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How Does Viagra® Work?

March 22, 2023

The little blue pill Viagra® is today universally recognized, but that wasn't always so. Viagra was developed in the 1990s and approved by the FDA to treat erectile dysfunction (E.D.) on March 27th, 1998, a hallmark moment for men globally. 

Today, it remains the most popular of the E.D. medications on the market. It's been used by millions of men around the world as an effective and safe oral treatment for erectile dysfunction.

To understand how Viagra works, it's helpful to be aware of its historical context in treating E.D., what it was originally developed for, and how erections happen.

It can also help to understand why Viagra works so well, and even why Viagra isn't right for everyone.

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The Historical Treatment of Erectile Dysfunction

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

E.D. has been happening to men for centuries. From the ancient Greeks to early Mesopotamia, ancient men have been dealing with E.D. throughout history. 

But our understanding of E.D. 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 E.D. 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 E.D. 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 closer look at E.D.'s underlying mechanisms as modern medicine pivoted towards "evidence-based" methods and an actual understanding of the processes that cause E.D. 

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

Today, care for mpotence is even more accessible, as E.D. treatments can cost as little as $2 a tablet, and a prescription can be obtained digitally through online doctors 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 naturally works 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. 

Viagra's Mechanism

You achieve an erection through increased blood flow to spongey structures in your penis that fill with blood, called the coprus 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 into the penis, and an erection.

During an erection, your penis can hold seven times its usual amount of blood!

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.

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). PDE5 is a crucial step 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 inhibits the PDE5 enzyme while the sexual stimulation signalling cascade occurs. With PDE5 enzymes busy with the Viagra molecule, degradation of the substances responsible for the erection occurs at a much slower rate.

How Was Viagra Made?

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 c_ardiovascular 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, sildenafil was ok 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 accidentally 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 Versus 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 it 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 E.D. treatments. With so many oral medication options, there’s a solution that's right for you and your situation.

Viagra Dosage

Dose is a key component in helping people find an effective solution for E.D. Your recommended dose of Viagra will be impacted by a wide range of factors, including: age, cardiovascular health, prior response to E.D. 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 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 (sildenafil), Cialis (tadalafil), and Levitra (vardenail) are all offered in a variety of doses which allow men with E.D. the opportunity to find exactly the right treatment for their situation.

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

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

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