- Category: Elderly
20 Apr 2014
- Written by Rogelio V. Tangco, MD / Right to Health
EVERYBODY knows about the little blue pill but is it safe for someone over 60 to take? Tales about heart attacks after taking sildenafil have been hyped by the media.
Erectile dysfunction (ED) is the inability of a man to get or keep a penile erection firm enough for sexual intercourse. ED is a usual problem among aging males, perhaps affecting more than 30 percent of men above 60. Causes include depression, low testosterone, nerve problems and some medications. Atherosclerosis is the leading cause of ED. It is part of the aging of blood vessels, the process that reduces blood flow to the heart can do the same to the penis.
The little blue pill, sildenafil, was developed accidentally by scientists who were testing it to lower blood pressure. The subjects reported a “desirable” side effect: penile erections that were harder, firmer and lasted longer. Sildenafil is a phophodiesterase inhibitor and works by improving blood flow to the penis during sexual stimulation. It triggers the release of chemical messengers, nitric oxide and cyclic GMP, which improves penile blood flow and causes an erection. Sildenafil is taken an hour before sexual activity and requires sexual stimulation to work.
It is best to ask first of all, is sex safe for 60 somethings? A treadmill stress test will be helpful to determine if insufficient blood flow to the heart will manifest during exercise. During the test, intensity of exercise is gradually increased and intensity is measured in METs where 1 MET (metabolic equivalent) is the amount of energy expended at rest. Exercising up to 6 METs is a safe margin to allow sex with a spouse or rightful partner. Extramarital affairs may entail a higher level of stress. Cardiac-rehabilitation experts state that the metabolic cost of maximal activity during sexual intercourse is approximately 6 kcal/min (5 METs) for less than 30 seconds and about 4.5 kcal/min during the preorgasmic and post-orgasmic periods. If one can do rapid walking for 10 minutes and then climb two flights of stairs for 10 seconds, this is a rough clinical index for readiness to resume sexual activity after a reasonable recuperation period following an acute heart attack.
Sixty somethings are best advised to consult a cardiologist who not only will gauge their stress-test performance but their over-all health and social circumstance. He will review medications, looking for those that may interact with sildenafil. Nitrates like nitroglycerin, isosorbide dinitrate or mononitrate may potentiate the blood-pressure lowering effect of sildenafil. A warning is also apt for those taking alpha-adrenergic antagonists like terazosin for blood pressure or prostate enlargement. Also those with congestive-heart failure with borderline low-blood pressure, some patients with hypertrophic cardiomyopathy, and possibly, patients on complicated drug regimens for hypertension may not tolerate the drug. Sildenafil can have an effect on color vision. One may get a bluish tinge of vision for several hours. Hence, pilots may not take sildenafil within six hours of a flight.
Geriatric specialists also recommend a go-slow approach, and advise patients to engage in moderate sexual activity at the effort level one ordinarily tolerates. Sixty somethings are no longer teenagers with raging hormones and boundless energy.