Timing it right for love

Dear Dr G,

I have not been a healthy chap for the last few years.

I was diagnosed having high blood pressure and high cholesterol recently.

I guess putting on weight and a lack of exercise has been the main culprit.

I was prescribed some blood pressure and cholesterol pills by the doctors and started to notice my erection dwindling after I started taking it.

My doctor says it is the disease process that caused my sexual dysfunction; personally, I blame the medicine.

Whatever the cause of the erectile dysfunction, I accepted I needed treatment to maintain the sexual relationship with my wife.

After months of hesitancy, I agreed to take the blue pills as the solution to my diminishing sex life.

One curious matter is that I don’t seem to be able to optimise the timing of love making with these pills.

On several occasions when I took the pills, I did not seem to get an erection soon enough. Most frustratingly, I managed to get a hard-on several hours later when the mood for love was long gone.

I went back to the doctors who asked me to change pills. I am not convinced as the problem is not that the drug is ineffective, but just getting the timing right.

On that note, I am putting Dr G on the spot for assistance to optimise the timing for lovemaking with the pills.

First of all, can you tell me what is the exact cause of my erectile dysfunction?

I understand there are several pills on the market. How do these pills work and what are the differences between them?

Appreciate the clarification.


Timing Tim

The accidental discovery of the blue pills in 1998 essentially altered the landscape of the treatment of ED (erectile dysfunction).

The compound PDE5-I (Phosphodiesterase 5 Inhibitor) was initially intended for the treatment of hypertension in the United Kingdom.

After the medication was observed to be ineffective for the control of blood pressure, the “desirable” side effect of erection enhancement was accidentally observed.

This led to the first line oral therapy for the treatment of ED. In addition to treating millions of men with ED, the pills have also led to a better understanding of ED.

ED is defined as inability to achieve or maintain erectile rigidity during sexual intercourse. This medical condition is well recognised to be associated with non-communicable diseases such as hypertension, dyslipidemia and diabetes.

The recent Health and Morbidity Survey Malaysia revealed the prevalence of this sexual dysfunction affects one in three men, likely to be related to the worsening general health of the population.

However, other correlations include smoking, alcoholism, and the side effects of many medications. In addition, anxiety and stress are also major obstacles in providing and sustaining an erection.

Twenty-six years since the introduction of the blue pills, many couples have benefited from the awakening of their sexual relationship, regardless of the etiology of the ED. The development of other PDE5-I has also evolved to provide a range of other medications to suit different needs in the bedrooms.

Five different types PDE5-I are now available in Malaysia, namely sildenafil, tadalafil, vardenafil, udenafil and avanafil - all with different drug characteristics to be effective.

All the medications share the common ability to enhance the blood flow to the penis, with overall efficacy around 80%.

Technically, the characteristics that distinguish the drugs from each other are the pharmacokinetics determining speed of onset, duration of action and the degree of attachment of the receptors.

The speed of onset is determined by the T(max), the time taken for the drug to achieve its maximum concentration. Generally, the fastest onset of the medication is around 30 minutes, but some may take up to two hours to see an effect.

Therefore, this knowledge allows men to work out the optimal time to “ride” the wave.

The other consideration many users will take into account before usage is the duration of action. This is determined by the half-life of the medicine, resulting in the categorisation into short- and long-acting PDE5-I.

The short-acting medicine tends to have half life of around four hours and the long-acting PDE5-I can have a half-life as long as 17 hours, technically allowing spontaneous erections for as long as 36 hours!

Men who can predict the timing (and manage to persuade their spouses to agree, of course) may opt for the short-acting medications that provide the window of opportunity for immediate intercourse, for others, in whom spontaneity is more acceptable in the relationship, the long-acting medication is generally the only option.

The only long-acting PDE5-I available is tadalafil, which has earned its nickname of “le weekend.” The medication is known to still be effective on a Sunday morning, despite being taken on Friday night.

Although the characteristics of the drug provide the added advantage of spontaneity, the impact of the side effects must also be considered.

Tadalafil is well-recognised to induce backpain and headache as two of the undesirable effects of the drug. Therefore, in addition to the spontaneous induction of erection, men consuming the medication may also need to put up with such undesirable effects of the drugs over the weekend.

The discovery of the blue pills has allowed the evolution of the medicine into different forms, with different timing to act, but the same outcome of hardness.

Although some may view this as an unnatural act of lovemaking, otherwise would consider this as God’s gift with fine-tuning of bespoke action of love.

Many men with no real understanding of the characteristics of the pills may face the obstacles of not “riding the wave” and failing to seize the maximum potential of the medicine.

American film producer and Lucasfilm president Kathleen Kennedy once said: “Success is always a matter of some luck and timing”.

When Dr G is put on the spot for men worrying about peaking at the right time after consuming the little blue pills, his response is: “Knowledge of the medicines will ensure that success is always a matter of timing, and not luck!”

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Dr G , Erectile Dysfuntion , PDE5-I , Pills , Timing

Dr George Lee

Dr George Lee

Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. This column is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. You can send him questions at askdrg@thestar.com.my


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