What’s important for men with spinal cord injuries to know about using oral medications for erectile dysfunction? - Diane M. Rowles, MS, NP

Oral medications right now consist of Viagra, Cialis and Levitra. And I do not have recommendations of which one or one specific one. I do have knowledge from my patients that some work better for some people, some work better for others. If you read about them, they should all work the same. The keys that I would tell people about, making the oral medications work for them, that frequently health care providers may not include in their instructions, are a lot times the oral medications work best on an empty stomach. Some people say they can have steak and potatoes and three glasses of wine, and their oral medication works fine. Other people know that if they eat that, then their oral medication is not going to work. The other very important thing to know about trying oral medications is it's not like it's said on TV and joked about, you take the pill and you wait, because it's actually an exchange of nitric oxide at the cellular level that medicines work. So for people with spinal cord injury, you want to take the pill, you want to wait 20 to 30 minutes and then stimulate the penis. If stimulating the penis is penetration, masturbation, oral sex, it's the skin to skin contact and stimulation of the penis that's going to maximize the benefit of the medication. And in fact, the medicine shouldn't work unless you stimulate the penis. But again, a lot of times health care providers who prescribe these medicines forget to tell the patient that. So trial it on an empty stomach, trial it with stimulation of the penis and remember that is going to work about 80-percent of the time. Now one of the common questions people say, "Well, how long do you have an erection for?" Generally, probably 30-40 minutes, again remembering that the stimulation it's what's going to help. People also talk about the fact that the commercials say for Cialis is good for up to 36 hours. Generally the best response is within that 20-30 minute stimulate, they get the best response. Many patients with spinal cord injury may get a later response, but generally they say it's not as good as the immediate one. And that's for people with spinal cord injury.