in the late 20th century, researchers began to take a harder look at ED as modern medicine pivoted towards "evidence-based" methods and an actual understanding of the underlying processes that cause ED.

Viagra revolutionized the way that erectile dysfunction was treated and perceived. 1998 was a cornerstone for sexual health. Rather than seeing ED as a lifelong challenge, men suddenly had a solution that worked and with very little inconvenience! 

Today, care is even more accessible, as ED treatments can cost as little as $2 a tablet, and a prescription can be obtained digitally through telemedicine services like Rex MD

How Does Viagra Work in the Body?

In the fewest words: Viagra helps you get and keep an erection by maintaining blood flow to your penis. It does this by blocking a natural enzyme in your body that tries to reduce the flow of blood into your penis.

The science behind the blue diamond shaped pill is now well-understood and surprisingly easy to understand. Below is a dive into the pharmacology of Viagra and how it helps in achieving an erection. 

You achieve an erection through increased blood flow to a structure in your penis called the corpus cavernosum. During arousal, the body signals for an erection through the release of nitric oxide in the penis and corpus cavernosum. Nitric oxide is the beginning of a signalling cascade that eventually results in penile blood vessel relaxation, blood flow to the penis, and an erection. During an erection, your penis can hold seven times its usual amount of blood!

After orgasm or resolution, nitric oxide levels in your body diminish. At the same time, the cascade of signalling molecules incited by nitric oxide begin to degrade by a naturally occurring enzyme called phosphodiesterase 5 (PDE5). This step is crucial in allowing the penile tissues to relax and the supporting blood vessels to contract, sending blood back out of the penis. 

Viagra works as a competitive inhibitor to the PDE5 enzymes. In other words, Viagra reduces the PDE5 enzyme while the sexual stimulation signalling cascade occurs. 

With PDE5 enzymes busy with the Viagra molecule, degradation of the molecules responsible for the erection occurs at a much slower rate. Viagra is able to effectively enhance the natural nitric oxide induced response.

Viagra and other PDE5 inhibitors basically work by "cutting the brakes" on your erection. With your body's natural braking mechanism on hold, your body can essentially get out of its own way, and an erection is much easier to attain and sustain. Viagra is effective for the majority of men who try it.

How Was Viagra Created?

With so many men affected by erectile dysfunction, it only makes sense that the scientific community would band together to help solve a problem that had no treatments available.

But that wasn't what happened. 

Viagra was not initially developed as a means of facilitating an erection. Viagra owes its development to the pursuit of drugs for cardiovascular issues. 

Many cardiovascular drugs work by interacting with receptors in the cells that line your blood vessels, intended to lead to the dilation or constriction of blood vessels to help in blood pressure regulation, and increase or decrease blood flow in your body.

The same was true for Viagra (sildenafil). Scientists at the pharmaceutical company Pfizer were working on a new medication for chest pain, and they thought that sildenafil's ability to improve blood flow might help treat hypertension around the lungs. In early human studies, it was decent at that, but test subjects had an interesting side effect: erections. 

The researchers at Pfizer pivoted and realized they had something real on their hands. Viagra was born. (Incidentally, sildenafil was eventually approved for pulmonary arterial hypertension (PAH) too.)

In the search for new drugs for cardiovascular health, Pfizer incidentally produced what would be one of the world's most popular treatments for erectile dysfunction, and one of the most successful medications ever made in terms of revenue. 

Viagra vs. Other Treatments

While Viagra is the household name for erectile dysfunction medication, it's not the only option. 

Cialis®, also known as tadalafil, is a PDE5 inhibitor too. Created by the pharmaceutical company Eli Lilly, Cialis has risen in popularity because of its longer lasting effects compared to Viagra. Cialis was approved in 2003, five years after Viagra.

Unlike Viagra, Cialis is also approved to treat benign prostatic hyperplasia and is available in a daily dose form. With the ability to take daily for day-long support, Cialis is a great option for those that prefer sex in the spur of the moment and need the convenience that a daily pill can provide. Cialis is available as both generic tadalafil and branded, and it can be dosed based on your needs.

The third most popular oral erectile dysfunction medication is Levitra®. Like these other treatments, Levitra is a PDE5 inhibitor that acts by enhancing the body’s natural chemical cascade during sexual stimulation to facilitate an erection.

While all of these options work by the same mechanism, they do have their pros and cons.

One solution may work well for one guy, but another may not. Giving an honest medical history is important in allowing your healthcare provider to help guide you through possible ED treatments. With so many oral medication options, there’s a solution that's right for you and your situation.

Dosage

Dose is a key component in helping people find an effective solution for ED. Your dose is impacted by a wide range of factors, including: age, cardiovascular health, prior response to ED medication, and frequency of need. 

Generally speaking, a healthcare provider will provide a middle-of-the road dose when starting out. In doing so, the patient and healthcare provider have room to alter the dose if needed. Viagra comes in doses of 25, 50 and 100 mg. Most most will begin dosing at 50 mg and adjust accordingly. Sildenafil is also available in doses of 20 mg for PAH under the brand Revatio® and in generic form.

Increasing your Viagra dose can increase the possibility of experiencing side effects, and more does not always mean better. Finding the right dose and medication is exactly what the Rex MD team is here for.

The Takeaway

In summary, Viagra works by inhibiting PDE5 action and enhancing your body's response to sexual arousal. 

In historical context, Viagra was a huge accidental innovation that gives guys their power and confidence back. After the creation of Viagra, numerous other PDE5 inhibitors were invented, and they all act by the same mechanism. Viagra, Cialis, and Levitra are all offered in a variety of doses which allow men with ED the opportunity to find exactly the right treatment for their situation.

Rex MD's licensed clinicians are here to make ED solutions easy, fast, and affordable. It's all done online, with medications shipped to your door in discreet packaging if approved. 

Clicl here to learn more.




Sources

Erectile Dysfunction: A Review of Historical Treatments With a Focus on the Development of the Inflatable Penile Prosthesis | NIH

Viagra (Sildenafil) | FDA

FDA Approves Viagra | History

The history of erectile dysfunction management | Nature