The Dangers of Recreational Viagra

Advertisements for erectile dysfunction (ED) medication are everywhere. Viagra® and Cialis® are enormously popular. And as the ads suggest, they’re highly effective at improving sexual performance in people with ED.

But the use of these medications is also booming in people who don’t have sexual problems. But know this: This “recreational” use of Viagra can be risky.

Urologist Raevti Bole, MD, discusses this problem and the risks involved.

Why do people without ED take Viagra?

To understand why people experiment with Viagra and Cialis recreationally, it’s helpful to understand how these drugs work.

Viagra and Cialis belong to a category of drugs called phosphodiesterase type 5 (PDE5) inhibitors. These medications open blood vessels and can be used to treat pulmonary hypertension and urinary problems.

But most famously, medications like Viagra and Cialis are used to address erectile dysfunction. The reason? Increased blood flow from PDE5 inhibitors results in firmer, longer-lasting erections.

Now, it’s important to note that erection firmness can be subjective. Most people will notice temporary differences in the quality of their erection depending on stress, energy levels, time of day, alcohol consumption and many other factors.

But if someone can reliably get and keep an erection that’s rigid enough for penetrative intercourse, they probably don’t have ED or a real need to pop a Viagra or Cialis, explains Dr. Bole.

That said, people without ED have recreationally used Viagra or Cialis to increase blood flow to their penis because they want to:

• Counteract the effects of alcohol or other drugs on their sexual performance.
• Improve the chances of an erection lasting long enough for sex multiple times.
• Increase their confidence by reducing anxiety about performance or premature ejaculation.

Does Viagra improve athletic performance?

People also use Viagra and Cialis recreationally to improve their exercise performance. But does it really work? To keep the answer simple: No.

“PDE5 medications can increase oxygen levels and heart function in people who have cardiac risk factors or cardiac disease,” says Dr. Bole. “For people who are healthy, there’s no good evidence that the medications significantly improve athletic abilities in a standard, sea-level environment.”

Why mention the altitude? Well, there’s some evidence that Viagra may make a difference for those doing activities in thin air at higher altitudes.

Researchers found that cyclists taking sildenafil, the medicine marketed as Viagra, improved cardiac output and exercise performance at higher altitudes. Another study focused on Mount Everest trekkers showed that sildenafil increased exercise capacity at high altitudes.

As noted, though, any benefits experienced closer to the clouds do not transfer to lower altitudes where most of us spend our time.

Five risks of recreational Viagra use

The potential consequences of taking Viagra and Cialis recreationally depend on medical, psychological and social factors. The risks range from mild to serious and include:

1. Dangerous interactions with other drugs

PDE5 inhibitors lower blood pressure. Mixing them with other drugs that also lower blood pressure can be potentially life-threatening, says Dr. Bole.

Be sure to review with your healthcare provider all supplements and medications you’re taking to check for potential interactions. Here are some examples of medications known to interact with Viagra or Cialis:

• Amyl nitrate, which can also be misused as a street drug known as “poppers.”
• Nitroglycerine, a medication used to treat angina (chest pain) in people with coronary artery disease.
• Certain types of blood pressure medications, prescription drugs that lower high blood pressure. (Isosorbide mononitrate is one example.)

2. Uncomfortable side effects

The side effects of Viagra and Cialis are usually mild. Headache is a common side effect that can vary from mild to pounding. You may also experience:

• Acid reflux.
• Facial flushing.
• Muscle aches.
• Stuffy nose.
• Vision changes.

One of the most severe adverse events is called priapism, a painful erection that lasts for several hours. “Luckily2, it is quite rare when using oral ED medications,” notes Dr. Bole. “But if this happens to you, seek emergency medical care immediately.”

3. Psychological dependency

Frequent use of Viagra or Cialis just to boost confidence can create psychological dependency — especially if you’ve never discussed the issue with anyone. You may eventually feel that you need it to have sex, creating a long-term issue for you and your partner.

“If you are having severe performance anxiety that’s affecting your erections, I recommend talking to your healthcare provider or a sex therapist,” says Dr. Bole.

“A medical professional can discuss your worries about sex; help you set personalized and realistic expectations; and develop strategies to improve your confidence without relying on medication alone.”

You may still choose to try a medication, but understanding the psychology behind sexual performance is a healthier strategy.

4. Unknown dosage and contaminants

ED drugs and supplements are easy to find without a prescription. People get them from friends, family members and online. You can even find them sold as vitamin or herbal supplements at gas stations.

But without a prescription from a reputable provider, you don’t know the dosage of active ingredients in the pills you’re taking or even what may truly be in the medication.

For example, the U.S. Food and Drug Administration (FDA) has issued advisories for “Rhino” male enhancement products. These products are available at gas stations, corner stores and online. Marketed as “dietary supplements,” tests show they may contain hidden PDE5 inhibitors.

Taking these sorts of fraudulent products can be dangerous for unsuspecting consumers, warns the FDA.

5. Association with high-risk behaviors

Combining Viagra or Cialis with alcohol or drugs can lower inhibitions. As a result, you may be more likely to engage in risky sexual behavior that could expose you to sexually transmitted infections (STIs).

“Using ED medications to enhance your sexual performance when you’re under the influence of alcohol or drugs can lead you to make choices that harm your sexual and overall health,” stresses Dr. Bole.

When to talk to your provider about Viagra use

If you’re taking Viagra or Cialis recreationally to improve your sexual or exercise performance, Dr. Bole recommends letting your provider know.

Long-term use could mask a real decline in erectile function due to underlying health problems such as:

• Diabetes.
• Heart problems.
• High blood pressure.
• Low testosterone.

“Some patients may feel reluctant or embarrassed to talk about their sex life,” recognizes Dr. Bole. “But we have these conversations all the time with patients. You are not alone. Our role is to help you understand the risks versus benefits and provide guidance without judgment.”