Viagra: What, Who, Why, and How

Sildenafil Citrate, more commonly known by the brand name Viagra, has become one of the most commonly prescribed drugs in America. Viagra is used to treat erectile dysfunction, also known as impotence. Erectile Dysfunction is best defined as the inability to maintain an erection necessary for sexual satisfaction. Sildenafil has been shown to be effective for a “broad range of ED patients, including those with a history of Mellitus, depression, hypertension, diabetes, and spinal cord injury” (Sildenafil Citrate, par. 29).

Pharmacokinetics

Viagra is taken orally. It is quickly absorbed into the system and usually reaches its peak concentration in about 30 to 120 minutes. However, as with most orally administered drugs, taking the pill on a full stomach will slow down its absorption (Sildenafil Citrate, par. 5). Viagra is metabolized in the liver by the cytochrome p450 system. It is converted into a metabolite that has properties similar to that of the pre-metabolized drug. Viagra and its metabolite have a “terminal half-life of about 4 hours” (Sildenafil Citrate, par. 4). Finally, Viagra is excreted primarily through feces in the form of metabolites (Sildenafil Citrate, par. 7).

Mechanism of Action

Sildenafil is a pharmaceutical breakthrough not only because it is the most effective treatment for erectile dysfunction available, but also because it is “the first in a new class of medications” (FDA, par. 3). But to understand how this drug works, it is necessary to explain the physiology of erection in the normally functioning male. Under normal circumstances, sexual excitement results in the release of nitric oxide. Next, the nitric oxide will activate guanylate cyclase, also known as PDE6, “which is involved in phototransduction in the retina” (Sildenafil Citrate, par. 17). Also, Sildenafil causes a decrease in blood pressure, though the cause of this is unknown (Sildenafil Citrate, par.13); further common side effects include “headache, flushing, and upset stomach” (FDA, par. 6). Finally, it is recommended that those who take nitrates (such as nitroglycerin, often used for the treatment of angina) not take Sildenafil as it was shown to “potentiate [increase] the hypotensive effects of nitrates” (FDA, par. 5).

“When we talk about marriage, which is the only state that makes sexual relations halal [religiously acceptable], we ask: What are the original aims of sexual relations?

The most common answer is for pleasure and to have kids. This what all humans have deep in their minds, whatever cultural background they come from. About the two drugs, how do they relate to these two aims of sexual relations? The answer is that erectile dysfunction drugs are associated with both positive sides of sexual relation, i.e. both giving pleasure and ensuring having kids. EC and all contraceptives are associated with a negative outcome of sexual relations, i.e. not having kids.”

Alternative sources

EDDs have a historical association with the black market/gift economy. When Viagra was first introduced and before lots of generic varieties were available, it was hard to get and expensive (it still is the most expensive brand on the market). People smuggled it into the country. It was given as gifts from one man to another. It is even used to grease the wheels of bureaucracy, being offered as a small bribe. Relationships with physicians are cultivated in order to access drugs that are hard to get. Even though Sildenafil is now widely available in a range of prices, other drugs said to produce the same effect (Cialis and Tramadol are two such examples) still circulate semi-illicitly, in the category of a commodity that is thought to require both connections and expertise to obtain, and this is part of their appeal: they’re more than just commodities, they have a special aura.

Viagra. the pill that can give you back your freedom

So in asking why don’t ECPs have the same aura and circulation among women, it’s partly because they’ve never been part of the black market. Packs of contraceptive pills, the kind you could cut up to equal a dose of emergency contraception, are government-subsidized, widely available, and really cheap. A banner advertising Viagra soup at a restaurant stall in Cairo. The starred text in the bottom left says, 

What is known

Finally, there are key continuities between modern pharmaceutical products for erectile dysfunction drugs and more “traditional” treatments, so the appeal of drugs like Viagra and Cialis is partly that they tie in with pre-existing ideas about how you can ingest a certain substance to increase your virility. I’ve already written about Viagra sandwiches, and there’s also Viagra soup, dates, and who knows what else? This takes the notoriety of a global pharmaceutical product and maps it out over pre-existing notions about the virility-enhancing power of seafood. Using drug brand names to label food is not just a phenomenon in popular (shabi, as they say in Egypt) restaurants, either; a famous restaurant in an expensive mall in Alexandria offers the same soup (but wouldn’t let us photograph their menu!). It’s not just seafood that has this reputation. Other foods that can be found at a local apothecary, or attar, which includes gargeer seeds or oil (that’s arugula to North Americans, rocket to Australians), about which there is a popular saying,

“If women knew what gargeer could do for their men, they would grow it under the bed” (rhyming gargeer, arugula, with sareer, bed).

 

Citations

“First Oral Therapy for Erectile Dysfunction” FDA Medical Bulletin, Volume 28,number 1. Food and Drug Administration, 1998.

“Sildenafil Citrate”. Health Central Rx. Accessed May 5, 2000.