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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.

Does splitting a Viagra tablet make it work faster because the coating is broken and the inside is exposed? Can I increase the rate of effect by cutting my dose into smaller pieces?

In general, people report widely varied onset times for Viagra, from 15 minutes to 90 minutes. Various factors can affect how quickly the drug is absorbed, including what you've eaten beforehand and how much. Many Viagra users buy 100mg pills and split them in half or in quarters to save money vs. buying 25mg or 50mg tablets. And it stands to reason that once a Viagra tablet's protective coating is breached and more of the medication's surface area is exposed, it will break down faster after being swallowed. 

Some people crush Viagra tablets into a powder and put it under their tongues. Users reports that this works, they do get faster results. And also, it tastes terrible. While we haven't heard of any negative effects aside from the taste, Viagra was designed to be delivered into your system at a certain rate. So it might not be the best idea to alter that by chewing or pulverizing the tablets. Substances absorbed sublingually go into the bloodstream more directly than through the stomach, which would affect the appropriate dosage. But again, you'd just be doing guesswork here in order to get the appropriate amount. And don't even think about snorting the powder.

If you want to chop up your regular dosage into tiny pieces and  swallow them, that seems like a safe compromise that might speed up your time to lift-off. One thing you should be wary of is the sublingual Viagra tablets, soft-tabs, or lozenges sold online. Pfizer doesn't make Viagra in a sublingual form, so these products are generic and may or may not have sildenafil in them.

Can you OD on Viagra? What happens? Has anyone ever died from a Viagra overdose?

You can get too much of a good thing, and that includes Viagra. For most people, the recommended dosage of 50mg or 100mg suffices, and they have no reason to take more than that. It's not advisable to take more than 100mg in a 24-hour period. And if the recommended dosage is working for you, why waste the pills?

But there have been cases reported of men taking excessive doses, and suffering the consequences. Viagra is sometimes abused recreationally by younger guys who don't have ED, and used in combination with other drugs, like ecstasy. In those situations, folks may be altered or drunk, and aren't aware of (or don't care) how much they're ingesting. Like Tom Kaulitz, the 20-year-old guitarist of German rock group Tokio Hotel, who overindulged during a tour of Asia after getting the tablets (and probably a few other things) from a drug dealer. Not exercising the best judgment, he popped several pills and woke up with a killer headache and blurry vision that lasted two days.

All things considered, he got off easy, unlike the Russian dude who supposedly downed a whole bottle to fuel a 12-hour sex marathon with two women, with a $4300 wager riding on it. He made it through the 12 hours, then promptly had a heart attack and died. He was 28. Medics said it was likely the excessive Viagra killed him. A bottle of Viagra has about 30 100mg tablets, so that would be 3000mg. I'm surprised his head (or another body part) didn't just explode first.

In laboratory settings, researchers have given people up to 800mg of Viagra, and they survived, but that was in a monitored clinical setting. And I'll bet those guys weren't having much fun. Too much of the drug can cause your blood pressure to drop dangerously. Symptoms of a Viagra overdose can include headache, blurred vision, nausea, dizziness and fainting, and irregular heartbeat. And there can be worse effects, like heart attacks and strokes.

So don't go overboard trying to fuel any record-breaking sex sessions, or the only thing that's going to be pounding is your head. Taken in normal quantities under a doctor's supervision, Viagra is a safe drug. But if you do suspect you've ingested too much Viagra, or are having a drug interaction, get medical help immediately.

I'm confused about the relationship between Viagra and strokes. Can Viagra cause strokes? I heard that it could be used to treat them.

While it's documented that use of Viagra is associated with an increased risk of heart attack, stroke, or transient ischemic attack (a mini-stroke), the causal relationship isn't clear. The correlation doesn't necessarily mean that the drug per se caused the heart attacks or strokes. It may be that men who are more at risk for those events are also more likely to use Viagra. Their erectile dysfunction may be a symptom of a more serious underlying condition. Or, if they were already at risk, it may be that the physical exertion and elevation of blood pressure during sex precipitated the heart attack or stroke. This is why it's so important to consult with a physician and review your medical history before taking Viagra, or any drug.

On the flip side, it's true that for several years, doctors have been researching the use of sildenafil to facilitate stroke recovery. Note that the drug is used to treat damage to the brain after a stroke - it's not used for stroke prevention. In laboratory settings, Viagra has been shown to aid mice in recovering from stroke damage, by helping regrow brain cells. And there have been reports of the drug being used successfully to treat human stroke victims. In a particularly dramatic case, a woman with "locked in syndrome" - paralysis so complete she could only move her eyes up and down - was able to move all four limbs and make facial expressions following treatment with sildenafil. Her doctors seemed a bit reluctant to definitively credit Viagra for her remarkable recovery, but it's been established that the drug can assist in neurological regeneration. The mechanism involved in sildenafil's effect on brain tissue is unrelated to those that make the drug effective for treating erectile dysfunction and hypertension.

There are a variety of risk factors - genetics, lifestyle, diet, as well as medications - that are associated with strokes. As always, talk to your doctor about these risks before using Viagra, follow up on any concerns, and continue to get regular checkups while using the drug. 

Can I take Viagra twice in one day?

If you need to go two rounds in one day, it might seem logical to take two doses of Viagra. However, the official dosing instructions for Viagra are only for once a day. Though the drug loses most of its effectiveness after a few hours, it's still in your system. So, we recommend sticking to the one-dose-a-day instructions.

If you're planning to make it an all-day-affair, you might consider trying out Cialis. Cialis is famous for its longer effectiveness, they don't call it the "weekender" for nothing. 

My prescription container says take 1 tablet EVERY DAY. Does that mean even if I am not having sex that day, I should still take the pill?

No, you shouldn't take Viagra every day. The effects last only for a few hours. It is best to take Viagra about an hour before you plan on having sex. Taking it once a day wouldn't get you the maximum effect, and you risk unnecessary side effects.

Some studies have been done on people taking low doses of Viagra on a daily basis. This might be effective, but unless if your doctor has specifically recommended this, we don't think it's the best way to take the drug. Timing it right before the action will get you the best effect with the fewest side effects.

How soon before sexual intercourse should I take Viagra?

A good rule of thumb is to take Viagra 45 minutes or an hour before you expect to have sex. After a few hours, its effects lessen considerably, so timing is of a concern.

Unfortunately, there's no one-size-fits-all answer to this question. How quickly Viagra works will depend on how much you have eaten, whether you've had any alcohol, and other personal factors. The best way to find out the answer is through practice, either alone or with a partner. Experiment with the drug, find out how it works on you at a time and in a place where there's no pressure to perform. Then you'll be ready for another situation where time is more of the essence.