“It transformed the field significantly”

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Viagra is a term for a drug [used] to treat erectile dysfunction that we all know. Some would say that unless you’ve been on another planet for the past 20 years, there’s no way you don’t know what Viagra is. It is also known as Coca-Cola. It is a well-known treatment for erectile dysfunction. He rose to prominence in commercials and commercials. And given the prevalent condition of erectile dysfunction as a form of sexual dysfunction in men, it has certainly come to the fore. The drug itself has gone through several iterations of names. It originated under the name of this drug called UK-92,480 and was studied as a drug to treat angina pectoris. In the first studies that were done with this drug, about 30 years ago now, [there was] an interesting observation among clinical trial investigators. Too, [at] It was around this time that the science of erection began to emerge – the science of erection related to nitric oxide and the signaling pathway we all hear out there. This is a scientific way that we now understand to be a real penis erection mechanism. Fortunately, I had a major role in the science of it all. So when this science began to emerge, observations from the heart disease trial [were] amazingly, patients would say, “It doesn’t help my heart, but my erections are improved.” Once it was set up it followed [the] recently described scientific way for erection, that’s when the drug appeared. It became known as Sildenafil, which is a generic term, and then the Pfizer company, which was behind it all, introduced it as Viagra.

What are some of the other innovative erectile dysfunction treatments that have become popular in recent years?

In recent years, we have continued to offer treatments taking into account a less invasive nature [and] greater ease of administration. So obviously oral therapies remain very popular and now there are versions of agents like Viagra called PDE-5 inhibitors. Now there are 4 that are available in the market. The management course with oral therapy [is] effective now, which is really light years away from what it was decades ago with various herbs and supplements that may also have been taken orally but weren’t very effective. So [it’s important to] know that this was a major theme that continued. There has been some interest in moving forward with other new options that could meet a new goal of not just treating erectile dysfunction, but possibly curing erectile dysfunction. We use this word “cure”, which to some extent means that we are trying to correct the underlying pathological conditions of the penis. Erections require the best health of the penile tissue, which is why these ideas have emerged in recent years to do restorative therapies or regenerative therapies. This is the message I say. I think these therapeutic perspectives are still in development, so I don’t know if we can claim that these are well-established therapies, which are so new [mechanisms] as shock wave therapy or platelet-rich plasma. I have to be quite frank in saying that I think these are still experimental therapies. They may have potential, they may correspond to penile healing ideas, which I think is the direction we want to go, but they remain to be fully investigated and have not yet been established in the lines guidelines to be authentic therapies for the time being.

What innovations do you foresee on the horizon for the treatment of erectile dysfunction in the near future?

Next year we won’t have much more than what I just mentioned. I think existing therapies will continue to be improved, at least in the short term. We have a range of options which, as I mentioned, range from oral therapies to more intermediate or semi-intrusive or invasive options, such as vacuum erection devices. [or] penile injections. We also have a bit more intrusive surgeries that could be really irreversible, like penile prostheses and that sort of thing. I think there will continue to be innovations along the way, especially when it comes to prosthetics. I see that in the near future, with exciting new developments of possible automated devices, easier-to-use devices, things like that. So be on the lookout for that. [It] can be quite imminent; give it a few years. We can continue to refine our pharmacological therapies. I think some of these regenerative therapies will be longer term. To see them really studied and proven effective, it may take several more years.

As other treatments are developed and refined, what is Viagra’s legacy in the treatment/management of erectile dysfunction?

I think there is a legacy associated with Viagra. I think it ushered in an era of treatments that we had never seen and had before. Who would be [have] never thought we would have effective oral therapy, [one] that somehow you take it into your body orally, but somehow it reaches the penis and has an effect there? It’s almost mind blowing to even consider how that would even happen. In fact, it’s based on the science of nitric oxide. Again, nitric oxide is the main story here. It has such a mechanism that it cleverly represents a pathway in the penile tissue which, with oral therapy, can exploit this. And so, it was the inaugural oral therapy that changed the way we approach the practice of managing sexual dysfunction in men. It was a real revolution, an intervention, if you will, for the field of sexual medicine. His legacy will be that it transformed the field in significant ways.

How did Viagra revolutionize the way erectile dysfunction is treated and managed?

Viagra revolutionized the field of sexual medicine and impacted the way we approach therapies. I think it opened our eyes to the possibilities. The [are] so many different dimensions of its impact. I think it helped us break the taboo around sexual dysfunction. This allowed us to recognize that he can be treated appropriately without saying that he has to be overly medicalized. Previously, erectile dysfunction was a psychological problem or an emotional problem, or a matter of interpersonal relationships, and therefore always in the domain of the psychiatrist or psychologist. We have evolved over the past 2 or more decades to understand that this is a physical issue, as a whole, and related to the health status of patients, and that there is a real medical condition which surrounds it. So that really helped us understand that it can be treated, that erectile dysfunction can be treated with physiological treatments that can be effective. It allowed us to open our eyes so that it was no longer a taboo subject and that we could talk about it. It helped us think about female sexual dysfunction. It has helped us recognize that the whole field of sexual medicine and sexual health is an appropriate topic, and that treatments that can address all aspects of sexual dysfunctions in men and women are fair game. We want to make sure people have better qualities of life and therapies that can fix all of that. [It] is a fully open season to find out how we can move forward to help all of our patients. [Viagra has] had a very dramatic impact.

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