With Viagra and some of the others it's all about TIMING!

I really miss the days when Cialis actually worked for me, because it made spontaneity SO much easier.  I could take it late Friday or early Saturday and be good to go through most of Sunday, which is why they call Cialis "The Weekender".  Sigh....  With Viagra and Levitra, however, you have to time the dose so you don't have to wait too long but then you don't wait so long the effects wear off before you can take advantage of them (and Staxyn takes so long to work you might just fall asleep before any fireworks can occur)..  My Lady is great because she likes to be surprised and is not adverse to a little action as soon as she wakes up in the morning.  Problem is, though, if I wait too long she gets  restless or hungry or has to pee and she goes off to remedy that and never returns, unless I reveal that I've already swallowed a $20 pill and would like to get our money's worth....  So, if I wake up before she does, I try to anticipate when she'll awake and take the pill about a half-hour before, but of course that doesn't always work out.  I suppose maybe we could work out a plan and ditch trying to be spontaneous, but it's just not quite as much fun.  This last time, we'd both been sick for a couple weeks and hadn't had any for a while, so she was plainly ready.  Knowing that, I just waited till she was awake, we started fooling around a bit, and then rather pointedly I went over to the nightstand where the glorious power nuggets awaited.  She just smiled.....  We then watched TV from the bed for a bit, finally began fooling around some more, and... SPROING!  Launch sequence initiated, entry assured, and a riotous blast-off point was reached a few minutes later.   Life was good again!   Maybe we can do that every time...?  Ah well, we'll have to see, I guess.  THANK YOU, PFIZER!  GOOD NIGHT!

The Related Problem of Lack of Desire

Yep, if there's a reason to fail sexually, I've had it, except for maybe Peyronie's Disease and some of the weirder stuff.  Some time ago I had no energy, felt tired all the time, got winded after just a little physical activity, had NO desire to get busy.  When I went to the doctor he gave me an EKG and promptly sent me off to a cardiologist with Atrial Fibrillation.  Luckily, that has been controlled with medication rather than the other kinda creepy alternatives (look up cardioversion, cardiac ablation, and mini-maze surgery, if you're interested).  

Even though I felt better I still had little or no energy and no desire.  Went to the urologist and found that I had low testosterone.  There are a number of forms that testosterone hormone replacement therapy (HRT) takes:  the tried-and-true testosterone patch, gels and lotions applied to the shoulders or underarms, and injections.  I started with Testim, a gel applied to the shoulders, which worked fine but was very expensive with my crappy health insurance, and you have to wear a t-shirt most of the time to keep family members from touching areas where the gel has been applied so they don't get testosterone effects themselves.  The patch came next, which worked fine but left the skin under the patch red and itchy.  Still, my insurance covered more of the patches' cost, so I wore them until eventually the redness and itching became unbearable.

Now I'm on Axiron, a gel applied to the underarms so you don't have to wear a shirt all the time, and it works really well.  When I first started taking testosterone there was an initial surge of effects:  I had tons more energy and I was freakin' horny for a change!  It also caused increased body muscle mass, which I'm sure would have been more pronounced if I were weight-training but I'm a slug, so that only increased a little bit.  After the first week or so, though, the effects tapered off. My desire now seems to run in cycles (does everyone's?) where I'm reeeeeally horny for awhile, then really NOT for a while.  Still, my energy and desire is much better than it was before HRT.  

Overdosing ED drugs and other no-no's.

I'm pretty tolerant of most drugs (maybe too much, where Cialis was concerned), so I've never had the priapism that the ED drugs sometimes produce.  Because of various circumstances (hey, you'll do almost anything to have sex sometimes, right?)  I have violated most of the rules prescribed by the drug companies in their package literature.  When the Cialis started to fail me, I once took 2 of them: it did not improve the erection but did increase the side effects.  I once tried taking Cialis with grapefruit juice, which in some people causes more of whatever drug you're taking to be digested in the small intestine, which magnifies its effects.  I am not one of those people, apparently, as it had no effect on Cialis' properties for me. There was once even a "Cialis Grapefruit" web page that had been created by someone, but when I tried to go there I received a response that the site had been taken down because it was "inappropriate", so I don't know if the effect achieved would have been good or bad.

Two Levitra tablets also produced no increase in performance, but it did make my nose TWICE as stuffy.  I've never taken two Viagra at once, but I did take two in one day, about 10 hours apart.  After taking the second tablet, the wife reneged on her commitment to doing the do, but did offer a hand-job as a compromise....  I didn't notice any difference in the erection until the climax: the two cavernosa blood vessels in the penis were so engorged that they somewhat constricted the uh, plumbing just like putting your thumb over the garden hose.  Upon ejaculation, my spooge attained a new personal height and distance record.  My Lady giggled, apparently pleased that she must have REALLY excited her man this time, so there was some benefit to that second pill in a day after all, although I'm not gonna make a habit of it, just in case one of those warnings might come true.  

UPDATE, 04/02/2015:  A footnote on one thing NOT to do....  When my doc some months ago prescribed Stendra for me, he said to start out with only 50 mg because of a possible drug interaction with my blood pressure medication, Diltiazem.  So while on vacation in Florida, I took the 50 mg and it did absolutely nothing for me....  Frustrated, I resorted to an Edex  injection...  Stupid, right?  I guess I just assumed that since the Stendra 50 had no noticeable effect, it wouldn't have any effect when I took the Edex injection.WRONG!  The good part: The Little Woman and I made mad, passionate, vacation monkey love, TWICE!  It was fandamntastic.... until the bad part a couple of hours later, when I figured out that my meat wand was still rock hard and showed no signs of softening. While TLW slept the night away (I'd worn her out, she said, probably just to massage my ego, but it still felt good to hear), I sneaked into the bathroom and cranked off another round in hope that the refractory period would help make the little guy become less angry, but to no avail.  Even though we have all heard "If you have an erection lasting 4 hours or longer, seek medical help",  I had read in the physician's information that comes with the medication that damage doesn't really occur until about 6 hours, so maybe they tell you to go to the hospital at 4 so you'll actually be able to get treatment by the 6-hour mark.  At 4 hours, he'd subsided a little bit, so I just hoped and prayed everything would be back to normal, soon.  By 6 hours, the swelling was just about gone, so I thought I was okay.  When I looked back on that, I wondered if maybe that was the cause of my Peyronie's a year or so later.  The urologist, however, said that probably wasn't the cause.  Still, ya never know....  BE WARNED!

Cialis vs. Viagra vs. Levitra vs. Staxyn vs. Other Stuff

(Revised 11/24/2022) I was going to list the various treatments as I experienced them, but most folks probably just want comparison info about them.  Here is what little I know from my own experience:

Cialis

Pro:  Effects last up to 36 hours (although with me it seemed a little shorter than that).  The doc told me Cialis is only officially rated for one session of intercourse during that period, but I experienced repeated erections.  My late wife and I once made love five (5) times in 24 hours when we were first together. Cialis made spontaneity much easier-- I could take it Saturday morning and be good to go through Sunday noon.  I've also tried the daily dose Cialis, which is a small dose tablet you take every day, but it didn't work for me.  If only it had, it would almost be like never having ED, I think.  Sigh....

Con:  It completely quit working for me after about 5 years, dunno why.  Even when it was working its best, the erection Cialis produced was more "springy" than hard, and if there was a break (like when My Lady has to go and pee before we start, which is pretty often) during which the erection would subside, it often took awhile to get it started again.  And Cialis usually worked well only when I took it on an empty stomach.  Any food in there at all would delay things or keep them from happening all together.  On the other hand, alcoholic beverages did not seem to affect my performance with Cialis as it does with the other drugs.  The bottom line for me is, if it works for you, Cialis is the way to go.  When I was taking it, it was the same price as Viagra and Levitra (although Stendra has an introductory deal that is pretty good), but it worked for so much longer....

Viagra

Pro:  The MacDaddy of oral ED drugs, the big V almost never fails to produce a rock-hard erection, sometimes almost too hard-- when I tried doggy-style with my "tiny giny" second wife, it hurt her inside and she constricted my  member so much that it hurt when I ejaculated and I then bled a little from the end of my penis. Some men, too, have told me that the expansion makes them feel so inflated and sensitive that they have difficulty controlling when they climax, often leading to a great but short-lived experience. Viagra is more fast-acting than some of the others, sometimes in as little as 20 minutes, although for me peak potency usually occurred at about an hour and fifteen minutes after taking the pill.  Viagra seems unaffected by food intake, although the package insert warns that taking it immediately after a high-fat meal can delay its effects.

Con:  Side effects-- Viagra makes my nose feel so stuffy I have to breathe through my mouth, and often my upper lip tingles. There is also a lack of spontaneity because, although its effects supposedly last 4 hours, I had trouble getting started after about two and a half hours.  On the other hand, if I got to have sex as soon as it took effect, I could usually perform a second or third time during that 4 hours, and on some occasions when we made love at the end of the night I was still good to go the next morning.  I dunno if the stuff lingers in your system while you sleep or what, but it  was quite a pleasant surprise that next day, more than 7 or 8 hours later.  The final Con for me is that alcohol intoxication usually kills its effects entirely, so no drunken debauchery on Viagra for me,  waaaah!  (UPDATE:  Big V no longer works for me-- see later post on Viagra Resistance.)

Levitra
Pro:  It works fairly quickly, and the effects supposedly last 6 hours, though I can't verify that-- but on occasion Levitra has given me the same happy morning-after surprise that Viagra provides.  Alcohol does not seem to affect Levitra as much as it does Viagra.  One day last week, I took the pill in preparation for the big finale, only to get involved in an argument with My Love over something really stupid, after which we went to bed angry.  I figured the pill was wasted and went to sleep.  Some hours later I must have had a Levitra-boosted night-time erection, as I was awakened by her rolling me onto my back.  She mounted me almost before I knew what was happening and rode me furiously until I exploded, after which she rose up off me, plopped onto her side of the bed without saying anything, and promptly went back to sleep.  We never talked about the episode, and I sure as hell don't remember what the argument was about!

Con:  Just like Cialis, for Levitra to work properly I had to take it on an empty stomach.  There was some nasal stuffiness, too, although not as bad as with Viagra, but that's more of a nuisance than anything serious. But, eventually it, too, quit working for me.

Staxyn
Pro:  This a new one to me.  It has the same ED medicine as Levitra, but it is in the form of a peppermint-flavored tablet that you dissolve on your tongue.  The package insert says it can be taken with or without food, so that may be an advantage over the food problems I had with Cialis and Levitra.  The package insert also says that the delivery system gets more of the medicine into your system than the same dosage Levitra pill.

Con:  It takes a long time to take effect, like 1 to 1.5 hours, although when it finally does come in, it does so spectacularly.  The wife and I tried a sample of it, and she reached over and stroked me every so often to see if it was working yet, which had me really worked up emotionally by the time things started to happen. She finally got tired of waiting and at the first sign of firmness (about 50 minutes) we tried to initiate the lift-off before the launch sequence had been completed, so we kind of went off half-cocked, as it were....   I awoke several hours later, though, with some serious wood, and I'm talking teak or mahogany, not bamboo.  By that time, though, My Lady was fast asleep.  If anyone has a sure-fire tactful technique of waking the little woman up to the Angry Little Man without offending her, please let me know!  As it was, I just had to go out into the workshop and hammer in some nails....  My problem with this one is that I needed to take two of them to get the full effect, and since they only have the one size dose, it would get quite expensive for me to use it very often.

Stendra
I managed to get my family doctor to prescribe Stendra for me. It is marketed as faster-acting, like in 15 minutes.  Because I'm also taking Diltiazem for heart rate/blood pressure, I'm supposed to be limited to 50mg of Stendra because the Diltiazem slows the metabolizing of Stendra so that some side effects may last for 8 or 9 hours. (And this may make it slower-acting as well.)  Unfortunately, 50 mg had no effect for me, and neither did 100 mg.  At the maximum dose for other people, 200 mg, however, things worked quite nicely, although it took 30 minutes or more to take effect.  Its effects are similar to Viagra, and I did get a REALLY stuffy nose when I took it, so I'm not sure there's any advantage to Stendra, other'n the fact it's the only PDE5 inhibitor that still works for me.  The manufacturer's website, Stendra.com offers a great coupon on your first 6 prescriptions, so it is worth a try. (Update:  It quit working after a while, too.)

Rugiet

I just did a new blog entry for this one on 11/20/2022-- look for it.


Papaverine, Edex, Caverject, Phentolamine: Bi-mix, Super Bi-mix, Tri-mix
These are all drugs you inject into the cavernosa of the penis, except that supposedly there's one form of Edex (Muse) that is a penile suppository (and I don't know anything about that particular product, sorry.) Papaverine was my first ED med and worked great, but the big drug companies don't make it anymore because it is no longer used for its primary purpose as a heart medicine.  My doctor said it would be available from a compounding pharmacy, but after the terrible meningitis outbreak caused by conditions at a Massachusetts compounding pharmacy as well as reports that my local one had been cited for unsafe conditions, I opted to go with Edex.  Edex is DA BOMB-- see my later posts about it.  Caverject is the same drug (Prostaglandin E1) as Edex, but the prepackaged syringe is kind of complicated to operate-- you put the needle on, then you have to adjust the plunger in a couple different ways to adjust the dose-- it's a whole thing. Bi-Mix is a combination of Papaverine and Phentolamine and Tri-Mix is a combination of all 3 drugs and it works quite well, although again, it has to come from a compounding pharmacy. I'm currently using Super Bi-mix, which is a stronger concentration of the first two drugs.  I've tried Tri-mix, but the Prostoglandin makes my willy ache, so I stuck with the Super Bi-mix.  I'm guessing this is likely the "proprietary formula" that Total Performance Medical sells to its patients.  Total Performance Medical charges you something like $300 up front to be seen, and like I said, the drugs they prescribe are "proprietary", so you can only get them from TPM, and I never went for treatment so I dunno what the drug price is.  The only cons for Edex are the expense (currently $160 for two doses, with my insurance) and initially having to experiment with the dosage so it works well but doesn't produce the infamous 4-hour erection.  I had one of those, and didn't go to the hospital, which may be why I now have Peyronie's disease, although it didn't happen right after that occasion, and Peyronie's is actually fairly common with men my age.  Then, too, Edex produces kind of a dull ache in my penis, but nothing too uncomfortable.  Alas, I so wish for my old Papaverine:  it made my little monster fat and hard as a rock for a consistent 1.5 hours. My new urologist convinced me to try Bi-mix, a combination of papaverine and phentolamine from a compounding pharmacy in Houston. It works better than Edex, doesn't produce the dull ache that Edex does, and it's a LOT cheaper-- $70 for enough for maybe 10 doses vs. $160 for only TWO doses of Edex.  It's a much more natural-feeling erection, too.)

Penis Pumps, Cock Rings, and Other Scary Devices
I understand that they can be quite effective, especially when combined with a cock ring, which I did recently try.  I'd had a couple of less than stellar erections, and at my regular visit to the urologist I mentioned this, since I was afraid that Viagra maybe wasn't going to work for me anymore (and eventually it didn't).  He gave me samples of Levitra and Staxyn, listed above, and suggested a penis ring.  Since the arteries into the penis are in the center of the organ and the veins out are toward the outside, a properly fitting ring can allow blood in while restricting its flow outward, keeping you harder longer (although it should be used for no more than 30 minutes, they say). The Levitra breathed new life into the little fella, though, and our next lovemaking session left us happily exhausted, making the cock ring unnecessary.  Afterward she asked me what the cock ring was for, and when I told her it would make me harder and  last longer she said "No, no, no...." for whatever reason.  So I've been using the ring (hope this doesn't offend you) as a masturbatory aid so I can save the drugs for the real thing, and so far it's worked pretty well but not well enough to be a substitute for the drugs. It does kind of restrict the urethra a little bit, producing a high-velocity ejaculation similar to the  effect of a Viagra overdose (see the "Viagra overdose and other no-nos" post).  The other options I was given 'way back when were last-resort alternatives when nothing else would work:  Penile implants, either a saline bladder inserted inside the cavernosa blood vessels that is then inflated with a little pump, or flexible, bendable plastic pieces the size of the cavernosa that either you slide into them (after an opening for them is made surgically), or which are completely implanted so you have to bend them upward to make an erection or downward to keep the little fella out of the way.  I saw where one ED doctor who specializes in implants for transsexuals recommended the static bendable ones for his younger patients who are likely to be more sexually active, because they don't wear out as fast as the inflatable implants, which supposedly last up to 15 years, but it may be that they last that long because older folks don't use 'em as much..

(UPDATE, 03/13/2014:  I may have to find out which implants are better-- see later posts about Peyronie's Disease. Sigh....)

ED 1000
A painless ultrasonic shock wave treatment that supposedly cures ED permanently in up to 95% of patients, it is available in medical clinics in Canada and the rest of the World, but is still in the investigational stage in the US but it becoming widely available anyway as of 2022.. It's been quite popular in the United Kingdom, because since they have socialized medicine, it saves the government money in the long run if they can more or less cure the patient's ED instead of continually buying drugs for him. I recently saw a small-scale study from Japan that kind of scaled back that 95% success rate to about 65%, but it WAS a really small sample of test subjects.  The last I heard about price was $4000 for the full set of treatments in Canada, and you would have to stay there for a while if you don't live nearby-- You get 2 treatments a week for 3 weeks, then a 3 week break, then 2 treatments a week for 3 more weeks.  Try Medispec.com for info-- they manufacture the device.

UPDATE 05/27/2022:  Although still not formally approved by the FDA, Low-intensity Shockwave Therapy (LISWT) is now widely available from various clinics, but is still generally not covered by most health insurance providers.  My urology clinic now offers it under the brand name U-Wave: when I signed up it was $1500 but is now $2000.  If I was in the first stages of ED it would certainly be worth the money, since it is most succesful with mild to moderately severe ED.  I have severe ED such that I am using Super Bi-mix, but I tried it anyway.  It made my injection-induced erections somewhat fatter, and I seemed to have gotten some of my length back after its previous Peyronie's-induced shortness, so to me even with that limited success it was worth the expense.  Sooner the better, I say!

In the Beginning, There was Papaverine....

I've suffered from ED since my early 20's, and when I try to Google the ED issues that are important to me on the Internet, it seems there is no frank discussion of them (although I'm probably not the most astute search engine user).  If you Google "Cialis vs. Viagra", for instance, you get a bunch of sites that tell what the medications do, their side effects, etc., but there is no real comparison information for them.  Well, I'm here to change ALL that, baby!  In subsequent posts (which will be shorter'n this one, I promise!), I will try to tell you in plain terms what my personal experience with ED and various treatments has been.  As I age, I hate to tell ya, the game continues to change so that the struggle continues, although things are still better today than when I began this battle....  Feel free to comment and share your own experience!

A brief (?) description of my background, which of course you can skip:  I'm 55 years old, am on my third marriage (ED was not a factor in them, far as I can tell), and I began seeking ED remedies back in the early 1980's.  At that time I thought it might be a psychological issue and went to see a couple of psychologists (not psychiatrists) which was futile: They told me to get in touch with my feelings, immerse myself in the moment, etc, etc.  Neither of them ever said maybe I should see a medical DOCTOR to see if maybe I had a medical PROBLEM.  Some of the literature on the subject I read back then mentioned the "postage-stamp" test, where at bedtime you put a string of stamps tightly around your johnson and glue the ends together so you can see if you have erections while you sleep, which implied that if you did have them, there was nothing physically wrong with you (which is 'way INCORRECT).  Well I knew I was having night-time erections and morning wood, so I figured my problem must be all in my head, sorry to say. Later I heard that something like 80% of ED cases are medical, not psychological, and I bet the percentage might be higher now that diagnosis and treatment options have improved.

I was able to muddle through sexual problems in my first marriage in my 20's because at that time my night-time spontaneous erections and morning wood could be made to last long enough to have a fairly satisfying sexual experience for both of us, although there were often long gaps between performances, mostly due to my fear of the big "I" happening, I think.  This went on until my marriage ended in 1992....  I soon met the woman I thought was really the love of my life, and when we were comfortable enough together, I explained the problem to her.  She was very supportive, and after reading Dr. Bernie Lubbers' great book Male Sexuality, I found the courage to consult my family doctor, who referred me to a doctor specializing in Sex Therapy, who sent me first to a Urologist.  He gave me a Papaverine test (hope I spelled it correctly, since I'm too lazy to look it up)-- they inject a drug into your penis(!) that causes a spontaneous erection and then see how long and how much of the drug it takes to work. The appearance is a bit curious, because if you're not aroused, the shaft of the penis enlarges but the head and skin remain soft.  When that happened, it was such a new experience that I kinda stroked it a little to see how it felt, which caused everything to be hard and tight.  When he came to check on me, the doc noticed it and told me not to play with it because it might skew the test.  It was kinda funny-- I'm kind of well-endowed, so the doc placed a small towel over my growing member to cover it, but of course it raised quite a tent in my lap while I waited, and at one point a nurse came in to that room by mistake, looked at me, mumbled something about being in the wrong room, stared at me for another second, then covered her mouth and giggled, then backed out the door!

The doc said the Papaverine test showed I was circulatorily challenged, so to speak, so after I finished dancing a jig and singing "IT'S NOT ALL IN MY HEAD!  IT'S NOT ALL IN MY HEAD!  WOOHOO!, he prescribed a 5cc Papaverin injection whenever I wanted to have sex (Viagra was not yet available).  It works great, once you get over the whole jabbing your penis with a hypodermic needle thing, but the process is rather lacking in spontaneity. We finally worked into kind of a routine, where we'd fool around a bit, which would arouse my manhood to it's maximum soft size, which then made the injection easier to perform....  Seems like it would take about ten minutes for the Little Man to fully stand at attention, but after that it was Katy Bar the Door!  The first time I tried it I was soooo ecstatic, we made love for almost an hour straight, and after a few minutes I could've gone another round, but she said enough was enough. If kept stimulated, the erection would last an hour and a half to two hours, but if put away immediately like when you need to leave for work,  it would only be about ten to fifteen minutes before you could go out in public without drawing unwanted attention.  I don't know if Papaverine is still available, but I think Total Performance Medical may prescribe a similar injectible.  TPM guarantees results, but there's a $300 fee to start their program and you can only get the exact drug formula they prescribe from them, and I dunno how that expensive that would be.  When Viagra came out I switched to that, but looking back, I'm not sure I should have....