Canadian Health: All About Impotence Men
IMPOTENCE (ERECTILE DYSFUNCTION)
I have heard that Viagra may be dangerous and cause heart attacks. Is this true?
Apart from the obvious answer about sex and heart attacks, Viagra and the other drugs in the same group do not normally have a bad effect on the heart – in fact Viagra was first developed as a drug to help heart disease. There is one very important occasion when Viagra may be dangerous for people with angina. If they are taking any form of nitrate, including a nitrate (GTN) spray, they should not take Viagra as this may cause sudden collapse. Commonly used nitrates are Suscard, isosorbide and Imdur. If you think you may be taking a nitrate for angina, please check with your doctor before taking Viagra. Since nitrates prevent angina, it is not really safe to stop taking them in order to be able to have sex stimulated by Viagra. 
I have used Viagra for three years for impotence. At first it worked very well but the effect now seems to be wearing off. Is there anything else I can try?
There is another drug on the market, which is designed to help men achieve an erection. It is called apomorphine (or Uprima), and should be placed under the tongue about 20 minutes before you want to have sex. Apomorphine has about the same success rate as Viagra, but may help some men who do not respond to Viagra. Apomorphine seems to be a safe drug, but you should avoid it if you have severe heart problems or if your blood pressure is low.
Is there any other treatment for impotence apart from Viagra?
Counselling by a therapist trained in this subject can be helpful, particularly in cases where the stresses and conflicts of life are the root cause. Testosterone should help men with a deficiency of this hormone. Vacuum therapy, with a device that looks like a rigid condom, can be very successful but does require a sense of humour in both partners. Injections of papaverine or alprostadil (Caverject) into the penis, and penile implants (which require an operation) are also effective. Choosing the best option for you as a couple requires a considerable amount of thought and discussion, both with your partner and your doctor. In our experience, most partners are sympathetic and understanding about impotence (whatever the cause) if you can talk about it openly. Many diabetes departments hold special clinics for treatment of impotence and they prefer both partners to take part in the discussion.
After sexual intercourse I recently suffered quite a bad hypo. Is this likely to happen again and if so, what can be done to prevent it?
Like any physical activity, sex can lower the blood glucose and lead to hypogly-caemia. When this happens, and it is not at all uncommon, you need to deal with the hypo in the usual way using fruit juice or Lucozade. You may find it useful to keep some quick-acting carbohydrate close at hand.
