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I saw a news article about pharmaceuticals, including Viagra, getting into the water supply. How does this happen? Does it cause environmental problems?

Viagra in the drinking water sounds like a fantasy or a joke (or a recipe for a very happy village), but it's not far from reality. Significant traces of prescription drugs have been found in groundwater, rivers, lakes, bays, and coastal waters, including erectile dysfunction drugs, antidepressants and other psychiatric medications, hormones, and other substances like caffeine and nicotine.

How does it get there? Well, what goes in has to come out. When you take a drug and your body can't metabolize all of it, some gets excreted. So, those drugs are getting into the water through wastewater, i.e. sewage. Even treated sewage can still have those chemicals in it. Yeah, it's not nice to think about. Drugs can also leach into groundwater if they are thrown away and disposed of in a landfill.

The good news is that (hopefully) not a lot of that is getting into the drinking water supply, but that depends on where you live and what your water source is. And they're still out in the environment, where you can be exposed to them, and they can impact wildlife. The full and longterm effects aren't known, because environmental agencies have just recently started monitoring pharmaceutical pollution.

For the average Viagra user, there's not a lot you can do to prevent this from happening. Maybe don't take a higher dose of Viagra than required, to avoid excreting the excess amount. In the (unlikely) event that you have some unneeded or expired Viagra that you need to dispose of, don't throw it in the trash or flush it down the toilet. Take it to a pharmacy, medical facility, or police station where they accept prescription drugs for disposal. This goes for any type of drug, prescription or over the counter, that you might need to get rid of.

Anyway, Viagra probably isn't one of the drugs that would have the greatest impact. The ones that are really causing problems are hormones - estrogen and phytoestrogens. They can disrupt the normal development and reproduction of wildlife, and exposure to excess estrogens can have serious health consequences for humans, including...impotence in men.

Does Viagra cause an increase in testosterone levels? Will it deplete my testosterone?

Since there is a correlation between testosterone and libido or sexual potency, it's not surprising that there could be some confusion about the connection between testosterone and Viagra.

However,  Viagra has no effect whatsoever on testosterone levels. The hormone testosterone is produced by the body's endocrine system, in the testes and pituitary gland. Viagra produces erections by affecting muscles and blood vessels, causing them to relax and dilate. The increased blood flow, not increased testosterone, is what causes an erection.

Using Viagra also doesn't utilize or "use up" your testosterone, and actually, some studies show that sexual activity causes an increase in testosterone levels in males.

That said, if you have erectile dysfunction and Viagra doesn't work for you, the cause may be low testosterone levels. If your testosterone levels drop too far, Viagra won't be enough to help.

While Viagra doesn't affect your testosterone levels, there are a lot of medications that do, none of which are related to sex. These include statins, Propecia/Proscar (finasteride), opiate painkillers, and some chemotherapy drugs, all of which may lower testosterone. Low testosterone levels can have negative health consequences for men, or may indicate other health problems, so if you have concerns about your testosterone levels, ask your doctor to have them checked.

Is it possible to be allergic to Viagra? What are the symptoms?

It's possible to be allergic to any drug, or a component in a drug, such as a filler or coloring. Viagra allergies are rare, but yes, it's possible.

There are certain side effects of Viagra that are normal, though. If you're having nasal congestion, that might seem like an allergy symptom, but it is a fairly common Viagra side effect. Facial flushing is also a common side effect, and could be mistaken for a rash.

However, if you develop a skin rash, itching, or hives after taking Viagra, this could be a sign of an allergy. Likewise, any kind of swelling of the face, lips, or tongue could indicate a serious allergic reaction. If you have wheezing or difficulty breathing after taking Viagra, you should get medical attention. These are all signs of an anaphylactic  reaction, which can be life-threatening.

If you think you've had an allergic reaction to Viagra, don't take it again. Allergic reactions can worsen dramatically from one exposure to the next, so while one reaction may be mild, the next one could be fatal. It's not worth taking a chance.

Can a guy become addicted to taking Viagra? Is the drug habit forming?

Viagra and other erectile dysfunction drugs are not addictive, even if you take them regularly. The way some people throw around words like "addiction" and "dependency", you might get a different impression. But if you read a tabloid headline about some celebrity's "Viagra addiction", rest assured it is just a figure of speech or a way of referring to their sexual exploits or compulsions.

If a man has a physical condition, like diabetes for example, that causes erectile dysfunction, and he has to take Viagra in order to function sexually, then you could say he is dependent on the drug, but only in order to get an erection. This isn't the same thing as a chemical dependency on, say, opiates or nicotine.

Taking Viagra or other ED drugs won't alter your sexual organs so that you'll become unable to achieve an erection without the drug. You'd have to have some underlying condition that causes ED in the first place.

That said, if the cause of erectile dysfunction is psychological rather than physical, it may be possible to develop a psychological dependency on Viagra. This can especially be true when performance anxiety is the problem. A man who is physically capable of getting erect without chemical help may come to rely on Viagra to bolster his confidence.

In either case, there is nothing about the drug that is compelling the individual to take it, or to take more of it more often, which are characteristics of addictions. You might see increased Viagra use - in quantity or frequency - in someone with compulsive sexual behavior, but the sexual compulsion would be driving the Viagra consumption, not the other way around.

Are there anti-doping rules in sports against Viagra? Is it considered a performance-enhancing drug for athletes?

This was a hot topic a few years ago, when the World Anti-Doping Association (WADA) was considering whether to ban Viagra from sports, and researchers released reports that cyclists could improve their (athletic) performance up to 45% at high-altitude conditions while using the drug.

There were also a couple of high profile cases of athletes taking the drug under somewhat suspicious circumstances. Former New York Yankees pitcher Roger Clemens was caught with a stash of Viagra in his locker, hidden in a GNC vitamin bottle. And cyclist Andrea Moletta was removed  from the Giro d'Italia after police found 82 Viagra tablets and some syringes hidden in toothpaste tubes in his father's car.

How does Viagra give athletes an edge? By dilating blood vessels, it makes it possible for the body to pump more blood through the lungs, increasing delivery of oxygen to the muscles. Reportedly, some athletes have also taken it in combination with anabolic steroids, to enhance absorption of the steroids.

And yet, after all the suspicion surrounding the blue pill, WADA has not yet banned its use for athletes. Follow up studies showed that the drug's effect at sea level was not proportional to its high-altitude boost, and some athletes didn't derive any real benefit from it. The jury may still be out though, as results from the studies continue to be analyzed.

However, it's unlikely that Viagra will be banned as a performance enhancing drug, since some male athletes take it for legitimate reasons, and there's no compelling evidence that it can be widely used to improve athletic results.

Is it harmful if you take a Viagra, and then don't have sex? Like, what if you took one by accident?

I don't think people take Viagra "by accident" very often - although the tablets do bear some resemblance to the over-the-counter analgesic Aleve (ironic if you took something for your stiff back and something else got stiff instead).

If "by accident" you mean you misinterpreted your date's signals and she decides to go home early, well, that's a more likely scenario. Using Viagra takes some planning, and things don't always go according to plan.

So, if you take Viagra and don't have an appropriate "outlet", will anything bad happen? No, your penis won't explode, no matter what the drug pamphlet warns about possible "permanent damage to the penis". Unless you have an erection for four hours or more - then you should get to the doctor asap. Otherwise, the drug will eventually work its way out of your system and everything should return to normal.

If you become aroused while under the influence of Viagra and don't have an orgasm, you may experience pelvic congestion, aka "blue balls". This is usually a dull pain in the pelvis and testicles, caused by the pressure of accumulated blood. While this may be uncomfortable, it's not harmful, and if you don't do anything about it, eventually it should subside as the effects of the Viagra wear off (if not, see above). If you're not going to be having sex, the easiest way to relieve it is to masturbate. Repeat as necessary.

I sometimes have difficulty keeping an erection after I've been drinking. Can Viagra help fix this?

Alcohol is infamous both for leading the bedroom, and leading to disappointment in the bedroom. As Shakespeare himself observed,  "[Alcohol] provokes the desire, but it takes away the performance." Viagra might seem like the cure for that dilemma, but it's not a good idea. The makers of Viagra advise against using the drug with alcohol, and so do many Viagra users.

Alcohol consumption dampens the effects of Viagra to begin with, so it may not work as well, or you might try taking more than your usual dose to get the same effect. Even if it does work, you may be very sorry the next morning.

An alcohol and Viagra cocktail can be a recipe for a killer hangover. Viagra can cause a pounding headache. So can alcohol. They both cause blood vessel dilation, which is the source of that incessant and painful pulsing in your skull, so they may amplify each other's effects. They also both cause stomach irritation.

Many people can take Viagra after having a couple of drinks and experience no ill effects - individual tolerance can vary. But if alcohol, whether on an occasional or ongoing basis, is the cause of your erectile dysfunction, you're better off not falling back on Viagra to solve the problem.

If older couples are more likely to have children with birth defects, could Viagra cause an increase in infants born with those problems?

We came across a syndicated health column recently in which a reader posed an interesting question about Viagra: Could Viagra be related to birth defects? Not directly related in the sense that, say, alcohol use or thalidomide during pregnancy could cause birth defects. Sildenafil has been tested extensively and thoroughly vetted by the FDA, and there's no reason to think that the drug, taken by men or women, has that effect.

The issue is more complex and relates to demographics. Women's eggs do have an expiration date - as women age, the chromosomal material in them is more likely to break down. Statistically, children born to  mothers aged 40- 54 years have the highest rates of Downs Syndrome, and in general women over 35 are more likely birth infants with that and other congenital conditions such as heart defects, hypospadias, clubfoot, and diaphragmatic hernia.

Given that Viagra and similar drugs are allowing older couples to have intercourse who might not otherwise, is it possible that erectile dysfunction drugs could be causing an increase in the incidence of birth defects? Older couples might not think to use birth control if the woman is perceived to be past child-bearing age.

It's an intriguing question, but I don't think it can be answered. In theory, it seems plausible, and the numbers are probably there to crunch if you're so inclined. But there are so many variables, and Viagra hasn't been available long enough to get a really solid statistical sample. But actually, the overall number of birth defects between 1999 and 2005 has declined or remained stable most years.

It's true there's been an average increase in the age at which women become mothers. But this has less to do with Viagra and more to do with socio-economic factors. The biggest change is that women are delaying childbirth so they can pursue careers.

Of course, you'd have to limit your data set to developed countries where you can get Viagra and women have the option (or obligation, depending on how you look at it) to pursue careers.

So the short answer is,probably not in any statistically significant way, but there's not enough information.

Does using Viagra regularly over a long period of time have any adverse effects?

It's difficult to say whether Viagra has any lasting effects for really, really long-term use, since the drug has only been available for about 13 years. There simply isn't any data about longer term use. Moreover, a lot of reported "side effects" have a correlated, rather than cause-and-effect, relationship with Viagra usage, meaning it's not clear whether the symptom is caused directly by the drug, develops in combination with other factors, or is just a coincidence.

While there are no problems known to be associated specifically with prolonged Viagra use, some side effects are acute and others take time to develop, so you would have to be using the drug over a period of time to experience them.

Some of the more serious effects can include joint pain and inflammation, bone loss, hearing loss, vision problems, and anemia. It's important to note that while heart attacks and other cardiovascular problems have been associated with taking Viagra, most of those users already had heart disease or were at risk for it. This is why it's so important to consult with your doctor before taking Viagra, and get regular check ups while using the drug.

One report we'd like to debunk: there's an article in circulation, supposedly from the New York Times, that cites unspecified US and UK studies claiming that long-term Viagra use causes permanent loss of sex drive and even genital shrinkage. Although it's been passed around on a lot of internet forums, the article is bogus, never appeared in any credible news publication, and contains completely inaccurate information.

So, if you're a regular, long-time user, don't worry that Viagra will kill your libido or cause your manhood to wither away. However, you should pay attention to any changes in your health, and check in regularly with your physician, especially if you smoke, use other medications, or are at risk for heart disease or other serious conditions.