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About Arthur Goldstein, M.D.
Expertise
Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience
I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations
American Medical Association, American Urological Association, American College of Surgeons
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You are here: Experts > Health/Fitness > Urology > Urology > Couple questions.
Expert: Arthur Goldstein, M.D.
Date: 8/28/2008
Subject: Couple questions.
Question
I have used viagra and cialis before just for fun, I am only 22. Is there anything wrong with that? I have woken up the next morning with pretty hard erections after using them the night before. I did get them from the doctor for performance anxiety, but I overcame that, and just started using it for 'fun'.
Also, do damaged sensory nerves in the penis due to stretching, or any other PE type exercise, ever heal?
And finally, what is that pop sound when stretching, the ligament? Is that actual damage, or just similar to popping knuckles.
Thanks doc. Appreciate it.
Answer
Eric, Viagra & Cialis are appropriate to prescribe for young men who suffer from performance anxiety. Once over the anxiety, just having them available, often alleviates the the difficulty with erection. However they should NOT be taken "just for fun" as they are potent drugs with many potential side effects. To follow is a "macro" I have written on this subject.
The class of drugs called PDE5 inhibitors include Viagra, Levitra and Cialis. They should only be used in individuals who have a true medical need for them. Because they have many potential side effects, some being serious, they should ONLY be prescribed by and taken only under the watch of a physician. Side effects may include headaches, flushing, heart- burn, nasal congestion, visual disturbances, dizziness, priapism,, etc. One of the visual side effects (NAION) may cause blindness although the relationship of this to PDE5 inhibitors is still under investigation. Prolonged erection (priapism) is rare but can occur. These drugs are contraindicated in patients with coronary artery disease who take nitrates (ie nitroglycerine) as some deaths have occurred in this group. There is also the potential for a severe drop in blood pressure if PDE5 inhibitors are used in patients who take alpha- blockers (ie Hytrin, Cardura, etc.) or are hypertensive. It is now a recommendation that not more than 25 mgm of Viagra be used within 4 hours of taking an alpha blocker Several other types of medication may alter the blood level of PDE5 inhibitors possibly leading to significant side effects. Other contraindications include certain types of liver and visual disorders (ie retinitis pigmentosa). PDE5 inhibitors have been noted to cause abnormal liver function tests in some otherwise normal men. Because of this, although PDE5 inhibitors are well tolerated by most, they should only be taken with caution and under the supervision of a physician. Therefore, I advise patients not to take these drugs unless medically indicated.
That being said, the likelihood of a significant adverse reaction in a young man taking a low dose of Viagra is small. This includes the possibility of priapism during sleep. There are basically 2 types of priapism, low flow and high flow. The former is much more common and is due to sluggish venous outflow of blood from the engorged corpora cavernosa. It characteristically is painful, High flow priapism is often painless and is due to a communication between the cavernosal artery and the corpora cavernosal body per se. Although high flow priapism may be congenital, it is usually secondary to injury. Viagra and other PDE5 inhibitors rarely have caused priapism. When this has occurred, it is of the low flow type. I am unaware of any reports of painless priapism due to PDE5 inhibitors. Viagra alone will not cause erections. The PDE5 inhibitors all require sexual stimulation for an erection to occur. This may be in the form of touch thought, dreams or sexual fantasies. Normally erections occur 3-5 times during our REM stage of sleep each night. If Viagra is in your system, it is quite likely that these erections during sleep would be enhanced. However, at low dosage, the chance of priapism although possible would be unlikely. Again I would not use the term "safe" because Viagra is not intended for recreational use and adverse reactions can occur.
A 4 hour erection without pain will not cause damage. I am unaware of damage being done by a prolonged erection with no associated pain. The danger of priapism is that if it persists too long, the blood in the erectile bodies can sludge and predispose to scarring (fibrosis) which can damage their elastic properties. The 4 hour limit is an artificial one to be used as a guideline. The point at which damage might occur varies greatly with each person. Certainly if one had either a painful erection or a prolonged erection (somewhere in the 6-24 hour range), it would be appropriate to consult with your urologist. This should give you a good margin of safety. As mentioned previously, the use of a shorter acting PDE5 inhibitor in the lowest possible dose decreases the risk of priapism significantly.
It is unusual for young men to need PDE5 inhibitors although some do occasionally use the drug for performance anxiety. If so, I suggest using the shorter acting drugs (Viagra or Levitra) which are generally eliminated from the system in 4 hours as opposed to 1-2 days with Cialis. I also suggest using the lowest dose possible to get the desired effect. Therefore, try 1/2 a dose (such as 25 mgm of Viagra -you can always take the other half if needed). The onset of action of viagra and Levitra is 30-60 minutes. Because of the expense of the medication and potential side effects, I do not believe in using any of the PDE5 inhibitors unless there is a proper clinical indication for its use.
Regarding sensory damage to the penis, this is quite common after utilizing some of the penile exercises you find on the internet. In my opinion, they do little good (in spite of the claims) and a great deal of potential harm. Damage to the sensory nerves usually heal over time but this may take up to one year. In the interim, further damage to these nerves must be avoided for healing to occur.
I cannot comment specifically on the "pop" sound you notice when stretching without doing a physical examination. However, this is very abnormal & again, you should avoid such stretching!!! In summary, you should not put your penis through any undo stress and just enjoy your natural endowment - otherwise you might end up with a less than satisfying organ. Your body is talking to you. Now it is up to you to listen to it. Good luck.
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