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

By Chris Williams, updated 1 year ago in Sex and dating / Sex

Man wearing briefs

Looking to alleviate performance anxiety, go at it like a champ all weekend, or just getting hard in general? Whatever your reasons, erectile dysfunction medications are fairly popular. While there’s high pleasure potential from a rock hard hard-on, here’s the lowdown on staying firmly safe.

Published in the Journal of Sexual Medicine, results from the Australian Flux study found around a third of gay and bisexual guys 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 guys across Australia.

Performance anxiety is a real concern for some. The consequences of experiencing it may manifest psychologically, challenging self-esteem (what you think of yourself), self-image (what you believe other people think of you), as well as potentially contributing to relationship difficulties. When confidence comes in 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 in 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 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, boners happen 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 an 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 in a class of drugs known as PDE5 inhibitors. They 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 also used for treating ED. This is a prescription medication injected into the side of the penis. It 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 used in consultation with a healthcare professional. While it’s possible to buy some EDMs online, it’s only legal to import medications 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 doctor or sexual health specialist will ensure they’re able to provide appropriate healthcare and prescribe treatment if needed.

Using oral EDMs

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

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 that could damage the body. Touchbase provides safety information for LGBTI folks who use 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 through 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 when using any type of EDM. Being aware and knowing what to do in case of experiencing any side effects can help you stay safe while making the most of sexual experiences.

Sudden loss of vision: With 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: With 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: With oral or injected EDMs, having a painful hard-on or an erection that won’t go away after 4 hours can be very dangerous and risks permanent damage to the penis. 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 the penis is very red or swollen; if a fever develops after injection; if pain develops more than 48 hours after injection and the injection site becomes painful. Left untreated, the trapped blood in the penis can become deprived of oxygen resulting in permanent damage to penile tissue, causing 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 using recreational drugs, it’s still important to seek immediate medical attention. Know 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 this carries health risks, a decent proportion of guys have already tried or do this regularly.

Wanting to maximise pleasure is a normal part of human experience. Knowing how to do so safely can help ensure someone can 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 HIV prevention strategy that combines using prescription medicine with regular sexual health testing.

For people living with HIV, using treatment to manage an undetectable viral load keeps them healthy and eliminates the possibility of passing the virus on through sex.

Using condoms prevents HIV and helps prevent most other STIs. Regular sexual health testing is still important for everyone whether they do or don’t use condoms.

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