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A partir de la apariciРїС—Р…n del citrato de sildenafil (Viagra) eficaz medicamento para la impotencia, hacen tambiРїС—Р…n su apariciРїС—Р…n, a su sombra, los “Viagras vegetales o naturales” y los “Viagras femeninos” viendo asРїС—Р… que cada paРїС—Р…s, llРїС—Р…mese Brasil, SudРїС—Р…frica, BРїС—Р…lgica, PerРїС—Р… o China, presentan alguno de estos productos.

En el caso de esta crema -que es un gel que produce una empresa belga- dicen que ayuda a la lubricaciРїС—Р…n y aumenta el placer sexual-, y es de uso cosmРїС—Р…tico, venta libre (tambiРїС—Р…n llamados OTC, over the counter –en el mostrador-) no hay, con relaciРїС—Р…n a su eficacia y seguridad, estudios validados seriamente ni pruebas de doble ciego (para descartar el efecto placebo) ni protocolos cientРїС—Р…ficos al estilo del Viagra . o de los otros fРїС—Р…rmacos que dos laboratorios (Bayer y Lilly) sacarРїС—Р…n a la venta probablemente en el 2002. O sea que la crema no es un medicamento bajo receta.

El texto del cable donde se da a publicidad dice asРїС—Р…:
ViacrРїС—Р…me no es un medicamento, sino un producto cosmРїС—Р…tico (asРїС—Р… se denomina a la familia de productos que mejoran la calidad de vida pero que no tratan patologРїС—Р…as) que, dicen, permite a las mujeres "acceder mРїС—Р…s fРїС—Р…cilmente al placer". Se presenta en forma de gel que se aplica sobre el clРїС—Р…toris antes de la relaciРїС—Р…n sexual. SegРїС—Р…n sus creadores, el ViacrРїС—Р…me actРїС—Р…a por "vasodilataciРїС—Р…n local del clРїС—Р…toris" y deberРїС—Р…a aumentar la sensibilidad de la mujer. Al tratarse de un cosmРїС—Р…tico y no de un fРїС—Р…rmaco, se venderРїС—Р… en los institutos de belleza y en los negocios de ropa РїС—Р…ntima.

En la Argentina, p. ej. al igual que en otras partes del mundo, hemos ensayado con gel de prostaglandina o crema de testosterona . ambos de uso tРїС—Р…pico (aplicaciРїС—Р…n local), en los casos de anorgasmia o falta de excitaciРїС—Р…n-lubricaciРїС—Р…n, sin resultados definitivos. Y acuerdo con una sexРїС—Р…loga de Bruselas que el tratamiento de las disfunciones sexuales femeninas no puede basarse sРїС—Р…lo en un producto de cosmetologРїС—Р…a. Ahora bien: РїС—Р…quРїС—Р… sustancias posee la crema, convertida en “milagrosa” por efecto de las leyes del marketing? L-arginina. aminoРїС—Р…cido precursor del РїС—Р…xido nРїС—Р…trico, que es el que produce, como primer mensajero la vasodilataciРїС—Р…n de las arterias del clРїС—Р…toris y del pene y que hemos usado por vРїС—Р…a oral desde hace tiempo; menta (o mentol, tal vez) como leve vasodilatador (que en gran cantidad puede irritar, al igual que el retinol. variante de la vitamina A que se usa como “antiarrugas” en la cara), y el aloe vera casi como un excipiente. Algunos de estos recursos ya los hemos utilizado con suerte diversa. De todos modos, como hecho auspicioso, hablar de esta crema es hablar de las problemРїС—Р…ticas sexuales femeninas (dРїС—Р…ficit en la lubricaciРїС—Р…n –comРїС—Р…n en la menopausia -, vaginismo y coito doloroso, disminuciРїС—Р…n del deseo sexual . anorgasmias . problemas en la excitaciРїС—Р…n y fobias sexuales . y quiero destacar que las grandes investigaciones farmacolРїС—Р…gicas de los prРїС—Р…ximos aРїС—Р…os, a no dudarlo, serРїС—Р…n en este campo.

Si pudiera ser, en ciertos casos, uno de los caminos para un abordaje mРїС—Р…s racional de estas disfunciones: РїС—Р…bienvenida la crema cosmРїС—Р…tica. que no es un fРїС—Р…rmaco activo, que nada en comРїС—Р…n tiene con el citrato de sildenafil (el cual tambiРїС—Р…n se estРїС—Р… ensayando -y esto lo explicamos en otro artРїС—Р…culo- su utilidad en mujeres salvo que ambos intervienen, de una u otra manera, en la respuesta sexual, erРїС—Р…tica y amorosa de las personas.

*Dr. AdriРїС—Р…n Sapetti
Psiquiatra, sexРїС—Р…logo, Director del Centro MРїС—Р…dico SexolРїС—Р…gico
Presidente de la Sociedad Argentina de Sexualidad Humana (SASH)
Autor de los libros “Sexualidad en la pareja” y “El sexo y el varРїС—Р…n de hoy”
Director del sitio de Internet www.sexovida.com

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Long monotherapy Sildenafil Citrate at various forms of erectile dysfunction

Purpose. studying of efficiency of long therapy sildenafil Citrate at sick of erectile dysfunction at which its use 50-60 minutes prior to sexual contact has appeared not completely effective.

Material and methods. Sildenafil Citrate applied two times a week a current of 1 year at 86 patients at the age from 32 till 72 years with erectile dysfunction which were dissatisfied reception of this preparation before sexual contact. At 24 from them there was a functional erectile dysfunction Cialis. at 62 — organic.

Results. at 60 (83 %) from 86 patients are reached by the functional and subcompensated and compensated organic erectile dysfunction positive takes according to questionnaire ICEF-5. At ultrasonic dopplerografii have taped authentic intensifying penile a blood flow. The expressed by-effects did not observe at one patient.

Conclusion. monotherapy sildenafil Citrate within 1 year promotes improvement of results of treatment of the functional and subcompensated and compensated stages of organic erectile dysfunction.

ONE OF the PRIMARY GOALS of modern medicine – improvement of quality of life of the patients which integral part are harmonious sex relations. Erectile dysfunction leads to appreciable deterioration of life as men, and women [1]. Prevalence of erectile dysfunction in Usa makes at the age from 20 till 29 years — 7,2 %, from 30 till 39 years – 18,9 %, from 40 till 49 years – 37,3 %, from 50 till 59 years-53,8 %. Thus easy degree of disturbance of an erection met in 16,2 % of cases, average — in 22,5 %, serious – in 8,7 % [2] that corresponds to the results received in 1998 in known Massachusetts research on studying of ageing of men [3].

Allocate the functional, organic and admixed forms of erectile dysfunction. Organic erectile dysfunction part at a stage that corresponds to representation about a continuity of the clinical and morphological changes occurring in a cavernous tissue and tunica to a cover of cavernous bodies of a penis: I (compensated), II (Subcompensated) and III (decompensated).Such division coincides with classification of the erectile dysfunction offered H.Feldman and co-workers.(1994): minimum – it is usually capable, moderated —It is sometimes capable, full – it is never capable.

Now at I and II stages of erectile dysfunction widely apply inhibitors phosphodiesterase 5 types, including sildenafil citrate (Viagra) 50-60 minutes prior to sexual contact. At some kinds of organic erectile dysfunction, in particular the vascular and admixed forms with prevalence of a functional component, the good effect is observed even at the initial stage of III stage. However at application sildenafil Citrate by the standard technique (i.e. directly ahead of sexual contact) at an appreciable part of patients observed by us with erectile dysfunction II and III Stages in 12-18 months appeared noneffective even the maximum doses of a preparation [1].

We have established that at erection stimulation sildenafil citrate partial pressure of oxygen (P02) in a cavernous blood which during an erection is admixed is arterial-venous, reaches 78-79,5 mm hg Though this indicator slightly more low, than at erection stimulation intracavernosal introduction of vasoactive preparations (85 mm hg), but nevertheless, it testifies to good oxygenation of a cavernous blood [1]. Last has great value for synthesis Endothelial factors, such as N0 and Prostaglandinum E1 which participate in occurrence of an erection [4,5]. Besides, at high value PO2, synthesis endotelina-1 is inhibited that also promotes intensifying of an erection [4]. On the basis of this data we have stated a hypothesis that regular reception of an inhibitor phosphodiesterase 5 types will allow to improve oxygenation of a cavernous tissue and to raise efficiency of medicamental therapy of erectile dysfunction.

Studying of efficiency of long therapy sildenafil citrate at sick of erectile dysfunction at which its use 50-60 minutes prior to sexual contact has appeared not completely effective was the Research objective.

Material and methods

In 1999-2004 86 patients with erectile dysfunction, including 24 patients at the age from 32 till 57 years with functional erectile dysfunction and 62 patients at the age from 51 years till 72 years with organic erectile dysfunction have been surveyed. At 14 from 24 patients with functional erectile dysfunction diagnosed a sexual neurosis on type “failure expectations”, at 4 — an asthenic syndrome, at 6 – the depressive syndrome bound to psychological and-or sexual problems. The reasons of organic erectile dysfunction were a diabetes (at 9), a hypogonadism (at 7), a sclerosis of a cavernous tissue of a penis (at 11), pathological venous dump of a blood (at 21), proctologic and urological operations (at 8), illness of Pejroni (at 6).

14 patients had I stage of erectile dysfunction (functional – at 4, organic — at 10) (tab. 1). At 60 patients with II stage of erectile dysfunction (functional — at 15, organic — at 45) initially viagra-test was positive. After reception sildenafil Citrate in the picked up dose these patients could enter sexual contact, however in the subsequent, despite augmentation of a dose of a preparation to maximum, sexual contacts were unsatisfactory. At 12 patients with III stage of erectile dysfunction (functional – at 5, organic — at 7) initial viagra-test was negative (a dose sildenafil Citrate – 100 mg).

TABLE 1. Distribution of patients with erectile dysfunction at a stage depending on results viagra-test

Stages of erectile dysfunction

- 100 mg at 7 patients

III stage – 7 patients

the Note: (+) – positive assay, (-) – negative

Monotherapy sildenafil Citrate continued within 1 year. Patients accepted a preparation regularly 2 once a week without dependence from sexual contacts. If after regular reception sildenafil Citrate the erection renewed, treatment continued; if necessary patients in addition accepted a preparation 50-60 minutes prior to sexual contact.

Before treatment conducted following researches:

  • Obshcheklinichesky survey.
  • Questioning on ICEF-5.
  • Questionnaire for an estimation the patient of results of monotherapy sildenafil Citrate: “excellent” — satisfactory sexual contacts 2 times a week, “good” — once a week, “satisfactory” — at occurrence of an erection without sexual contact, “unsatisfactory” – in the absence of an erection.
  • Ultrasonic doppler sonography research of vessels of a penis on apparatus “UltraMark-9″ with frequency of the gauge of 7,5 MHz and “Vivid-4″ with frequency of the gauge 10 MHz, Estimated basal and stimulated a blood flow. Stimulation was spent by the LOD-DEVICE by the technique developed by us (the patent of the Russian Federation for the invention в„–2141799 from 11/27/1999). Investigated the cavernous Arteries in phases of erection Er3-Er4 (on a scale of Junema).
    Results of researches analyzed by means of statistical package SPSS-14.

Results

Treatment sildenafil Citrate have finished 20 of 24 patients with functional erectile dysfunction and 52 of 62 patients with organic erectile dysfunction. In the course of treatment at patients arose spontaneous or an erection. If at sex stimulation after additional reception of a preparation or without it there was a sufficient erection, they entered sexual contact.

The Analysis of results of questioning under questionnaire ICEF-5 before treatment sildenafil is presented by Citrate (Viagra) to tab. 2. At functional erectile dysfunction the quantity of patients with satisfactory and normal indicators of the questionnaire has authentically increased after end of treatment with 10 (41,7 %) to 14 (70,0 %). At organic erectile dysfunction the quantity of patients with satisfactory and normal indicators also was authentically enlarged with 18 (29,0 %) to 35 (67,4 %). This data testifies to clinical efficiency long monotherapy sildenafil Citrate at functional and organic erectile dysfunction. After end of a year course of monotherapy those patients at whom results of treatment have appeared good, stopped regular reception Sildenafil Citrate and used it only before sexual contact in a combination to sex stimulation.

TABLE 2. Results of questioning in points on ICEF-5 before treatment

Full or
Sharp disturbance (0-5)

Expressed
Disturbance
(5-10)

Note: p 0,001 between groups. Have left group with functional erectile dysfunction 4 patients, with organic – 10

The Analysis of parametres basal penile a blood flow has shown (tab. 3) that after end of course of treatment at functional and organic erectile dysfunction the maximum rate of a blood flow in a systole (Vsis) was authentically enlarged on the average by 10 % in comparison with an initial indicator. The resistance index (IR) was authentically enlarged at functional and to a lesser degree at organic erectile dysfunction. The index pulsation (Pi) also was authentically enlarged by 20 % at functional and to a lesser degree at organic erectile dysfunction.

TABLE 3. Parametres of a basal blood flow in cavernous arteries of a penis before treatment at different kinds of erectile dysfunction

Kind erectile
Dysfunctions

Note: p 0,001 between groups. Have left group with functional erectile dysfunction 4 patients, with organic – 10. Vsis – the maximum rate of a blood flow in a systole; IR – a resistance index; Pi – an index pulsation

At comparison of parametres stimulated a blood flow before monotherapy sildenafil Citrate (tab. 4) taps blood flow augmentation in cavernous arteries of a penis on 17 % at patients with functional and on 13 % at patients with organic erectile dysfunction. Y513 in group of patients with functional erectile dysfunction it was enlarged by 19 %, and in group of patients with organic erectile dysfunction – On 12 %. KK it was enlarged by 25 % and 17 %, accordingly, and KP – on 24 % and 14 %. At the majority of patients the venous hemodynamic of a penis has improved also.

TABLE 4. Parametres stimulated a blood flow in cavernous arteries of a penis before treatment at different kinds of erectile dysfunction

Kind of erectile dysfunction

% of augmentation of a blood flow

Vsis (TRIMS.) – Vsis (bases.)
(Sm/c)

Note: p 0,001 between groups. Have left group with functional erectile dysfunction 4 patients, with organic – 10. KR = IR (TRIMS.) / IR (bases.). KP = Pi (TRIMS.) / Pi. (Bases.)

Thus, along with substantial improvement of clinical results at long monotherapy sildenafil citrate had been reached authentic augmentation basal and stimulated a blood flow in penis arteries. For studying of opinion of patients it was offered to them to answer questions of the additional questionnaire on results of the spent treatment (tab. 5) which consisted of following questions:

  • “As you estimate results of treatment? (Unsatisfactorily, well, well, perfectly)”
  • “you can note What positive moments of this course of treatment?”
  • “you can note What negative moments of this course of treatment?”
  • “you Intend to continue course of treatment by a preparation Viagra?”.

Were happy with treatment 18 (90 %) from 20 patients with functional and 30 (57,7 %) from 52 patients with organic erectile dysfunction. From advantages of a preparation speed of offensive of an erection, reliability of results and absence of complications have been noted. From the negative moments high cost of a preparation is allocated. Have agreed to continue treatment 20 (100 %) patients with functional and 35 (67,3 %) patients with organic erectile dysfunction.

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"The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause. "

- Fourth Amendment to the United States Constitution

The Electronic Communications Privacy Act (ECPA) was a forward-looking statute when enacted in 1986. It specified standards for law enforcement access to electronic communications and associated data, affording important privacy protections to subscribers of emerging wireless and Internet technologies. Technology has advanced dramatically since 1986, and ECPA has been outpaced. The statute has not undergone a significant revision since it was enacted in 1986 – eons ago in Internet time.

As a result, ECPA is a patchwork of confusing standards that have been interpreted inconsistently by the courts, creating uncertainty for both service providers and law enforcement agencies. ECPA can no longer be applied in a clear and consistent way, and, consequently, the vast amount of personal information generated by today’s digital communication services may no longer be adequately protected. At the same time, ECPA must be flexible enough to allow law enforcement agencies and services providers to work effectively together to combat increasingly sophisticated cyber-criminals or sexual predators.

The time for an update to ECPA is now. Privacy advocates, trade associations, think tanks, legal scholars, start-ups, and major Internet and communications companies have developed consensus around the notion of a core set of principles intended to simplify, clarify, and unify the ECPA standards; provide clearer privacy protections for subscribers taking into account changes in technology and usage patterns; and preserve the legal tools necessary for government agencies to enforce the laws and protect the public.

Changes in Technology Have Outpaced the Law

Justice Brandeis famously called privacy “the most comprehensive of rights, and the right most valued by a free people.” Of course, privacy must be balanced against other societal interests. Electronic communications and associated data can provide key evidence in the investigation of many crimes, and the assistance of service providers is often necessary to access such evidence. With respect to communications privacy and law enforcement investigations, the courts and Congress have sought to develop rules for government surveillance that balance three interests: the individual’s constitutional right to privacy, the government’s need for tools to conduct investigations, and the interest of service providers in clarity and customer trust.

Since enactment of ECPA, there have been fundamental changes in communications technology and the way people use it, including –

  • Email: Most Americans have embraced email in their professional and personal lives and use it daily for confidential communications of a personal or business nature. Because of the importance of email and unlimited storage capabilities available today, most people save their email indefinitely, just as they previously saved letters and other correspondence. The difference, of course, is that it is easier to save, search and retrieve digital communications. Many of us now have many years worth of stored email. Moreover, for many people, much of that email is stored on the computers of service providers.
  • Mobile location: Cell phones and mobile Internet devices constantly generate location data that supports both the underlying service and a growing range of location-based services of great convenience and value. This location data can be intercepted in realtime, and is often stored in easily accessible logs files. Location data can reveal a person’s movements, from which inferences can be drawn about activities and associations. Location data is augmented by very precise GPS data in many devices.
  • Cloud computing: Increasingly, businesses and individuals are storing data “in the cloud,” with potentially huge benefits in terms of cost, security, flexibility and the ability to share and collaborate.
  • Social networking: One of the most striking developments of the past few years has been the remarkable growth of social networking. Hundreds of millions of people now use social media services to share information with friends and as an alternative platform for private communications.

In the face of these developments, ECPA does not provide protection suited to the way technology is used today:

  • Conflicting standards and illogical distinctions: ECPA sets rules for governmental access to email and stored documents that are not consistent. A single email is subject to multiple different legal standards in its lifecycle, from the moment it is being typed to the moment it is opened by the recipient to the time it is stored with the email service provider. To take another example, a document stored on a desktop computer is protected by the warrant requirement of the Fourth Amendment, but ECPA says that the same document stored with a service provider may not be subject to the warrant requirement.
  • Unclear standards: ECPA does not clearly state the standard for governmental access to location information.
  • Judicial criticism: The courts have repeatedly criticized ECPA for being confusing and difficult to apply. The Ninth Circuit in 2002 said that Internet surveillance was “a confusing and uncertain area of the law.” In the past 5 years, no fewer than 30 federal opinions have been published on government access to cell phone location information, reaching a variety of conclusions.
  • Constitutional uncertainty: The courts have been slow to address the application of the Fourth Amendment to new services and information. So far, among the regular federal appellate courts, only the Sixth Circuit has held that the Constitution protects stored email (Warshak), while the Ninth Circuit has held that there is a Constitutional privacy right in stored text messages (Quon). The Supreme Court has ruled that prolonged tracking with a GPS device is a search under the Fourth Amendment, but it has not yet ruled on use of cell tower data for tracking over time.

This murky legal landscape does not serve the government, customers or service providers well. Customers are, at best, confused about the security of their data in response to an access request from law enforcement. Companies are uncertain of their responsibilities and unable to assure their customers that subscriber data will be uniformly protected. The current state of the law does not well serve law enforcement interests either, as resources are wasted on litigation over applicable standards, and prosecutions are in jeopardy should the courts ultimately rule on the Constitutional questions.

The solution is a clear set of rules for law enforcement access that will safeguard end-user privacy, provide clarity for service providers, and enable law enforcement officials to conduct effective and efficient investigations.

Guiding Principles for ECPA Reform

The overarching goal of our ECPA reform principles is to balance the law enforcement interests of the government, the privacy interests of users, and the interests of communications service providers in certainty, efficiency and public confidence.

We are guided by the following concepts:

  • Technology and Platform Neutrality: A particular kind of information (for example, the content of private communications) should receive the same level of protection regardless of the technology, platform or business model used to create, communicate or store it.
  • Assurance of Law Enforcement Access: The reform principles would preserve all of the building blocks of criminal investigations – subpoenas, court orders, pen register orders, trap and trace orders, and warrants – as well as the sliding scale that allows the government to escalate its investigative efforts.
  • Equality Between Transit and Storage: Generally, a particular category of information should be afforded the same level of protection whether it is in transit or in storage.
  • Consistency: The content of communications should be protected by a court order based on probable cause, regardless of how old the communication is and whether it has been “opened” or not.
  • Simplicity and Clarity: All stakeholders – service providers, users and government investigators – deserve clear and simple rules.
  • Recognition of All Existing Exceptions: Over the years, a variety of exceptions have been written into the ECPA, such as provisions allowing disclosures to the government without court orders in emergency cases. These principles should leave all those exceptions in place.

Rather than attempt a full rewrite of ECPA, which might have unintended consequences, our recommendations focus on just a handful of the most important issues – those that are arising daily under the current law: access to email and other private communications stored in the cloud, access to location information, and the use of subpoenas to obtain transactional data.

Our principles do not seek to answer all questions or concerns about ECPA. Though members of the coalition may differ on the specifics, and some individual members would support additional changes, we all agree that these principles provide a framework for opening a public dialogue on the issue.

Specific Background on ECPA Reform Principles

1. The government should obtain a search warrant based on probable cause before it can compel a service provider to disclose a user’s private communications or documents stored online.

  • This principle applies the safeguards that the law has traditionally provided for the privacy of our phone calls or the physical files we store in our homes to private communications, documents and other private user content stored in or transmitted through the Internet "cloud"– private emails, instant messages, text messages, word processing documents and spreadsheets, photos, Internet search queries and private posts made over social networks.
  • This change was first proposed in bi-partisan legislation introduced in 1998 by Senators John Ashcroft and Patrick Leahy. It is consistent with appeals court decisions holding that emails and SMS text messages stored by communications providers are protected by the Fourth Amendment, and is also consistent with the leading legal scholarship on the issue.

2. The government should obtain a search warrant based on probable cause before it can track, prospectively or retrospectively, the location of a cell phone or other mobile communications device.

  • This principle addresses the treatment of the growing quantity and quality of data based on the location of cell phones, laptops and other mobile devices, which is currently the subject of conflicting court decisions; it proposes the conclusion reached by a majority of the courts that a search warrant is required for real-time cell phone tracking, and would apply the same standard to access to stored location data.
  • A warrant for mobile location information was first proposed in 1998 as part of the bipartisan Ashcroft-Leahy bill. It was approved 20 to 1 by the House Judiciary Committee in 2000.

3. Before obtaining transactional data in real time about when and with whom an individual communicates using email, instant messaging, text messaging, the telephone or any other communications technology, the government should demonstrate to a court that such data is relevant to an authorized criminal investigation.

  • In 2001, the law governing “pen registers and trap & trace devices”—technologies used to obtain transactional data in real time about when and with whom individuals communicate over the phone—was expanded to also allow monitoring of communications made over the Internet. In particular, the data at issue includes information on who individuals email with, who individuals IM with, who individuals send text messages to, and the Internet Protocol addresses of the Internet sites individuals visit.
  • This principle would update the law to reflect modern technology by establishing judicial review of surveillance requests for this data based on a factual showing of reasonable grounds to believe that the information sought is relevant to a crime being investigated.

4. Before obtaining transactional data about multiple unidentified users of communications or other online services when trying to track down a suspect, the government should first demonstrate to a court that the data is needed for its criminal investigation.

  • This principle addresses the circumstance when the government uses subpoenas to get information in bulk about broad categories of telephone or Internet users, rather than seeking the records of specific individuals that are relevant to an investigation. For example, there have been reported cases of bulk requests for information about everyone that visited a particular web site on a particular day, or everyone that used the Internet to sell products in a particular jurisdiction.
  • Because such bulk requests for information on classes of unidentified individuals implicate unique privacy interests, this principle applies a standard requiring a showing to the court that the bulk data is relevant to an investigation.

To simplify, clarify, and unify the ECPA standards, providing stronger privacy protections for communications and associated data in response to changes in technology and new services and usage patterns, while preserving the legal tools necessary for government agencies to enforce the laws, respond to emergency circumstances and protect the public.

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    Viagra and Alcohol

    Although studies have shown that combining alcohol and Viagra is unlikely to cause problems, you should still be aware of potential risks. For example, because both substances cause the blood vessels to dilate, combining these two may lead to dizziness, a rapid heart rate, and low blood pressure. To avoid any problems, talk to your healthcare provider about consuming alcohol while taking this drug.

    Is It Safe to Drink Alcohol With Viagra?

    According to the manufacturer of Viagra ® (sildenafil citrate ), drinking alcohol while on this medication is not expected to cause problems. Although some similar medications may cause problems when combined with alcohol, this does not seem to be a problem with Viagra.

    Research on Viagra and Alcohol

    Both Viagra and alcohol can have similar effects on blood vessels, causing them to dilate (open wider). However, studies did not show such problems in men who combined the two to achieve a blood alcohol level of 0.08 percent (legally intoxicated).

    Although studies indicate that combining alcohol with Viagra is unlikely to cause problems, it is a good idea to be aware of problems that could theoretically occur due to overly dilated blood vessels, such as:

    Talking With Your Healthcare Provider

    You should talk with your healthcare provider about alcohol consumption and Viagra. You and your healthcare provider understand your situation best. Based on what you want and expect, as well as your current health situation, the two of you can make a shared decision about your intake of alcohol while on this medication. There may also be other medical reasons why you should not consume alcohol.

    Written by/reviewed by: Kristi Monson, PharmD; Arthur Schoenstadt, MD

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    I do have a party lifestyle sometimes and have had it with a fair amount of alcohol – definitely the alcohol isn’t a good thing. It reduces the effect and increases the headache. Best times are with no alcohol, or a glass or two only is fine.
    – Australia, Age 35

    For me the effects of Viagra are greatly diminished if taken before or with a meal. Much better on an empty stomach and no alcohol. – Bob, age 63, California

    I also noticed that drinking alcohol reduced the effectiveness of the Viagra. My solution was NO alcohol before sex, and only the 25 mg dose. Works great, and no side effects noticed. – Phil, Age 60, California

    I can’t eat anything at all before I take it or its effects are decreased considerably.

    Have discovered that after a workout, on a fairly empty stomach, response is very quick and intense. Taken with meals really causes a lag for me. – Bob, Age 45

    I get a headache but it is worth it.50 mg on empty stomach seems to work best. – Mike

    Viagra will work better on an empty stomach, and keep off the alcohol. – Age 51

    I used it with food both times and also had a few beers after I took it and had no problem. – Age 44, New York

    I am single but have sex about once each week thanks to Viagra. Currently I take the 50 mg tab and it works for me best if taken on an empty stomach. It is mostly ineffective if taken on a full stomach. – Age 81

    Can You Combine Alcohol And Viagra?

    Can Viagra be taken with alcohol?

    Viagra is the most popular treatment for men who suffer from erectile dysfunction. However, alcohol is one of the reasons why you might be experiencing erectile dysfunction in the first place. Although alcohol may help you overcome anxiety, it can also take a toll on your sexual function. 

    Drinking alcohol decreases the blood which stays within your penis, which makes it harder for you to get an erection. If you’re taking Viagra because you have had erection problems in the past, you should avoid alcohol.

    In addition, alcohol and Viagra can interact. Viagra lowers your blood pressure, as does alcohol. If your blood pressure gets too low, you may experience dizziness, light-headedness, fainting, headache and even heart palpitations. Having these  side effects of Viagra isn’t just potentially dangerous – it also certainly doesn’t improve your sexual performance.

    No alcohol with Viagra?

    It is important that you limit your alcohol intake while you are taking Viagra but it is safe to enjoy a small amount of alcohol, such as 2 – 3 units – so there’s is nothing wrong with having a glass of wine or one beer.

    Does alcohol cause erectile dysfunction?

    It is not only advisable to limit your drinking while taking Viagra, it can also help you combat ED and other sexual problems. A study published in the Indian Journal of Psychiatry found, that 72% of men suffering from alcohol dependence were also experiencing some form of sexual dysfunction. This included not only erectile problems but also premature ejaculation, loss of libido and difficulty achieving orgasm. 

    The study also found, that men who consumed 3 units of alcohol or more a day were significantly more likely to encounter sexual dysfunction than men who didn’t drink. However, a follow-up study also found, that within 2-3 months of abstinence, the study participants were no more likely to suffer from sexual problems than the control group of men who generally abstained from drinking. 

    Too much alcohol also increases your risk of certain conditions which can lead to ED, such as prostate problems and low levels of testosterone.

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    Very effective. Take without food to help absorption quickly and last longer. Effect does *not* run out in 4 hours. I have taken as little as 10-15 mg and felt the benefits for well over 12 hours. This of course will be different for everyone. Would recommend starting with a very, very low dose. My first dose of 25mg made my penis hurt due to the long lasting and persistent erections. Here are my recommendations and items to consider based on my personal experience: 1. Take without food 1 hour before love-time. It takes a bit to kick in. I have always felt a little “preview” effect of Viagra in about 15 minutes. but then it really kicks in after an hour. To get the Viagra flowing through your penis, manipulate yourself a little (may not take much. just an extra few giggles in the restroom). 2. Drink lots of water. Dehydration is BAD for erections. 3. Pop a couple of tums or rolaids. Viagra can make your stomach acidic. 4. Pop a breath mint as it can give you tart breath. 5. Take a very, very low dose the first time. Also, take it while you are alone so you can get used to how much you really need and the benefits. DON’T take it for the first time with your partner. 6. Don’t take it too often because it can make your prostate swell up. So don’t take it every other day so you can masturbate for 3 hours. 7. Headaches are common. pop a couple Advil with it. 8. Once you are having sex, it will keep your erection going even if what you are doing doesn’t feel that good. This is BAD. You don’t want to get used to having sex in positions that don’t feel good to you, since your erection will continue, but you may not be able to “get back into it” and have an orgasm. Certainly, there are times when this may be okay, but it gets awkward when you are in bed with a woman, have a rock hard erection, and you can’t have an orgasm. Women ask questions. And if she doesn’t know you are taking Viagra, she will probably figure it out. Good luck.

    Comment from: New_user, 45-54 Female on Treatment for less than 1 month (Patient) Published: October 20

    This drug worked extremely well for me. My doctor recommended that I start with 100 mg which I did with results that would put a teenager to shame. I experienced a mild headache the next morning and some nasal stuffiness. I also experience a very slight sensitivity to light. (These are all documented side effects and not considered unusual). I cut the dosage to 50 mg and the side effects virtually disappeared. without any noticable decrease of the drug’s effectiveness. I even tried 25 mg with good results. With 100 and 50 mg dosing, the effect of the drug kicked in after only 15-20 minutes. And the results lasted much longer than the advertised 4 hours – as much as 12 -14 hours for me. With this drug, I’ve been able to ejaculate every time and the erection does go away as promised (something I was concerned about after hearing the warning of the “4 hour erection” in the commercials). This drug has given me back my lovelife and in a way that has made it better than it’s ever been. If you’re having issues, but not sure what to do, I strongly encourage you to visit with your doctor and see if this drug (or similar) will work for you. I guarantee that, if it does (and my doctor tells me it is almost always effective), you will be the happiest guy on your block! Good luck!!

    Comment from: working at it, 45-54 Female on Treatment for 2-5 years (Patient) Published: February 11

    Guys, listen up.This is not a cure all. You have to experiment to see what works for you. First, you are paying by the pill and it’s crazy exspensive. Buy a pill splitter and cut your price in half or by 75% depending on the dossage you need. It takes practice to get a perfect cut but i’ts worth the effort. If you drink alcohol you’ll have to see how much you can consume with out diminishing results which is about 6 beers for me. Also I have found that I can take it at 10 or 11 at night and wake up with a raging hard on the next day which works out perfectly in my relationship and lasts till late afternoon. By the way I’m 50 and had a heart attack when I was 42.

    Comment from: 35-44 Female on Treatment for less than 1 month (Patient) Published: December 24

    Works great. I am only 40. Started having problems about a year ago. Got a sample pack from Dr. with 6 pills. The first three I took worked perfectly. Took on empty stomach or at least one hour after a meal. Within an hour, took effect. Makes my face flush and nose run (common side effects) The fourth time I took it, I split the pill in half to see if it would work at lower dose (I was taking a 50mg dose) This DID NOT work. I dont know if it was the lower dose, if it had something to do with what I ate beforehand (Mexican food), or if your not supposed to split them. Also, most of the time, it still has effects several hours after. Even up to the next morning if taken at night.

    Comment from: CallhimMrHappy, 45-54 Female on Treatment for less than 1 month (Patient) Published: August 26

    Am 46 years old and just started having problems getting erections. Tried “herbal” remedies, was hit or miss, mostly miss. Also libido was on the down turn, I just didn’t feel like I needed or wanted sex. Talked to Dr and was given free trial of 50 mg. Took one a hour before bed, and was very amazed at the erection it gave me when the wife and I started messing around! Not to mention waking up with morning wood, something that hasn’t happened in a LONG time!

    Patient Comments are not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your physician or other qualified health provider because of something you have read on RxList. The opinions expressed in the comments section are of the author and the author alone. RxList does not endorse any specific product, service or treatment.

    If you think you have a medical emergency, call your doctor or 911 immediately.

    Report Problems to the Food and Drug Administration

    You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

    Viagra: How Young Is Too Young?

    From the WebMD Archives

    Rafael Palmeiro seems an unlikely Viagra pitchman. The Texas Rangers slugger is only 37 and won’t admit to having erection problems, yet he recently agreed to appear in ads promoting the drug. The deal has made people wonder whether Palmeiro really represents men with erectile dysfunction. or whether Pfizer, the company that makes Viagra, wants to persuade young men to try it for fun.

    It’s true that erectile dysfunction is more common in older men, but many potential Viagra users are hardly senior citizens: About 40% of 40-year-old men in the U.S. have some degree of erectile dysfunction. Most Viagra users today, according to Pfizer, are in their early to mid 50s. So it makes sense that the company would want to reach more men around Palmeiro’s age.

    Urologist Myron Murdock, medical director of the Impotence Institute of America, says these men are likely to use Viagra because sexual performance is a high priority for them.

    A younger man, Murdock says, “wants his V-12 Jaguar working just perfectly,” whereas an elderly gent may be content with less dependable erections. What’s more, the sexual partners of younger men “are more demanding of their performance,” Murdock says.

    Pfizer denies that it’s promoting Viagra for recreational use. “We’ve consistently opposed that,” says spokesman Geoff Cook. Nevertheless, Murdock says it’s fine to pop the little blue pill to “optimize” your sexual performance.

    We assume all young men have normal sexual functioning, “but they’re really not normal,” Murdock says. Hardening of the arteries. which restricts blood flow to the penis. can begin during the teen years, so that by the time a man is in his 20s, his ability to get and keep an erection has already begun to decline. Murdock says many men who seek Viagra for recreational use actually have minor erectile dysfunction.

    There’s also some evidence that Viagra can shorten the time it takes a man to recover after sex and be ready for another round. This is called the “refractory period.” Normally it lasts 20 minutes or longer. One study, published in the journal Human Reproduction in January 2000, found that Viagra shortened the refractory period by about 10 minutes in healthy men .

    Continued

    What Viagra cannot do is increase your sexual appetite or make you ejaculate if you have problems reaching orgasm. Ira Sharlip, urologist in San Francisco, says you shouldn’t expect your erections to reach staggering new proportions, either. “I don’t believe that Viagra can increase an erection beyond 100% of normal,” he says.

    “Viagra is a super-safe drug,” Murdock says, assuming you have a healthy heart and don’t take nitrates.

    Nitrates include nitroglycerin — a drug that many men take for chest pain from heart disease — and “poppers.” Poppers are little vials of amyl or butyl nitrate. Breaking the vial releases nitrate vapor, which gives a brief high when inhaled. It’s most often used to enhance sexual pleasure, and mostly by gay men. Poppers are not all that safe to use on their own, and they’re especially dangerous when you’re on Viagra.

    Nitrates widen blood vessels, and Viagra increases that effect. Mixing the two can cause your blood pressure to drop drastically. A sudden drop in blood pressure can make you pass out, and you may die if your blood pressure stays too low for too long.

    Preservatives like sodium nitrate — found in processed food — do not cause this problem, so you won’t die from eating a hot dog while on Viagra. Even so, it’s best to take it on an empty stomach. That way, the drug absorbs into your bloodstream faster. Wine may contain nitrates, but not the kind that cause problems with Viagra. It’s fine to play some Marvin Gaye on the stereo and sip a glass of Chardonnay, if that’s what puts you in the mood.

    Although you may be tempted to order Viagra discreetly from one of the hundreds of Web sites that sell it, don’t. “It’s bad medicine,” Murdock says. You really must bring your doctor into your sex life if you want to use Viagra.

    When you buy from an online pharmacy, you just have to answer some health questions before you proceed to the checkout page. If you answer honestly — and that might be a big “if” for those determined to get what they want — the questionnaire may catch some possible complications. But the pharmacists who fill your order don’t know your medical history, and no questionnaire can diagnose the root cause of your problem. Erectile dysfunction can have serious underlying causes, like diabetes. heart disease. liver disease, or thyroid disease.

    Continued

    Cook says Pfizer is opposed to Internet Viagra sales. “Our goal with any of our marketing is simply to reach men and encourage them to see a doctor,” he says.

    It seems that Viagra can make sex better for women, too. Like the penis. the clitoris is erectile tissue — spongy tissue that becomes engorged with blood during sexual excitement. By increasing blood flow to the clitoris, Viagra may heighten a woman’s sensation and arousal. It also seems to increase vaginal lubrication.

    Murdock says many couples like to heat things up by splitting a dose of Viagra. “It’s an interesting sexual situation,” he says. The recommended dosage for men is up to 100 milligrams per day, and that seems to be just as safe for women. Young people may get results from a smaller dose: As little as 25 mg may be enough.

    The FDA has not approved Viagra for women, but Murdock says, “It’s just a matter of time.” He says he and other doctors who specialize in sexual medicine prescribe it to women, which is perfectly legal. Doctors are allowed to use their best judgment. Drug companies, however, can’t advertise any use that isn’t FDA-approved.

    The studies being done to test Viagra’s safety and effectiveness in women have shown good results so far. “We’re cautiously optimistic,” Cook says.

    Martin F. Downs is a health writer in New York City. He was formerly an editor at CBS HealthWatch. He has also written for Health.com, Salon.com, and POZ magazine and is the editor of the Alicubi Journal (alicubi.com).

    В© 2002 WebMD, Inc. All rights reserved.

    How Long Does Viagra Last After Expiration?

    Not everyone gets through their prescriptions quickly, and they find themselves looking at the expiration date and wondering “Does this last?”

    It does, sort of. Viagra, like any drug, loses its effectiveness over time as the molecules in the drug break down. This is why most pharmacies recommend taking medication within one year of prescription; after that point, the drug will be less effective.

    However, there are no side effects that come from taking expired Viagra, except for the side effects the drug itself may cause. There’s simply less of it to affect you, in fact, so those side effects may be milder. You should still not take Viagra, even “expired” Viagra, if you have a severe reaction to a full dose.

    Five years from manufacture, it will be completely inert. Until then, it will simply have a weaker effect than a full, fresh dose, and the older the drug, the weaker the effect will be. If you’d like to extend the life of your Viagra, put it in a refrigerator; the cold will keep more of the drug active for longer, due to the cold preventing molecular breakdown. Otherwise, you can take the Viagra: just don’t expect quite as much of a lift.

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    "The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause. "

    - Fourth Amendment to the United States Constitution

    The Electronic Communications Privacy Act (ECPA) was a forward-looking statute when enacted in 1986. It specified standards for law enforcement access to electronic communications and associated data, affording important privacy protections to subscribers of emerging wireless and Internet technologies. Technology has advanced dramatically since 1986, and ECPA has been outpaced. The statute has not undergone a significant revision since it was enacted in 1986 – eons ago in Internet time.

    As a result, ECPA is a patchwork of confusing standards that have been interpreted inconsistently by the courts, creating uncertainty for both service providers and law enforcement agencies. ECPA can no longer be applied in a clear and consistent way, and, consequently, the vast amount of personal information generated by today’s digital communication services may no longer be adequately protected. At the same time, ECPA must be flexible enough to allow law enforcement agencies and services providers to work effectively together to combat increasingly sophisticated cyber-criminals or sexual predators.

    The time for an update to ECPA is now. Privacy advocates, trade associations, think tanks, legal scholars, start-ups, and major Internet and communications companies have developed consensus around the notion of a core set of principles intended to simplify, clarify, and unify the ECPA standards; provide clearer privacy protections for subscribers taking into account changes in technology and usage patterns; and preserve the legal tools necessary for government agencies to enforce the laws and protect the public.

    Changes in Technology Have Outpaced the Law

    Justice Brandeis famously called privacy “the most comprehensive of rights, and the right most valued by a free people.” Of course, privacy must be balanced against other societal interests. Electronic communications and associated data can provide key evidence in the investigation of many crimes, and the assistance of service providers is often necessary to access such evidence. With respect to communications privacy and law enforcement investigations, the courts and Congress have sought to develop rules for government surveillance that balance three interests: the individual’s constitutional right to privacy, the government’s need for tools to conduct investigations, and the interest of service providers in clarity and customer trust.

    Since enactment of ECPA, there have been fundamental changes in communications technology and the way people use it, including –

    • Email: Most Americans have embraced email in their professional and personal lives and use it daily for confidential communications of a personal or business nature. Because of the importance of email and unlimited storage capabilities available today, most people save their email indefinitely, just as they previously saved letters and other correspondence. The difference, of course, is that it is easier to save, search and retrieve digital communications. Many of us now have many years worth of stored email. Moreover, for many people, much of that email is stored on the computers of service providers.
    • Mobile location: Cell phones and mobile Internet devices constantly generate location data that supports both the underlying service and a growing range of location-based services of great convenience and value. This location data can be intercepted in realtime, and is often stored in easily accessible logs files. Location data can reveal a person’s movements, from which inferences can be drawn about activities and associations. Location data is augmented by very precise GPS data in many devices.
    • Cloud computing: Increasingly, businesses and individuals are storing data “in the cloud,” with potentially huge benefits in terms of cost, security, flexibility and the ability to share and collaborate.
    • Social networking: One of the most striking developments of the past few years has been the remarkable growth of social networking. Hundreds of millions of people now use social media services to share information with friends and as an alternative platform for private communications.

    In the face of these developments, ECPA does not provide protection suited to the way technology is used today:

    • Conflicting standards and illogical distinctions: ECPA sets rules for governmental access to email and stored documents that are not consistent. A single email is subject to multiple different legal standards in its lifecycle, from the moment it is being typed to the moment it is opened by the recipient to the time it is stored with the email service provider. To take another example, a document stored on a desktop computer is protected by the warrant requirement of the Fourth Amendment, but ECPA says that the same document stored with a service provider may not be subject to the warrant requirement.
    • Unclear standards: ECPA does not clearly state the standard for governmental access to location information.
    • Judicial criticism: The courts have repeatedly criticized ECPA for being confusing and difficult to apply. The Ninth Circuit in 2002 said that Internet surveillance was “a confusing and uncertain area of the law.” In the past 5 years, no fewer than 30 federal opinions have been published on government access to cell phone location information, reaching a variety of conclusions.
    • Constitutional uncertainty: The courts have been slow to address the application of the Fourth Amendment to new services and information. So far, among the regular federal appellate courts, only the Sixth Circuit has held that the Constitution protects stored email (Warshak), while the Ninth Circuit has held that there is a Constitutional privacy right in stored text messages (Quon). The Supreme Court has ruled that prolonged tracking with a GPS device is a search under the Fourth Amendment, but it has not yet ruled on use of cell tower data for tracking over time.

    This murky legal landscape does not serve the government, customers or service providers well. Customers are, at best, confused about the security of their data in response to an access request from law enforcement. Companies are uncertain of their responsibilities and unable to assure their customers that subscriber data will be uniformly protected. The current state of the law does not well serve law enforcement interests either, as resources are wasted on litigation over applicable standards, and prosecutions are in jeopardy should the courts ultimately rule on the Constitutional questions.

    The solution is a clear set of rules for law enforcement access that will safeguard end-user privacy, provide clarity for service providers, and enable law enforcement officials to conduct effective and efficient investigations.

    Guiding Principles for ECPA Reform

    The overarching goal of our ECPA reform principles is to balance the law enforcement interests of the government, the privacy interests of users, and the interests of communications service providers in certainty, efficiency and public confidence.

    We are guided by the following concepts:

    • Technology and Platform Neutrality: A particular kind of information (for example, the content of private communications) should receive the same level of protection regardless of the technology, platform or business model used to create, communicate or store it.
    • Assurance of Law Enforcement Access: The reform principles would preserve all of the building blocks of criminal investigations – subpoenas, court orders, pen register orders, trap and trace orders, and warrants – as well as the sliding scale that allows the government to escalate its investigative efforts.
    • Equality Between Transit and Storage: Generally, a particular category of information should be afforded the same level of protection whether it is in transit or in storage.
    • Consistency: The content of communications should be protected by a court order based on probable cause, regardless of how old the communication is and whether it has been “opened” or not.
    • Simplicity and Clarity: All stakeholders – service providers, users and government investigators – deserve clear and simple rules.
    • Recognition of All Existing Exceptions: Over the years, a variety of exceptions have been written into the ECPA, such as provisions allowing disclosures to the government without court orders in emergency cases. These principles should leave all those exceptions in place.

    Rather than attempt a full rewrite of ECPA, which might have unintended consequences, our recommendations focus on just a handful of the most important issues – those that are arising daily under the current law: access to email and other private communications stored in the cloud, access to location information, and the use of subpoenas to obtain transactional data.

    Our principles do not seek to answer all questions or concerns about ECPA. Though members of the coalition may differ on the specifics, and some individual members would support additional changes, we all agree that these principles provide a framework for opening a public dialogue on the issue.

    Specific Background on ECPA Reform Principles

    1. The government should obtain a search warrant based on probable cause before it can compel a service provider to disclose a user’s private communications or documents stored online.

    • This principle applies the safeguards that the law has traditionally provided for the privacy of our phone calls or the physical files we store in our homes to private communications, documents and other private user content stored in or transmitted through the Internet "cloud"– private emails, instant messages, text messages, word processing documents and spreadsheets, photos, Internet search queries and private posts made over social networks.
    • This change was first proposed in bi-partisan legislation introduced in 1998 by Senators John Ashcroft and Patrick Leahy. It is consistent with appeals court decisions holding that emails and SMS text messages stored by communications providers are protected by the Fourth Amendment, and is also consistent with the leading legal scholarship on the issue.

    2. The government should obtain a search warrant based on probable cause before it can track, prospectively or retrospectively, the location of a cell phone or other mobile communications device.

    • This principle addresses the treatment of the growing quantity and quality of data based on the location of cell phones, laptops and other mobile devices, which is currently the subject of conflicting court decisions; it proposes the conclusion reached by a majority of the courts that a search warrant is required for real-time cell phone tracking, and would apply the same standard to access to stored location data.
    • A warrant for mobile location information was first proposed in 1998 as part of the bipartisan Ashcroft-Leahy bill. It was approved 20 to 1 by the House Judiciary Committee in 2000.

    3. Before obtaining transactional data in real time about when and with whom an individual communicates using email, instant messaging, text messaging, the telephone or any other communications technology, the government should demonstrate to a court that such data is relevant to an authorized criminal investigation.

    • In 2001, the law governing “pen registers and trap & trace devices”—technologies used to obtain transactional data in real time about when and with whom individuals communicate over the phone—was expanded to also allow monitoring of communications made over the Internet. In particular, the data at issue includes information on who individuals email with, who individuals IM with, who individuals send text messages to, and the Internet Protocol addresses of the Internet sites individuals visit.
    • This principle would update the law to reflect modern technology by establishing judicial review of surveillance requests for this data based on a factual showing of reasonable grounds to believe that the information sought is relevant to a crime being investigated.

    4. Before obtaining transactional data about multiple unidentified users of communications or other online services when trying to track down a suspect, the government should first demonstrate to a court that the data is needed for its criminal investigation.

    • This principle addresses the circumstance when the government uses subpoenas to get information in bulk about broad categories of telephone or Internet users, rather than seeking the records of specific individuals that are relevant to an investigation. For example, there have been reported cases of bulk requests for information about everyone that visited a particular web site on a particular day, or everyone that used the Internet to sell products in a particular jurisdiction.
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    This consequently increases the supply and leads to erection. It isn’t as if the disorder doesn’t have optional cures, but no treatment matches the drug in the sheer simplicity of its administration. Which explains the euphoric reception to its arrival.

    “We can now give oral tablets to the patients,” says Saxena, “and it will also stop them from going to the quacks.” For eminent Mumbai-based andrologist Vijay Kulkarni, “it’s one more tool for treating the patient”.

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    Side-effects notwithstanding, the pharmaceutical companies are upbeat. “We’re on top of the world,” exclaims a jubilant S.D. Kaul, regional director, Asia and Middle East, Ranbaxy. He has reason to be. With India’s billion-plus population, the sheer numbers translate to tremendous market potential. “The market would run to about Rs 50-100 crore. It’s a blockbuster drug,” says Kaul.

    Other companies provide similar estimates. But with so many vying for a slice of the pie, a bit of shine may rub off soon. Stiff competition will define price and profit margins to the patient’s benefit. The approximate price of the new drug is Rs 20 per tablet, which is already a big gain for patients who are currently shelling out Rs 500 per tablet for the imported Viagra in the grey market.

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    Penegra was Cadila’s choice both because it refers to problems of penetration, and the penis, says President Ganesh Nayak. Blue and diamond shaped, the Penegra pill is an exact copy of Viagra. Ranbaxy’s red triangular tablets are deliberately designed to be different, while Torrent’s tablets are blue and round.

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    An India-specific marketing challenge for the companies is people’s reluctance to talk openly about sexual matters. Says Kaul: “We don’t just have to create a brand but also a market, as ED is a hush-hush affair here.” Besides, impotence is not just any other disease like diabetes or malaria.

    Striking at the very core of manhood, its impact finds an echo in every aspect of man’s life: the wife doomed to a celibate existence and the boss stuck with a depressed, less-productive employee. Small wonder then that the drug is seen as the best thing to happen to the Indian male in a long, long time.

    Some of the optional cures available to erectile dysfunctional patients in India are:

    • The most popular and affordable treatment so far has been the papaverine injection. At Rs 15-20 per shot, it is the price, not convenience, that dictates its popularity. The drug has to be injected locally into the phallus, a painful procedure that can lead to infection unless done in aseptic conditions, according to Professor N.K. Mohanty, head of urology at Delhi’s Safdarjung Hospital.
    • The vacuum erection device is the only non-invasive treatment that has no side-effects, says Mohanty. There are no injections, no tablets – only a hollow tube that creates a vacuum and sucks blood into the penis, leading to an erection. At Rs 10,000- 20,000 one-time cost, the price at least induces a sense of satisfaction.
    • Some men – such as traumatic paraplegics – suffer from extreme impotence. A penile implant is then the only option. The device is designed to last a lifetime. But, insists Ajit Saxena, senior consultant urologist at Delhi’s Apollo Hospital, implants should be prescribed only after a thorough psychological assessment, when all else fails. This procedure involves placing an artificial implant into the phallus. The price can range from Rs 40,000 to Rs 2 lakh but the result is near-normal function. The biggest drawback is infection and rejection by the body, which occurs in about 2 to 3 per cent of the surgeries.

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    The “mill” is across the orchard from the “woodshed”. It now houses the theatre’s shop operations and its costume collection. However during the years of self-sufficient farming, it was one of several lumber mills built on the property by Lewis Where To Get Viagra In India in the middle part of the 1900’s. This was a complete finish lumber mill powered by an Allis Chalmers tractor. If you listen carefully through the whirr of the belts and the screech of the saws you might just be able to hear Lewis and Almon Allen, and young Carelton Where To Get Viagra In India, prepare a load of lumber for the newest construction project.

    The Where To Get Viagra In India family has a long tradition of entertaining locals and summer visitors in the Beaver Dam section of Berwick. Samuel’s weekly barn dances at the “Forget Me Not” were a favorite pastime during the early decades of the 1900’s. His son Lewis, a local and state Grange Master, was also a master of many musical instruments. He had a passion for starting bands and performing in Beaver Dam and across the state of Maine. His son Carleton organized several theatre groups, first at the Beaver Dam grange, and then at his barn now called Hackmatack Playhouse.

    Every year thousands of people gather outside the Playhouse with tickets to the summer’s productions. Every year talented actors audition for their chance to perform at Hackmatack Playhouse, and to experience the history and excitement of being part of Hackmatack’s family. The farm and its building have many stories to tell. Perhaps 200 years from now Where To Get Viagra In India great, great grandchildren will be telling this story to aspiring actors nervously waiting for their audition slot, and to friendly crowds waiting to take their seats; of how the barn became home for the Hackmatack Playhouse.

    After the death of the founder in 1995, the S Carleton Where To Get Viagra In India Memorial Fund was established to preserve and improve our historical buildings. The fund also is dedicated to advancements of dramatic arts, both for the participant and the community, and to the commitment of providing quality family entertainment and drama at a reasonable price. Contributions are always welcomed. We thank you in advance for helping us secure the future of Hackmatack Playhouse for potential Hackmatackers.

    Hackmatack exists because of the generosity of it’s patrons, friends and those that appreciate the theater’s contribution to local culture and community. It is committed to the advancement of dramatic arts and to providing quality family entertainment at a reasonable price.

    We ask that you would consider a donation, and thank you in advance.

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