Why isn't viagra working?

So you’ve gone for your first PSA check post surgery. You’ve gone through the list of life-as-it-is-now side effects. And you’ve left the urologist’s office with a script for viagra (or cialis) for your ED.

Here’s what I hope you got told :

  1. This will only ‘work’ (as in create any sort of erection reaction) if your cavernous nerves (those less-than-paper-thin erection makers surrounding the prostate) are ONLINE. Online and firing out chemicals getting the penis to stand to attention. If the nerves are offline (which is likely in almost all case of prostate removal for some time after surgery) then there will be NO RESPONSE to viagra. Zero. Nil.

  2. This will also only ‘work’ if you are hot and bothered. Arousal is 100% necessary because erections begin in between your ears, not your legs. The brain registers sexy contexts and makes a phone call down the spine. If the nerve’s are online (see point one) they answer the phone and pass that message on to the penis.

    BONUS : if you’re extra lucky you will also get told about stress. The perfect environment for viagra is high horn, low stress, empty-ish stomach.

So if viagra isn’t working for you post surgery, it’s not you, it’s likely one of these factors. And if you weren’t told about these factors I am very sorry, because it’s awful to have high hopes dashed. In fact one study found 73% of men after trying viagra for the first time quit trying any erection aids ever again, and mismatched expectations were the main reason for quitting (Salonia, 2008).

This is why it’s important we have open conversation around sex life interventions, a script is not enough.

reference : Salonia, A., Gallina, A., Zanni, G., Briganti, A., Dehò, F., Saccà, A., Montorsi, F. (2008). Acceptance of and Discontinuation Rate from Erectile Dysfunction Oral Treatment in Patients following Bilateral Nerve‐Sparing Radical Prostatectomy. European Urology, 53(3), 564‐570.

Victoria Cullen