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Men who don't want to discuss erectile dysfunction with their doctors can get their little blue pills online (although often it's the female partner who actually does the ordering). The ready availability of drugs like Viagra isn't always a good thing.

If you live in the USA, you can't watch commercial television very long without seeing a man and a woman holding hands, watching the sunset, soaking in separate bathtubs. Viewers are left to imagine what comes next, but the announcer explains the benefits of Eli Lilly's blockbuster anti-impotence drug Cialis, which recently surpassed the older Pfizer erectile dysfunction drug Viagra in sales-each drug bringing in more than $2 billion per year.

On the market since 1998, Viagra (now available in some countries as a generic drug, sildenafil) revolutionized the sex lives of many men suffering impotence. Viagra stimulates nerve endings in the arteries leading to the penis to open wide so blood can flow into the corpus of cavernosum of the penis to power an erection. One of the first medications of its kind that reliably worked, Pfizer sold billions of dollars of the drug around the world, and continues to market the drug even since its patents expired in 2012.

The drawback to taking the "little blue pill," however, was that a certain amount of planning was necessary.

Viagra takes about 20 to 30 minutes to begin to work. It only works for a couple of hours (unless the user is one of the unfortunate few who experiences priapism, an erection that lasts more than four hours). Many men and their partners complained that spontaneity wasn't possible with the drug. The Eli Lilly innovation Cialis, however, gave men the opportunity to put some distance between their problem and its solution.

Cialis (which has the chemical name tadalafil) doesn't have to be taken right before sex. There is a version of the pill known in French-speaking countries as "le weekender," a pill that enables men to have erections at any time during a 36-hour period, and another version of the pill taken once a day more or less like a medication for allergies or high blood pressure. There is a third, less popular, ED (erectile dysfunction) medication called Levitra (vardenafil), which has a period of effectiveness similar to Viagra but which is helpful for men who have a problem with premature ejaculation.

Cialis, as the advertisements featuring the lovers in separate bathtubs suggest, allows couples to have sex when they are both in the mood. And since Pfizer had been aggressively hiking the price of Viagra for years in anticipation of its patents running out, most men who use medications of this class were very ready to pay whatever price the makers of either medication wished to charge. Online vendors may or may not charge less than the pharmacy, again, many men don't care, but they at least take away the need of making an appointment with the doctor, having a consultation that may not be paid by insurance, and discussing sexual inadequacies with a stranger. Or do they?

Continue reading after recommendations

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