How does Viagra actually work?

Is it easy to get an erection?

Getting an erection involves more than just getting in the mood. It's an intricate system involving the heart, blood, nerves, and hormones. The system starts with the brain and ends with an erect penis. It starts with arousal which triggers the brain to send a signal to the body via the nerves. The nerves send a chemical signal to the blood vessels. The blood vessels release nitric oxide which stimulates an enzyme that is involved in the production of messenger cyclic guanosine monophosphate (cGMP). cGMP is a chemical messenger that relaxes the muscles and dilates the arteries in the penis. This leads to increased blood flow to the penis. The veins then contract, trapping blood in the penis which causes the erectile tissue to swell with blood and stiffen. And voila, you've got a hard-on. An erect penis is plump with 8 times more blood than a flaccid penis. When it's over, the blood is released and the erection disappears and normal blood flow is restored. In ED, the brain and the nerves aren’t talking to each other which means there isn’t sufficient blood flow to the penis.

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Sometimes the blood flow in the penis is inhibited for other reasons ie. narrowing of the blood vessels that supply the penis. Medical conditions causing ED:

Depression
Diabetes
Heart Disease
High Blood Pressure
High Cholesterol
Obesity
Prostate Cancer Treatment
Spinal Cord Injury

Lifestyle causes that can affect blood flow:

Smoking
Drinking
Stress

It's not hard to help yourself

Making these little changes can help you avoid conditions in the future that can lead to ED.

Stay more active (ie. go for walks with your dog, do a gym class)
Maintain a healthy diet and watch your weight. Stop the snacks and have 3 proper meals a day.
Reduce your alcohol consumption
Quit smoking
Reduce stress in your life. Give yourself some downtime.

How does viagra work?

In 2016, more than 25 million men were prescribed viagra. Viagra maintains a level of the chemical messenger cGMP in the smooth muscle cells of the penis. This messenger helps relax the muscles in the penis needed for an erection. This helps more blood flow to the penis helping it stiffen. This keeps the blood flowing to the penis keeping it up and keeping you happy. Viagra works within the hour when taken on an empty stomach and enables you to get an erection within 3-6 hours. Viagra doesn’t produce an erection that lasts 3-6 hours. If the little blue pill is taken on a full stomach after a fatty meal, it may take longer to work. However, as it works on sexual arousal, it can be taken up to 4 hours before sex. Sexual stimulation is required to achieve an erection. After sex, the erection should disappear as per normal. If the erection doesn’t go away after 4 hours make sure to visit the emergency room to avoid long term injury. Viagra takes 2 to 3 hours to leave the body but it really depends on your metabolism and can take up to 5 to 6 hours.

Common side effects:

Headaches
Stomach aches
Flushing
Runny or stuffy nose
Muscle pain
Nausea
Dizziness
Rash
Changes in vision

Who should avoid using Viagra:

Viagra should not be used if you have these medical conditions. Men who have:

Have severe underlying heart or liver problems
Suffered a stroke or heart attack recently
Have low blood pressure
Have certain rare inherited eye conditions

Mythbusters

Viagra works immediately: Viagra isn’t a wonder drug. It needs sexual arousal for it to be effective. If you're not turned on, your brain will not trigger the release of nitric oxide and hence the production of cGMP.
Viagra always works: Viagra works on approximately ? men, helping them attain erections hard enough to have sex. However, sexual arousal is still needed and viagra doesn't tackle the sexual response needed for the drug to work. Psychological barriers such as performance anxiety and depression may prevent viagra from working.
Viagra is only used for ED: Though Viagra has been marketed as a drug for ED, it has other uses too. Viagra is used to treat pulmonary arterial hypertension which is basically high blood pressure affecting the lungs.
Viagra can be used as much and as often as needed: Yes Viagra has been designed to be used when its needed, however, it should only be limited to one a day. If you are planning on having sex multiple times a day, you should not take multiple doses of Viagra a day. Instead, consult your doctor and discuss other alternatives such as longer-lasting medications.
Viagra can be bought over the counter: Currently, in the US, Viagra is a prescription medication and needs a prescription from a doctor.
Viagra makes you last longer: Viagra helps treat ED and improves in one's ability to get an erection and keep it up. It does not have any effect on how long you last in bed.

References

Feldman HA, e, "Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. - PubMed - NCBI.". in Ncbi.nlm.nih.gov, , 2019, <https://www.ncbi.nlm.nih.gov/pubmed/8254833> [accessed 25 September 2019].
Cold, F, E Health, H Disease, L Disease, P Management, & S Conditions et al., "How the Penis Works.". in WebMD, , 2019, <https://www.webmd.com/erectile-dysfunction/how-an-erection-occurs> [accessed 25 September 2019].
"Viagra Information, Viagra Sales | BPAS". in , , 2019, <https://www.bpas.org/more-services-information/erectile-dysfunction/viagra/> [accessed 26 September 2019]
"How Long Does Viagra Last: Effects, in Your System, More". in , , 2019, <https://www.healthline.com/health/erectile-dysfunction/how-long-does-viagra-last#how-long-it-lasts> [accessed 26 September 2019].