For many men, Valentine's Day will be Viagra Day, as the holiday of love meets the wildly popular pill for male impotence.
But the pill alone is not a miracle cure and is not enough to address many of the underlying problems surrounding sexual dysfunction, which afflicts both men and women. A study published Wednesday in the Journal of the American Medical Association found that 43 percent of women and 31 percent of men suffer from some form of sexual problem, from impotence to lack of sex drive.
For couples dealing with those problems, romance and expressions of love may be more important than any pill or reputed aphrodisiac.
Since the initial explosion of interest in April, when Viagra hit the market, it has now been prescribed more than 7 million times, according to Pfizer, the manufacturer. Research continues on refining it, and there is even some suggestion it could help women, said Ronald Lewis, chief of urology at Medical College of Georgia, who has studied Viagra.
"There has been some suggestion -- and I think we should be careful and say a suggestion -- that Viagra might have some aid perhaps with some female sexual problems," Dr. Lewis said.
Viagra (sildenafil citrate) works on the complex chemical reaction that allows a man to achieve an erection. Within the penis, a layer of smooth muscle surrounds a network of spongy cells; during an erection, the smooth muscle relaxes and allows six to 10 times the normal blood flow into the cells, causing them to become engorged and constrict the veins carrying blood away from the penis, trapping the blood inside. An enzyme called phosphodiesterase type 5 breaks down the chemical process that started the erection and allows the erection to recede. Viagra blocks that enzyme.
That same chemical process may be at work in female lubrication, which is why Pfizer is now looking at doing some pilot studies on women, Dr. Lewis said.
"It's probably very much related to the same activity that is present in male erectile function ... there is not a sufficient blood flow and response to some of the natural hormones that are in that area," Dr. Lewis said.
Another exciting branch of research involves chemical processes within the brain's sexual-control areas that may also be a cause of erectile dysfunction, Dr. Lewis said. In what he described as the mid-brain area -- a regulatory center where signals pass from the brain to the body -- there may be an interruption in the signal, Dr. Lewis said.
"That signal either is being interfered with because of some other chemicals that compete (with it) or not enough of the chemicals that turn on the message," Dr. Lewis said. Researchers are looking at a chemical called a dopamine agonist, a key neurochemical linked to male sexual response that research has shown improves the response in rates.
Even though Viagra has been effective in many cases, there are many different kinds of erectile dysfunction. In cases involving diabetes, spinal-cord injury or radical prostate cancer surgery, for example, Viagra has not been as successful, Dr. Lewis said. Also troubling is the link between Viagra and some cardiac problems -- the product carries a warning that it is not to be taken with nitrate medicines.
The American College of Cardiology has suggested that be expanded to those with congestive heart failure and low blood pressure, those who are taking three to four medications for high blood pressure and those with unstable angina, Dr. Lewis said. And the impact of taking Viagra over a stretch of years remains unknown, he added.
"I think physicians have to honestly say from the testing that has been done, there appears to be little risk, but we don't know yet the long-term effect," Dr. Lewis said. "We just have to be very honest. And if the patient has any reservation, I just say we ought to take some other kind of treatment."
Even if it is successful on the physical problem, and 80 percent of impotence has a physical cause, there are other problems to deal with, doctors said.
"Even when there is a physical cause, such as diabetes, it's very hard for a man not to have an emotional reaction as well," said psychologist Diane Solursh, an associate professor at MCG who counsels couples and teaches about human sexuality.
And, Dr. Lewis said, doctors must be "savvy enough" to pick up on what the other issues are.
"Some people come in and their marriage is on the blink and (they think), `If I could just get this sexual thing fixed up,"' Dr. Lewis said. "But the truth is there may be some deeper seated issues. There may be some true emotional issues of abuse, emotional issues of being under a lot of financial problems that's really straining the marriage and the relationship far, far more than just this sexual (problem)."
One side benefit of the hype over Viagra is that it has encouraged a number of men to seek treatment, Dr. Solursh said. The bad news is that it hasn't focused the attention on treating the problem within the context of the relationship and concentrating on the needs of both partners, said Lionel Solursh, a psychiatrist at MCG and the Department of Veterans Affairs Medical Centers and Diane Solursh's husband.
"What someone does with this is important to someone else," he said.
What plagues many couples is losing what they had in the beginning, Diane Solursh said.
"Many couples have lost sight of that whole aspect of what brought them together in the first place," she said. "That's all been submerged by years of work and kids and taxes and things like that."
Taking the time to be together, making time for each other, is an important step toward restoring the romance, the Solurshes said. A day like Valentine's Day can often be the date that rekindles that romance, they said. Oft-touted aphrodisiacs -- raw oysters, rhino horn powder and the like -- have little medicinal value, Lionel Solursh said. But enhancing things emotionally -- taking the time to find a special gift, make a gesture can do more because it means time spent thinking about and caring about the other, the Solurshes said.
"Those little things mean a lot," Diane Solursh said.