Where's the sex drive drug for women?

Low sexual desire in women isn't necessarily a problem of menopause or later.

For about a month, Barbara Gattuso felt at least 40 years younger.

Gattuso, 65, had enrolled in a clinical trial for a drug aimed at women who have low sexual desire. There is no treatment available in the United States for boosting the female sex drive, but women like Gattuso hoped that would change with this experimental medication, called flibanserin.

"It was amazing, absolutely amazing, and it just makes you feel whole," Gattuso said, recalling her feeling of taking this drug. "It makes you feel like a complete woman again."

Outside such experimental settings, there are no medications available in the United States for female hypoactive sexual desire disorder. That's the technical term for when women have a distressing lack or absence of sexual desire or fantasy. Up to one-third of adult women may experience it, according to a 2002 study.

Flibanserin seemed like a potential answer for many. But the U.S. Food and Drug Administration has rejected applications to green-light the drug.

Sprout Pharmaceuticals, which is pursuing approval of the drug, has appealed the FDA's most recent decision, and was scheduled to have a meeting with FDA officials on Friday, said the company's president and chief operating officer, Cindy Whitehead.

Given that the drug has been through numerous, rigorous clinical trials, and so much has been invested in it, the FDA's refusal to approve it is a turning point in the field of sexual medicine, says Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego, California, who collaborated on clinical trials for flibanserin.

If there is no positive action on the drug, it could spell doom for pharmacological efforts to manage female sexual desire, he said. "It will go back to dark ages of saying, 'This is all a relationship problem,' even though we know it's not," he said.

The FDA declined to answer specific questions regarding the matter.

FDA spokeswoman Andrea Fischer said in a statement: "The FDA is only able to provide information on approved drug product applications. Any information on an application that has yet to receive an approval or was denied approval belongs to the manufacturer/sponsor developing the drug."

Sprouting a drug

Flibanserin was initially developed by pharmaceutical giant Boehringer Ingelheim, but the company ditched it in 2010 after the FDA declined to approve their new drug application, asking for more research, Goldstein said.

A smaller operation, Sprout Pharmaceuticals, took over work on the drug in 2011, and resubmitted an application with 14 new clinical studies, encompassing data on more than 3,000 new patients, according to the company.

In total, more than 11,000 people have participated in clinical trials for flibanserin, Whitehead said. Still, the most recent attempt to get flibanserin off the ground failed; the FDA did not approve the company's revised drug application in October.

The FDA characterized the drug as having a "modest" effect in its response letter, Whitehead said. But clinical trial results show statistically significant improvement in the women who took the drug, compared to those who took a placebo, she said.

"In terms of what we see, I would say 'modest' is meaningful," Whitehead said.

Sex is doctor's life's work

A 2013 study in the Journal of Sexual Medicine showed that women taking the drug reported an average increase of 2.5 satisfying sexual events in four weeks, compared to an increase of 1.5 among women using a placebo.

Flibanserin is not a hormonal treatment and does not appear to affect fertility or interact with birth control medications, Whitehead said.

The drug works by increasing brain blood flow in particular ways, Goldstein said. It increases levels of the neurotransmitters dopamine and noradrenaline, and lowers levels of serotonin.

Side effects of flibanserin include dizziness, nausea, fatigue and sleepiness. Unlike some treatments for men, flibanserin needs to be taken once a day, every day.

Other options

There are other experimental treatments for low female sex drive in the works.

Drugs called Lybrido and Lybridos, developed by a company called Emotional Brain, have undergone several randomized studies with results that are "very promising and will be published soon," according to the company's website. A drug called Bremelanotide is being investigated by Palatin Technologies for both men and women. None of these drugs has completed phase 3 trials, which are necessary before approval.

Whitehead counts 24 FDA-approved treatments available in the United States for male sexual dysfunction, including popular drugs such as Viagra (sildenafil citrate). For women, it's zero.

"A lot of times, the medical community has really put men's needs first and hasn't really addressed women's sexual needs," said Jennifer Foust, a sex therapist in Aventura, Florida, who is not affiliated with flibanserin.

Because doctors have no solutions, women have tried less-proven treatments for their low sexual desire, such as diets and herbs. None of Foust's clients has had success with them. She said some women who aren't functioning well sexually would be "open to anything."

"I've had women complain, 'Why isn't there a female Viagra?' " Foust said.

Sex drive: It's complicated

Sex drive is more complicated for women than for men, Foust said. There are a lot of factors that could explain a woman's low desire -- and not all of them are medical, she said. Lifestyle and relationship issues may come into play.

Having a first child can be a problematic factor for some women; the adjustment and figuring out how to restructure their sex life can throw off desire. Foust has spoken to some new mothers who feel they are constantly being asked for something from their body, as if they are "touched out," but find their lack of desire troubling.

Some couples maintain satisfying sex lives over many years -- but some, over time, go on autopilot and have less and less sex.

"You have to continue to feed your sexual relationship, and feed your relationship in general," Foust said. "A lot of it depends on how much importance and energy you put toward your sex life."

Sometimes stress is the issue, too, she said.

Foust offers cognitive-behavioral, focused exercises to help women who are distressed about their low sexual desire.

Low sexual desire in women isn't necessarily a problem in menopause or later. Foust works with many women complaining of low sex drive who are in their 30s and 40s. The average age of participants in the flibanserin trials was 36, Whitehead said.

Gattuso's daughter is in her late 30s, and she and her friends are having similar problems, Gattuso said.

Her physician friends want a solution for low female sexual desire, too, she said; they want to be able to offer female patients something besides "I'm sorry."

Follow Elizabeth Landau on Twitter at @lizlandau

Do Viagra like medicines have side effects? (Sex query)

Q: I am a 27-year-old and sometimes take  to please my girlfriend. Is it harmful for my health? What about my future sex life? Will I always have to take them? 

All the different tablets mentioned here have the same chemical composition – Manforce and Pengra are actually the desi versions ofViagra, which in turn is the brand name of the generic drug sildenafil. In countries like the US or UK, the drug is only available through prescription but lax laws in India means that it can be easily purchased over-the-counter. One thing you’ve to clearly understand is that Viagra is a drug to beat erectile dysfunction and it’s not an aphrodisiac or libido booster. In simple words, it will only give you an erect penis when you’re aroused. Now the drug is most commonly used by people in their 50s and 60s, those at an age where there heart finds it hard to pump enough blood to the penis to maintain an erection.

However, recent studies have shown that the recreational use of Viagra has gone up among youngsters. Most doctors recommend that the drug shouldn’t be used like this because one’s body can get dependent on it and you could reach a phase where you will find it hard to get hard without the drug. There are other harmful effects as well. You shouldn’t take the drug if you are taking other medicines which contain nitrates. These are usually used to treat chest pain,hypertension and other such ailments. Some of the other common side-effects are facial flushing, headaches, liver problems, heart attacks (rarely), blurred vision, bluish vision and sensitivity to light.

The most infamous side-effect though is erections which last for four or more hours. Sometimes these erections can be extremely painful as well. If you experience that you should call a physician and visit a hospital immediately. In conclusion you should definitely stop using these drugs; they are not for recreational use or to show off your sexual prowess but an aid for men really suffering from a problem. Read more about kegel exercises that can help you beat erectile dysfunction.

Click on the picture below to view photos on – 8 things you didn’t know about Viagra.

Image source: Getty Images

The Dangers of Using and Abusing Viagra

Once upon a time, a big American pharmaceutical company named Pfizer accidentally discovered a new treatment for erectile dysfunction -- Viagra, the little blue pill. Originally developed as a treatment for heart disease, its penile erection enhancing effects were noted in clinical trials and Pfizer quickly saw the drug's potential marketability as the first pill for men with trouble getting it up or keeping it up. Patented in 1996 and approved by the U.S. Food and Drug Administration for prescription-only sale in 1998, Viagra became a smashing financial success, exceeding annual sales of $1 billion every year since its introduction.

The shrewd folks at Pfizer surely knew they had a pistol of a drug on their hands -- after all, men are obsessed with their own erections. And in the beginning, Pfizer pretended to be all serious about erectile dysfunction, even managing to convince the unsuccessful Republican presidential nominee of 1996, Robert Dole, to endorse Viagra in those now-famous television commercials. You have to congratulate Pfizer for recognizing the inherent snicker factor of its product, so casting humorless elder statesman Dole, a man with the charisma of a lemon, as a spokesperson makes perfect sense. Pfizer cunningly gave us permission to mock the failed presidential hopeful about his sex life while we simultaneously and silently thanked Jesus for the discovery of the little blue pill.
Now that everyone on the planet, excluding Chinese peasants with no access to TV, knows about Viagra, Pfizer has brazenly shifted its marketing strategy. And their advertising isn't even remotely directed at men with erectile dysfunction anymore -- it's full of vibrant sports heroes (NASCAR drivers declaring, "Gentlemen, start your engines!"), attractive professional types strutting through offices (colleagues ponder what's different about Joe and Bob these days) and most recently, ads featuring guys with the blue V from Viagra's brand logo rising behind their heads like a pair of Devil horns. The slogan? "Get back to mischief?" Pfizer is now selling sexual performance, which clearly goes beyond the FDA-approved indication of the drug. The not-so-very subtle new message is obvious: every guy can have a mischievous, raging, new and improved penis.

Since 1998, 23 million men worldwide have filled Viagra prescriptions, making it one of the most successful drugs of all time. Not surprisingly, other pharmaceutical companies scrambled to create their own versions of the drug. This past year, GlaxoSmithKline unveiled Levitra, which is similar in profile to Viagra, but Eli Lilly introduced Cialis, a product the manufacturer claims will start working twice as fast as Viagra and continues for up to 24-36 hours, compared to Viagra and Levitra's promised 4-6 hour window. With Cialis, the implication is that you can swallow one Friday night and you're good to go for the whole weekend. You just know Pfizer and GlaxoSmithKline researchers are busier than Santa's elves right now, toiling away night and day to create bigger, better boner drugs. Viagra is facing some ... stiff competition.

For men, the inability to get or sustain an erection usually leads to all kinds of performance anxiety and self-esteem issues. There are multiple causes for erectile dysfunction -- from physical conditions such as heart disease, prostate cancer and diabetes to psychological factors like stress, anxiety anddepression. Even drugs widely prescribed to treat anxiety and depression -- Paxil, Prozac, Zoloft, Luvox, Celexa -- have sexual side effects that can make it difficult to achieve an erection or have an orgasm. Until Viagra and its pharmacological brethren came along, the typical treatments for impotence were penile implants, penile injections, vacuum pumping and insertion of a suppository into your urethra. No wonder we're now willing to pay roughly $10 out-of-pocket per pill when insurance companies refuse to cover these drugs. Apparently, we're also willing to endure the side effects -- headache, stomach upset, flushing (a warmth and redness of the face, neck and upper chest), nasal congestion and changes in vision. And death. There are hundreds of Viagra-related deaths on record and they aren't just a bunch of elderly guys with heart conditions.

Drug task force agents report that they routinely discover Viagra in the possession of college guys who don't have erection problems -- or a prescription.

In 2000, researchers at Cedars-Sinai Medical Center in Los Angeles did an analysis of 1,473 major adverse medical events involving the use of Viagra. There were 522 deaths, most involving cardiovascular causes developing within 4-5 hours of taking a 50 mg dose of Viagra. The majority of deaths occurred in patients who were less than 65 years of age and had no reported cardiac risk factors. Other deaths were associated with the use of nitrates (drugs prescribed for chest pain, angina and heart problems) and amyl nitrate, the common ingredient found in "poppers," a liquid whose vapors typically cause an intense head rush and drop in blood pressure when inhaled. Cedars-Sinai researchers concluded that there "appears to be a high number of deaths and serious cardiovascular events associated with the use of Viagra."

As the deaths go unpublicized and the side effects are downplayed, health and law enforcement officials all over the country report that young men who do not have erectile dysfunction are using Viagra as a party drug. In Athens, Georgia, home to the University of Georgia, drug task force agents report that they routinely discover Viagra in the possession of college guys who don't have erection problems or a prescription. They steal it from parents, order it online or buy it from friends. A 2002 San Francisco, California Department of Health study of patients at San Francisco STD clinics found that gay and bisexual men were four times more likely than their heterosexual counterparts to use Viagra. The study also revealed that gay men sometimes combined Viagra use with crystal methamphetamine and other illegal drugs such as Ecstasy, cocaine and ketamine.

What's going on here? Viagra abuse? Yes, and the only real surprise is that more people didn't see it coming. Look, Pfizer guilefully marketed its little blue erection pill, successfully making Viagra a household name within a year of the drug's FDA approval. They provided generous samples to doctors' offices and in many cases, physicians simply doled out freebies to men who asked for it, impotent or not. Men all over America, gay and straight, are getting prescriptions from doctors too embarrassed to ask a lot of specific questions. Your doctor won't prescribe it? No problem. Order it from an Internet pharmacy without the benefit of a good-faith medical examination at all. You can also bet the 23 million Viagra users worldwide shared the wealth with quite a few of their buddies, too.
Last August, Dr. Jeffrey Klausner, director of STD prevention and control for the San Francisco Department of Public Health, petitioned the FDA to list Pfizer's Viagra and similar drugs as Schedule III controlled substances, making them easier to track and harder to prescribe. Klausner, one of the most cogent voices in STD and HIV prevention today, points to several studies documenting an association between recreational use of Viagra and higher rates of risky sexual behavior. In one study, co-written by Klausner, 31% of a group of men who have sex with men reported taking Viagra without medical supervision and use of the drug was associated with higher rates of STDs, including HIV. And Klausner refers to another study -- presented last July at the XV International AIDS Conference -- which found that recreational Viagra users were twice as likely as nonusers to be HIV positive.
Naturally, studies like these are wide open for interpretation and Klausner hasn't many allies. The Executive Director of New York's Gay Men's Health Crisis, Ana Oliveira, robotically repeats a familiar observation, "It's unprotected sex that increases the risk of HIV." And sounding like a woman who doesn't quite grasp the male erection, she adds dismissively, "It's a behavioral issue, not a Viagra issue." Dr. Jason Schneider, a board member of the Gay and Lesbian Medical Association and clinical instructor at Emory University in Atlanta, says Klausner is "a bit extreme," but concedes that "health providers have a responsibility to inquire about a patient's sexual behavior before and after prescribing the medication" and "drug manufacturers could put some money into educating the general public about the use of Viagra in combination with drugs that clearly do lead to risky sexual behavior."
Not surprisingly, Pfizer opposes reclassification of Viagra and balks at making label changes or increasing patient education efforts. Pfizer has, in fact, recently adopted aggressive new advertising strategies to court new consumers and win back customers who migrated to Levitra or Cialis. Meanwhile, boys will be boys. Darlene Weide, Executive Director of San Francisco's Stop AIDS Project, reports that agency surveys indicate a third of gay men interviewed there had used Viagra. "It is well-known in the gay community that Viagra is used as a recreational drug." Erectile dysfunction drugs are increasingly popular and common at sex clubs, bathhouses and even gay campgrounds, where they are shared as casually as a Tic Tac between strangers.

The FDA and Pfizer aren't going to address the sex lives of gay men. It's up to sexually active gay men, positive or negative, to use the head on their shoulders instead of the one between their legs. What do we know for sure? Men who take HIV medications are more likely to experience impotence. If that's happening to you, talk candidly with your doctor about it. Certain protease inhibitors can significantly increase blood levels of Viagra and that can lead to visual problems, headache, fainting or a condition called priapism, where a prolonged, painful erection can last hours or days.

Giving Viagra, Levitra and Cialis away to strangers or acquaintances when you are unfamiliar with their medical history or current prescriptions is irresponsible -- someone could end up unwittingly mixing these drugs with nitroglycerin or nitrate-based heart medications and the results could be fatal. Taking erectile dysfunction drugs with recreational party drugs is just a bad idea, and never inhale nitrate substances, known commonly as "poppers," if you're on Viagra, Levitra or Cialis because it lowers the blood pressure to dangerous levels and can lead to death.

David Salyer is an HIV-positive journalist, educator and activist living in Atlanta, Georgia. He leads safer-sex presentations for men and has facilitated workshops for people infected or affected by HIV since 1994. Reach him by e-mail at cubscout@mindspring.com.

How Viagra can mess up your marriage

Be careful what you wish for, I think as my husband reaches again for his new toy. Tragically, it's not a Ferrari or the latest Mac laptop —  it's his Penis 2.0—the new, pharmaceutically enhanced model.

I married an older man, and lucky for us both, the only part on him that's given out is his knees. But since I was writing about erectile dysfunction (ED) drugs, I wanted him to help me out. Would he try one? The little blue pill enables older men to sexually respond like 18-year-olds. "Wouldn't that be interesting," I asked him, "journalistically speaking?"

The 10 secrets of a lasting longterm relationship.

John was skeptical. "What if I take this and things never work without the pill again?" he asked. I pointed out that the label of a leading brand, Viagra, does not list physical dependence as a side effect (although it does mention headaches and an upset stomach). True to promise, when John used Viagra, everything was perfectly fine. But to my chagrin, it was perfectly fine a lot.

1. 
   

And therein lies a problem I wonder whether the makers of Viagra and its pharmaceutical cousins Levitra and Cialis foresaw. While men of a certain age are undoubtedly thrilled to have their sexual potency restored, maybe their wives' enthusiasm is a bit more subdued?

What at first glance seems an obvious win-win situation for both husbands and wives can have a raft of unintended consequences. Don't get me wrong: Viagra is a wonder drug. Since the early '90s, when researchers testing a new heart medication called Sildenafil discovered that it had a startling side effect in men, erectile dysfunction drugs have become more than a billion-dollar industry.

One study conducted by Express Scripts, a pharmacy benefit management company, found that nearly 20% of all American men over age 45 have tried them. And since, according to the National Institutes of Health, approximately 5 percent of 40-year-old men and from 15 to 25 percent of 65-year-old men experience ED (for reasons ranging from narrowing of the blood vessels with age to high blood pressure, diabetes, obesity, and neurological problems), these drugs have been a godsend to millions.

ED drugs can also, indirectly, be lifesavers. Thirty-four to 70 percent of all men who take antidepressants experience sexual dysfunction as a side effect, and of those who have this problem, almost 90 percent stop taking the antidepressants so their sex lives can go back to normal.

40 Things you should know about sex before the age of 40.

But ED drugs are so readily available, so much a jokey part of the cultural landscape, that few of us really know how they work and what the potential dangers are. This leads to misuse — not so much life-threatening as knuckleheaded.

Essentially, ED drugs work like this: What gives a man an erection is blood flow to the penis. The vessels dilate, and blood flows in. There is an enzyme that counteracts the dilation. ED drugs inhibit that enzyme, allowing dilation to occur more easily and last longer. They can also diminish a man's refractory time, meaning that after orgasm he can more quickly get an erection again.

The one thing most people know about Viagra and its cohorts is that they are not supposed to be used by men who take nitroglycerin, a common medication for heart patients that also dilates the blood vessels. But ask around. That little piece of knowledge has translated into "Viagra is bad if you have a heart condition."

Not so, says Arthur S. Agatston, MD, a cardiologist and associate professor of medicine at the University of Miami Miller School of Medicine and Prevention editorial advisory board member. In fact, Dr. Agatston says, because Viagra keeps the blood vessels from becoming "sticky" and helps blood flow through them smoothly, not just in the penis but throughout the body, in the future, many of us—women included—may end up taking some small amount of Viagra daily, the way we take baby aspirin, which has the same nonsticking effect on blood itself.

So when a man takes Viagra, he has to avoid anything that dilates the blood vessels, not just nitroglycerides. Drinking, lying in the sun — both are problematic. Viagra won't give him a heart attack, but, taken with too much alcohol, it could make him pass out, Dr. Agatston says.

Perhaps more damaging than ignorance of the physical ramifications of ED drugs is ignorance of their potential interpersonal blowback. When not discussed frankly, Viagra can cause a lot of misunderstanding and hurt between couples. "There is something about a hard erection that is extremely important to a man's identity," says Steven Lamm, MD, an internist in New York City and author of The Hardness Factor. "And of course most couples would prefer that the man be able to have one. But there are some who may have adjusted to life without sex. Perhaps the woman doesn't really want it anymore, for one reason or another. And for those couples, the introduction of an ED drug can throw them seriously out of sync."

That leads to what is perhaps the biggest complicating factor: the reality that a woman's postmenopause genital health can put her physically at odds with her partner's newfound, drug-assisted prowess. As women age, their hormonal balances change. Reduced estrogen levels often mean less sexual desire but also decreased vaginal elasticity and lubrication, and thus more potential for sex to be painful.

Menopause or Peri-menopause? 11 Truths about hot flashes, crazy mood swings, out-of-nowhere belly bloat, and more

The problem can be especially daunting for older women who are widowed or divorced or just beginning to date after years of being alone or with one man. Certainly this was the case for Marjorie P., a 60-something woman who complained about the drugs on a 50+ Web site: "Men have been saved from their middle-age sexual issues by Viagra and Cialis. They can be thirty again, while I have to deal with the sexual issues of being my age. It's put the world on 'tilt.'" Andrea D., a twice-divorced physician from Santa Monica, CA, and an over-50 dater, put it more bluntly. "Viagra has been liberating for men, but unless a woman is taking hormone therapy, she may have vaginal dryness and really not be that interested in the kind of driving, pounding intercourse he's now capable of."

There is also fallout from the erroneous belief that Viagra causes not just greater blood flow but also greater desire. The hormone testosterone is the driving force behind libido; a man with little or no testosterone will not have any desire to have sex, Viagra or no. Moreover, even with normal amounts of testosterone, "Viagra does not just instantly give a man an erection," says Abraham Morgentaler, MD, associate clinical professor of urology at Harvard Medical School and author of The Viagra Myth.

"You have to be in a sexual situation, you need to have desire and intent, in order for the drug to work." Dr. Morgentaler tells the story of a patient who was very upset because Viagra didn't do the trick for him. "He said, 'Doc, I followed your directions exactly. I took the pill an hour in advance. Then I watched a baseball game on TV and waited.' The man's wife was in the other room, waiting too; neither of them realized that the drug would be effective only if they were together, doing what couples do."

The misunderstandings cut all ways: Some women think ED drugs make men amorous and that their presence isn't required. "What a lot of women need to be turned on is the feeling that they're desired," adds Virginia A. Sadock, MD, director of the program in human sexuality at New York University Langone Medical Center. "So with Viagra, they think, Oh, it's not me he wants; it's the Viagra talking. In my practice, I spend a lot of time reassuring them that this isn't the case — and I tell men they must reassure the women too."

Another big issue for many women: ED drugs drastically shorten the interval between climaxing and achieving another erection. Men look at this differently than women do. For them, it's not a bug, it's a feature. And for the woman?

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"We want maybe twenty or thirty great minutes of sex," says Susan K., a mother of two in Connecticut. "We don't want an interminable two hours." Not to mention the fact that prolonged intercourse, particularly without sufficient lubrication, can do damage. It can lead to vaginal abrasions and even tearing and can expose a woman to risk of getting yeast infections and — particularly for a woman who is dating or divorced — to sexually transmitted diseases.

There are, too, single women who worry that men with new-and-improved sexual abilities will be less likely to commit to marriage, and wives who worry that their husbands will be more apt to look outside the marriage for sex

What Happens When You Overdose on Viagra?

The guitarist for the German emo band Tokio Hotel just overdosed on Viagra! What happens when you pop too many of the diamond-cut erection-makers? Sanjay Gupta didn't return our calls, so let's check Google.

According to the New York Post, 20 year-old Tom Kaulitz took multiple doses of Viagra while the band was on tour in Asia. Their side-effects so debilitated him that he had to take two days off to recover.

Why did the presumably virile Kaulitz decide to take multiple doses of Viagra? Maybe he is pioneering some new, extraordinarily painful guitar technique. Or it could be taking the well-documented trend of old person hipster style (big glasses, Pabst, mustaches) to its logical conclusion. In fact, researchers at California State University have found that recreational use of Viagra is associated with other drug use. Viagra is a hot club drug! Also, idiocy. That has to be a very large part of it. Plus, there's nothing to do in Asia, so he was probably bored.

Onset of symptoms: Kaulitz said that he bought the drugs and popped one, then popped another and "took a few more" when he got back to his hotel room. "The next morning, my head was pounding and everything in front of my eyes was blurry. It wasn't fun anymore. It was pretty bad," Kaulitz said. Kaulitz then had to take a two-day break from touring. Why so much pain from so innocuous a drug? Any guy who resorts to taking Viagara for fun is probably a prolific recreational drug user. Many of these drugs have nitrates. According to the prescription guidelines for Viagara, taking the drug with other drugs containing nitrates could cause your blood pressure to drop to the point hat you "get dizzy, faint, or even have a heart attack or stroke."

Symptoms: So, symptoms of Viagra overdose, according to Tom Kaulitz: blurry vision and head ache. Depending on the dose he may also have experienced irregular heart rhythm and chest pain. And of course uncomfortable penile super-function. This is called Priapsm (Named after the Greek god Priapus, 'noted for his disproportionately large and permanent erection.' He was the god of fist bumps, keg stands and Ultimate Fighting.) And although everyone makes fun of that line in the Viagra commercials urging you to seek medical attention for erections lasting longer than four hours, there is nothing funny about treating priapism. Let's just say it involves shunts.

Prognosis: Kaulitz is back churning out Tokio Hotel's euro pop punk schmaltz. He'll be fine. Unlike this "MAD RUSSIAN". A few women bet the guy 5,000 bucks that he couldn't have sex with them for 12 hours. He did it, but after winning he died of a heart attack. Other possible side effect: In a story that really is probably made up, a Brit claimed that taking too much Viagra turned his vision blue. Just like the pill! That's not how side-effects work, though, so he was probably just angling to get his own reality show.

Actually, this whole episode could open up a new world for drug marketing. Maybe Viagara should sponsor Tokio Hotel, like they do race car drivers. Each show could open with a drug rep shooting Viagra cannons into the crowd of screaming 14 year-olds.

Curious Women Are Seeing if Viagra Works Wonders for Them

RECENTLY, eight female friends in their 30's and 40's gathered for lunch at Coco Pazzo Teatro on West 46th Street. After two weeks of rain, the sun was shining, the women were in high spirits, and after one showed a picture of the man she is dating (an underwear model), talk turned to spring fever, love, sex -- and Viagra.

''I'd try it,'' one woman said, sipping a Kir royale.

''I'd try it, too,'' chimed in another, a pink flush creeping up her decolletage.

''After amyl nitrate in college, why not?'' burbled another.

The waiter lingered a little too long while clearing the salad plates, eager to eavesdrop, and the point was made. Everyone is awfully curious about what the male potency pill might do for women.

The scientific community is curious, too. Just as Viagra helps men with erectile dysfunction by increasing blood flow to the penis, it causes blood to flow to women's sexual organs, potentially increasing sensitivity.

But even before the results are in from studies of the drug's effect on women's sexual arousal and satisfaction, a number of women, inevitably, are stepping into the breach on their own to try it. They do not necessarily complain of sexual dysfunction, but simply want to satisfy their curiosity.

There are no figures available on how many women are experimenting with off-label use of Viagra, but call any urologist who has written Viagra prescriptions for men and you will hear of a wife, a partner or a girlfriend who has tried it.

This handful of women around the country have access to Viagra because their partners (or generous friends) have prescriptions, or their profession allows them access to prescription drugs. And they are willing to try it out, despite doctors' warnings that no one knows what the potential long-term side effects might be for women.

Take Dr. Susan C. Vaughan, 34, a psychiatrist in Manhattan. She considers herself a healthy, normal woman. Everything that should work, does.

But come to think of it, she said she wouldn't mind trying Viagra.

''I've come across a number of women who are curious about it,'' Dr. Vaughan said. ''Some of them are taking Prozac or similar drugs, and find that those medications are affecting their sexual response. And then there are lots of normal women who are, frankly, just curious. They're wondering: 'How good can this get? Can it get even better?' ''

A 42-year-old nurse in New Jersey, who like most women in this article refused to be quoted except on condition of anonymity, said she tried Viagra for the first time last weekend. She wanted to be able to discuss the drug's effects with patients; she also thought it might help with the fact that she is reluctant to have sex at certain times in her menstrual cycle.

''I only see my boyfriend every two weeks because we live in different states,'' she explained. ''And if I'm not in the mood on one of those weekends, well, then there goes the month. I've been with him for about two and a half years, and it's just not as exciting as it used to be.''

Last Saturday night, she swallowed a blue, diamond-shaped Viagra pill, which she sneaked from a cache in the office where she works. The dosage was 50 milligrams, the standard for male sexual dysfunction. She chose not to tell her partner. ''We were watching television, just a regular movie,'' she said, noting that after an hour she began to feel ''a fullness. I can't say it was a tingling, but it was some effect of the increased blood flow to the area.'' The couple retreated to the bedroom, and the pill began to work its alleged magic.

''I have to say it was great,'' the woman said. ''It was animalistic. I can definitely say it was not a placebo effect. I'm a nurse, and I'm trained to recognize those things.'' Of the side effects reported by male users of Viagra -- a drop in blood pressure, a mild headache, a blue tint to the vision, a flushed face -- she reported only one: exceedingly rosy cheeks, which she explained to her boyfriend as springtime allergies. She has no hesitancy about trying the drug again, despite doctors' warnings that women of childbearing age should not take the drug. ''I've had children, and I was using birth control,'' she explained.

Dr. Jennifer Berman, a urologist at the University of Maryland in Baltimore, is conducting a study of the effects of Viagra on women who have some level of sexual dysfunction and is giving the drug only to those who have had hysterectomies or are postmenopausal.

''We're not giving it to women of childbearing potential because we're just not sure of the effects on women of childbearing age,'' she said.

Dr. Stanley Bloom, a urologist in Livingston, N.J., who plans to study the effects of Viagra on women, uses harsher warnings. ''There's a lot of curiosity and there's going to be more and more experimentation,'' he said. ''I see a lot of men, and invariably some of them are going to give it to their partners. But we should be cautious. Do you remember thalidomide? You can't be too blase with this stuff. No one could have foreseen the disastrous effects of that drug.''

Study Finds Viagra Works for Women

A new study has found that the impotence drug Viagra could ramp up the sex lives of women who take it, just as it has done for men.

The 12-week study focused on 202 post-menopausal or post-hysterectomy women who complained of female sexual arousal disorder. The women in the group who took Sildenafil — the little blue pill commonly known as Viagra — took notes after each sexual experience, and reported better overall sexual satisfaction compared with those who took a placebo.

Their enhanced sex lives included better arousal, lubrication and orgasm.

The study was conducted by Laura Berman, director of the Berman Center and a professor of OB-GYN and psychiatry at Northwestern University in Chicago, and Dr. Jennifer Berman, director of the Female Sexual Medicine Center at UCLA Medical Center in Los Angeles. The researchers say that the results are preliminary.

"In terms of ability to achieve orgasm, there was a statistically significant movement," Laura Berman said on ABCNEWS' Good Morning America.

"It increases blood flow to the genital area, increases the sensation of warmth, tingling and fullness," she said.

More than 50 million women experience some type of sexual dysfunction.

Jennifer Berman said it's important for women to remember that this pill can't overcome mental and emotional barriers to a satisfying sex life.

"At this point, we can say that women with significant emotional or relationship problems and women that have desire problems related to their interest in being sexual might not be the best candidates," Jennifer Berman said. "It's for women who were satisfied with their sexual response at one point and now, for whatever medical reason, are no longer able to respond," she said.

Increased Blood Flow Theory

Women who suffer from female sexual arousal disorder can experience a variety of symptoms, including lack of "excitement," vaginal dryness, loss of sensation and sensitivity in the genitals and nipples and low blood flow to the genitals. Women in the study were screened to make sure that psychological or relationship issues were not the cause of the problem.

Since Viagra enhances sexual arousal in men by increasing the blood flow to the penis, the Bermans theorized that the drug could have a similar effect on women, increasing the blood flow to the female genitals and thereby producing better arousal, sensation and lubrication in the genital area.

Women in the study were given doses of 50 milligrams, which was increased to 100 milligrams only once during the study based on how well the lower dose was working, and the women's tolerance to it. The pill was to be taken prior to sexual activity but no more than once daily.

Each patient had to engage in sexual activity at least once a week and keep a personal log about it. During the course of the study, neither the patients nor the doctors knew which patients were receiving the Viagra. Women taking Viagra reported mild to moderate side effects, including headache, flushing, nausea, and vision symptoms — the same side effects reported by men who take the drug.