Fitness and body

Pills, pricks and pleasure – firm safety advice for medicated hard-ons

Looking to alleviate first date performance anxiety, go at it like a champion all weekend, or have difficulties getting or staying hard in general? Whatever your reasons, using erectile dysfunction medication is fairly popular among men who have sex with men. And while there’s high pleasure potential from a rock hard hard-on, here’s the lowdown on how to stay firmly safe.

Published in the Journal of Sexual Medicine this year, results from the Australian Flux study found around a third of gay and bisexual men have used oral erectile dysfunction medications (EDMs) in their lifetime, often for recreational use. Common reasons were to maintain an erection for longer, or make it easier to get a hard-on in the first place.

Researching attitudes towards drugs, the Flux study found that some EDM use was associated with illicit drug use and higher rates of sexual risk behaviour. But that’s not necessarily a reflection of all gay and bisexual men across Australia.

Performance anxiety is a real concern for some guys. The consequences of experiencing it may manifest psychologically, challenging one’s self-esteem (what you think of yourself), one’s self-image (what you believe other people think of you), as well as potentially contributing to relationship difficulties. And when there’s an option to add confidence in the form of a pill, it’s possible to see the attraction of a convenient and discreet solution.

Overcoming psychological barriers may be one reason to use EDMs, but other factors may be at play too. In Australia, more than 50 per cent of men aged between 40 and 70 years were found to experience some form of erectile dysfunction (ED). It’s also now understood that more than 85 per cent of these cases are a result of a physical problem. Contrary to what some people may believe, ED isn’t a normal or inevitable consequence of getting older, nor is it about how much testosterone someone’s got.

Erections and medications

Ordinarily, guys get a boner in response to some form of sexual stimulation. When this happens, various body parts work together to produce a rapid increase in the amount of blood that flows into spongy, tissue filled chambers within the shaft of the penis. Brain, nerves, heart, blood vessels and hormones are all involved in generating hydraulic pressure to keep these chambers filled with blood, resulting in an erection. If any of those parts, including the penis itself, aren’t operating optimally, this may result in erectile dysfunction.

In this event, using prescription medication may be a functional treatment option. Doing so is effective for about 70 per cent of men experiencing ED.

Products taken orally, such as Viagra (sildenafil), Cialis (tadalafil) and Levitra (vardenafil) are prescription medications that belong to a class of drugs known as PDE5 inhibitors. They’re intended to assist the body’s natural response to sexual stimulation, helping to achieve and sustain an erection.

Other products such as Caverject Impulse (alprostadil for injection) are used for ED treatment. It’s a prescription medication injected directly into the side of the penis which works by increasing blood flow to the area, trapping it in the spongy erectile tissue causing the penis to become erect.

Obtaining EDMs

EDMs are prescription drugs in Australia and should only be obtained and used in consultation with a healthcare professional. While some EDMs are possible to buy online, it is only legal to import medications from overseas with a prescription from an Australian doctor. The Australian Therapeutic Goods Administration (TGA) provides consumer recommendations on its website.

Discussing use of EDMs with a sexual health specialist or GP will ensure they are able to provide appropriate healthcare, and prescribe treatment if appropriate.

Using oral EDMs

As prescription medications there are some health warnings to consider. It’s best to discuss these with a doctor. This is especially important if choosing to use them in a recreational setting, or obtaining them via other means. Down ‘An Dirty provides some safety information for using EDMs.

HIV treatment medication: Taking oral EDMs with some HIV protease inhibitor drug combinations (such as those containing cobicistat or ritonavir) has some potential dangers. These HIV medications reduce the action of liver enzymes which may significantly increase concentration of the EDMs, resulting in an increased risk of side effects.

Other prescription medications: Oral EDMs should not be used in conjunction with prescription medications such as nitrates prescribed for chest pain, or guanylate cyclase stimulators prescribed for pulmonary hypertension, as the combination may cause an unsafe drop in blood pressure.

Amyl: Combining oral EDMs with amyl (“poppers”) is dangerous as it may cause an unsafe drop in blood pressure. How Hard provides some safety information.

Other recreational drugs: When mixed with stimulants such as speed, cocaine or crystal meth (“ice”), oral EDMs can significantly increase stress levels on the heart, resulting in excess strain damaging the body. Touchbase provides safety information for some EDMs as well as other recreational drugs.

Using injected EDMs

Using injecting equipment requires specialist knowledge and should not be attempted without consulting a medical professional. Blood borne viruses such as Hepatitis B, Hepatitis C and HIV can be transmitted when sharing injecting equipment. Syringes should only be used to administer a single dose and then discarded safely in an appropriate sharps container.

Injecting into the penis can cause a small amount of bleeding at the site of injection. This can increase the possibility of transmitting or acquiring blood borne viruses. Using other prescription medications that prevent blood clots (such as warfarin or heparin ) may further increase the chance of bleeding after injection.

Dosing and side effects

Taking only the recommended dose of medication is important to keep in mind when using any type of EDM. Being aware of side effects and knowing what to do in case of experiencing any adverse effects can help to stay safe while making the most of sexual experiences.

Sudden loss of vision: When using oral EDMs, sudden loss of vision in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). In this event, stop and seek immediate medical attention.

Sudden loss of hearing: When using oral EDMs, sudden decrease or loss of hearing, tinnitus (ringing in the ears), or dizziness may be experienced. In this event, stop and seek immediate medical attention.

Painful or permanent erection: When using oral or injected EDMs, having a painful hard-on, or an erection that won’t go away after four hours can be very dangerous and risks permanently damaging someone’s dick. Medically known as priapism, blood may remain in the penis for unusually long periods of time. It is important to seek immediate medical attention if experiencing a hard-on for more than 4 hours; if someone’s cock is very red or swollen; if someone develops a fever after injection; if pain develops more than 48 hours after injection, and the injection site becomes painful. If untreated, the trapped blood in the penis can become deprived of oxygen resulting in damage to penile tissue, causing permanent erectile dysfunction or disfigurement of the penis.

Using EDMs in conjunction with some prescribed medications (including some HIV treatment medications), amyl, or other recreational drugs can increase the chance of experiencing side effects.

In case of side effects or taking too much, contact a doctor, or the Poisons Information Hotline on 13 11 26, or go to the nearest hospital emergency room. If an ambulance is required, dial triple zero (000).

If experiencing adverse effects of EDMs while also using recreational drugs, it’s still important to seek immediate medical attention. Remember that paramedics are not obliged to involve the police.

Maximum pleasure, minimum harm

Using EDMs to achieve a formidable boner can help someone feel confident to go at it like a porn star. Though EDMs themselves don’t increase sexual desire, or reduce inhibitions, mixing them with other drugs might. Even though doing so carries some health risks, a decent proportion of guys have already tried, or do so regularly.

Desiring to maximise sexual pleasure is a normal part of human experience. Knowing how to do so safely can help ensure someone has the chance to continue having the sex they enjoy. Combining this with sexual health strategies to manage HIV and STIs can help make sure everyone’s equipped for as much enjoyment as they desire.

For people who are HIV negative, PrEP is a highly effective biomedical strategy that helps to prevent acquiring HIV.

For people living with HIV, using treatment will help maintain someone’s health as well as being the key to managing an undetectable viral load, resulting in effectively zero chance of passing the virus on.

Using condoms can also help to reduce the chance of acquiring HIV and other STIs, though going for regular testing is still important for everyone as condoms don’t always cover affected areas and some STIs can still be transferred by oral sex without a condom.

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