Timing and food can be important in effectiveness of Viagra

DEAR DR. ROACH: My husband and I are very fortunate to have had a happy relationship for many years. Our lovemaking has always been a pleasure for both of us. Now, we have to add Viagra to the mix. Sometimes it works; sometimes it doesn’t, which is a disappointment to both of us. Is there anything we can do to enhance its effectiveness? Or is there something else you can recommend that would do what we wish Viagra would do consistently? — Anon. ANSWER: Sildenafil (Viagra) and similar medicines have been very effective treatment for many men who have difficulty achieving and maintaining adequate erections for sexual intercourse. However, they are not effective for all men, and many people have a misunderstanding about how they work. Most importantly, Viagra does not increase libido, the desire for sexual contact, in men or women. It works by changing the way blood flows in and out of the penis. Erectile dysfunction can be caused by circulation problems such as blockages in the arteries; neurological problems; endocrine problems, especially low testosterone; and relationship issues. Viagra helps to some extent for men with any of these problems, but it’s worth reconsidering whether there is an underlying medical issue going on, both before prescribing it and periodically while taking it, especially if it doesn’t seem to be working as well. Still, oftentimes the problem with Viagra working intermittently is that it is affected by food, which many men don’t appreciate fully. Food slows down absorption of the medication, making the optimal time of administration more difficult to determine. I have often repeated the advice I heard from a urologist: “Take Viagra at 6, have dinner at 7, and you are good until midnight.” Viagra does become progressively less effective in some men, requiring higher doses to have the same results. Or, your husband could switch to one of the other Viagralike drugs, which have greater flexibility with timing and food. They work better for some men. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGood-Health@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

Ask Dr. Keith Roach M.D