Viagra: Double The Sex, Half The Effort

The "little blue pill". The "wonder drug". As it celebrates its 20th anniversary next year, take a look at how this humble drug solved erection related problems for men worldwide.

Next year, Viagra — the erectile dysfunction drug known for its ads of elderly men and their wives lounging on the beach and/or in white bathtubs — will turn 20 years old. It's a landmark birthday for any drug, but it's particularly significant given the drug's tremendous success: to date, 62 million men around the world (and counting!) have bought Viagra at some point, according to Quartz, which has earned Pfizer (Viagra's parent company) a cushy US$1.4 billion (S$1.88 billion) annually in North America alone.

But Viagra's path to success wasn't as straightforward as one might assume. In fact, researchers weren't even looking to solve erectile dysfunction when they first started running experiments using Sildenafil, a compound synthesized by British researchers in the 1980s. Pfizer was simply trying to figure out a way to help dilate blood vessels in the heart for another middle-aged male health dilemma: pulmonary arterial hypertension, or high blood pressure.

Sildenafil, which is also known as a type of PDE-5 inhibitor, seemed promising in this respect: As Quartz points out, Sildenafil worked quite well in animal tests without any negative side effects, encouraging Pfizer to start testing on humans. At the time, however, researchers didn't know that Sildenafil didn't work in humans the way it seemed to in animals. Sure, it dilated blood vessels, but not those that were nestled next to the heart. Rather, Sildenafil seemed to affect the blood vessels that fed into the penis, a.k.a. the corpus cavernosum, according to reports from nurses who found patients lying on their stomachs after taking Sildenafil, because they were embarrassed that they were having erections.

Related: Erection Problems: How Blood Type Can Affect Your Penis

The researchers later discovered that PDE-5 inhibitors illuminated a process that was not previously fully understood. When taken before sexual intercourse, the drug penetrated smooth muscle cells leading into the corpus cavernosum and blocked the enzyme CGMP, which usually blocks relaxation. PDE-5 inhibitors relaxed these smooth muscle cells, allowed the floodgates of blood to flow into the penis and helping men deal with impotency with one fell swoop.

In retrospect, this isn't all that surprising. After all, an erection is caused by the dilation of blood vessels in the penis, allowing a dude's penis to get engorged with blood and ready for sexual intercourse. It might seem like sex ed 101, but as lead researcher Ian Osterloh said, scientists were only just beginning to understand the biochemistry of penises. In other words, we couldn't have predicted Sildenafil's accidental erection-causing powers, because we didn't really understand how erections worked in the first place.

The drug, which was later rechristened Viagra, was crucial to our understanding of how penises get hard enough for sexual intercourse. If Viagra hadn’t had the unexpected side effect of embarrassing men who were trying to treat their high blood pressure, boners might still remain a mystery to the modern man.

Related: Morning Erection! Here's Why You Wake Up Feeling Horny

While there are other erectile dysfunction drugs on the market, such as Cialis, none have been able to successfully incorporate Pfizer’s secret formula Sildenafil for their own use. In 2020, however, Pfizer will lose its copyright on Viagra, ending a remarkable run for science, penises, and pharmaceutical research in general. But without Viagra to lead the way, we never would have fully understood how the penis works, or how to treat impotence among younger men.

By Tanya Basu

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