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    Sildenafil (Viagra) is the first effective oral therapy used in the treatment of erectile dysfunction.
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    Patients whose erectile dysfunction is caused by spinal cord injury or spina bifida (a congenital condition affecting the spinal cord, also called myelomeningocele) frequently respond to 25 to 50 mg of Viagra . Men with complete spinal cord injuries tend to require higher doses than those with incomplete lesions.
    Viagra is successful in restoring erectile function in 60% of men with erectile dysfunction who are on hemodialysis and continuous ambulatory peritoneal dialysis, and was well tolerated.
    Viagra has been shown to increase sexual satisfaction in men with inflatable penile prostheses.
    The response rates of Viagra after radiation therapy exceed 70%. Men who note some erectile function, albeit inadequate, after external-beam radiation therapy have up to a 90% response rate with Viagra , whereas those who do not note any erections at all after external-beam radiation therapy have a 52% response rate with Viagra . Most men require the 100 mg dose.
    Satisfaction rates with Viagra for postradical prostatectomy erectile dysfunction range from 15% to 80%. Preoperative erectile function, the nerve -sparing nature of the surgery, and the timing of Viagra administration affect response rates.

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    Lack of erections, both sexually aroused and nocturnal , after radical prostatectomy has been associated with penile fibrosis and loss of penile length over the long term.
    Exciting studies evaluating the benefit of consistent use of Viagra or injection therapy to promote penile blood flow after radical prostatectomy are being evaluated.
    It is the hope that enhancing tissue oxygenation will minimize scarring and may lead to earlier recovery of erectile function or improved response to therapy.
    If you tried Viagra and it didn t work for you, it is important that you re-evaluate how you used the medication.
    Remember the effects of diet and stomach emptying on the absorption of the medication.
    Also, if you only tried a few pills, you may not have given it a sufficient trial.
    Studies have shown that it may take up to eight trials with the medication (including the need to increase the dose if several attempts at a lower dose are not effective and are not producing significant side effects) before you get a good response.
    In a similar manner, if you are anxious, concerned, worried, or stressed when you are trying the medication, Viagra will not be as effective.
    It is important for both you and your partner to be as relaxed as possible and to minimize the pressure and anxiety related to concern about whether it will work so that it has the best chance of working.
    Some people advocate taking the pill and participating only in foreplay on several occasions, just to get both you and your partner to relax, and then giving it a complete trial.

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