Several erectile dysfunction medications have been recently developed, such as sildenafil (Viagra®), vardenafil (Levitra®) and taladafil (Cialis®), which are selective phosphodiesterase type 5 (PDE5) enzyme inhibitors. Upon sexual stimuli, their action results in smooth muscle relaxation and increased blood flow within the corpora cavernosa of the penis, ultimately leading to penile erection.
Though PDE5 inhibitors are only recommended for men who suffer from erectile dysfunction, the recreational use of these drugs among the young has been increasingly widespread. Most of these young men do not present any erectile complaints– they use these medications recreationally for different motives: fun, curiosity, lack of self-confidence, or because they believe they will increase pleasure during sexual act.
In Brazil, a study has shown a wide recreational use of PDE5 inhibitors among young male medical students (n=167): 9% of the individuals reported previous use of PDE5 inhibitors without medical indication. Within this group, 46.7% had used PDE5 inhibitors more than three times, and 71.4% had mixed them with alcohol. In fact, young males frequently consume alcohol concomitantly with erectile dysfunction drugs, because alcohol can increase self-confidence and lead to loss of social inhibition. There is also a common belief that alcohol consumption can increase pleasure and enhance sexual performance – however, depending on the amount consumed, alcohol actually decreases libido. After the combined use of alcohol and erectile dysfunction medications, young men can feel euphoric, strong and disinhibited. Nevertheless, alcohol leads to decreased risk perceptions and impairs decision making. Thus, one of the most serious concerns is that many of these users engage in unprotected sex, which increases the risk of sexually transmitted diseases and unwanted pregnancy, for example.
The inadequate use of these medications (when there is no erectile dysfunction) does not benefit the user and serious side effects may occur, including headache and priapism. Alcohol dependent men commonly suffer from erectile dysfunction, and alcohol use may even worsen a pre-existent erectile dysfunction, since. Although the interactions between PDE5 inhibitors and alcohol are not well established yet, no significant hemodynamic or pharmacokinetic interactions have been reported. However, the hemodynamic changes induced by sildenafil during sexual intercourse may be magnified by the consumption of alcohol.
It is important to alert that, similarly to alcohol, PDE5 inhibitors use has been also associated with increased sexual risk behavior, but there are still some controversies depending on the population analyzed. Moreover, the potential side effects of PDE5 inhibitors have not been explored in young men – long-term effects, such as decreased fertility, have been suggested. There are also counterfeit erectile dysfunction medications - which are produced and commercialized illegally – due to their well-known beneficial effects. Importantly, the counterfeit medications may lead to even more serious adverse health events.
The easy access to these medications and the lack of information regarding the potential serious side effects, associated with one’s common beliefs and sexual expectancies, further increase this widespread recreational use of PDE5 inhibitors combined with alcohol. Hence, it is necessary to publish and transmit this information as well as incentive scientific research in this field.
Alexander Grinshpoon, Anatoly Margolis, Abraham Weizman, Alexander M. Ponizovski. Sildenafil citrate in the treatment of sexual dysfunction and its effect on quality of life in alcohol dependent men: preliminary findings. Alcohol Alcohol 42:340–346, 2007. IF: 2.137
Christopher B. Harte, Cindy M. Meston. Recreational use of erectile dysfunction medications in undergraduate men in the United States: characteristics and associated risk factors. Arch Sex Behav 2010 (in press). IF: 2.294.
Fernando Korkes, André Costa-Matos, Renato Gasperini, Pedro V. Reginato, Marjo D.C. Perez. Recreational use of PDE5 inhibitors by young healthy men: recognizing this issue among medical students. J Sex Med 5:2414–2418, 2008. IF: 5.393