On March 28, 1998, we ushered in a new era in the sexual revolution. Never in recent memory has a medication received the publicity or popularity of Sidenafil (Viagra). In fact, only the birth-control pill has come close to prompting the societal and cultural changes brought on by the little blue pill.

In spite of its popularity and effectiveness, Viagra has proven to be far from the perfect solution to erectile dysfunction. Many men—such as those with severe cardiovascular disease, curvatures of the penis, or prostate cancer—have found the medication ineffective. Complaints about the loss of spontaneity are commonplace. The cost is also prohibitive for many couples. Eating a meal or drinking alcohol tend to reduce the drug's potency, and the use of nitroglycerine is not advised. Severe headaches, visual disturbances, stuffy nose, and nausea are frequently reported as adverse reactions.

But for men with spinal-cord injury (SCI), Viagra has been especially effective and generally a welcome addition to the more traditional invasive treatments for erectile dysfunction. The use of injection therapies and the vacuum pump have drastically declined among men with SCI and other disabilities. Furthermore, the penile prosthesis, once the treatment of choice for men with SCI, is rarely used except in cases where other systemic medical issues have a significant negative impact on the quality of erections.

With the mounting concerns about Viagra's cost and side effects, the time has been ripe for competition to Pfizer's "miracle drug." Fortunately, we won?t be disappointed. The year 2002 promises to be an exciting one in the sexual arena when the second generation of "Viagras" make their debut. As expected, the new drugs will be better, quicker acting, and more effective than those currently available. Not only can we expect the second-generation pills to be more potent, but the pharmaceutical industry also has a few surprises in store for us!

On September 21, 2001, Bayer Pharmaceutical Company applied for FDA approval for its new erection medication, Vardenafil. As of this writing the company has not released the brand name. The new Bayer product will have many distinct advantages over today's oral erectile medication and is expected to be released by fall 2002.

Bayer promises that Vardenafil will outperform Sidenafil in all the important aspects of safety, effectiveness, cost, and speed of onset. Clinical trials of the new medication, which included men with diabetes, have also been encouraging in that side effects are reported to be significantly less than with Viagra.

Even before Bayer's Vardenafil hits the market, Lilly-ICOS will unveil its new product some time around early summer 2002. Submitted for FDA approval in June 2001, the Lilly-ICOS product Tadalafil is potentially the erection medication many men have waited for. Some people speculate it will revolutionize the whole field of sexually related oral medications. Lilly-ICOS promises it will be worth the wait.

The most astounding feature of Tadalafil is its length of action. According to some reports, this new medication will facilitate for as long as 48 hours a man's ability to achieve an erection. Thus, one dose on a Friday night will allow the man to achieve a rigid erection anytime he becomes sexually aroused over the entire weekend. Concerns regarding the need to plan for sex and the lack of spontaneity will be virtually eliminated. Issues regarding cost will also be reduced since a single pill will enhance erectile functioning over an extended period of time.

Like Bayer's Vardenafil, the new Lilly-ICOS product has also addressed issues regarding safety and side effects. Although price has not yet been established for either of these two new medications, both pharmaceutical companies have said they will be competitive with Pfizer's Viagra.

In conclusion, the second generation of oral medications for erectile dysfunction will be especially encouraging for the many men who found Viagra disappointing or ineffective. It will also provide men with several alternatives that will reduce unwanted side effects, improve spontaneity, and potentially reduce the cost associated with the medication. Clearly, these are revolutionary times in the field of sexual medicine, and this year is especially exciting.



The above information was provided by Stanley H. Ducharme, Ph.D. Dr. Ducharme is a clinical psychologist, certified sex therapist, and consultant specializing in sexuality and disability issues. He is a member of the medical staff at Boston Medical Center and a professor of Rehabilitation Medicine and assistant professor of Urology at Boston University School of Medicine. A past president of the American Association of Spinal Cord Injury Psychologists and Social Workers, Dr. Ducharme serves on the boards of directors of several professional organizations. Send questions anonymously to Stanley H. Ducharme, Ph.D., Boston University Medical Center, 720 Harrison Avenue, Suite 606, Boston, MA 02118. ducharme@bu.edu / www.Stanleyducharme.com.