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We live in a strange time. For thousands of years, people have been making and selling concoctions they claimed would cure erectile dysfunction. Dozens of herbs have been touted as a remedy, like yohimbine, ginseng, and even cocaine.

The simple fact is that the results of these attempts were probably, in most cases, little better than a placebo effect. That might very well have been enough to help some men, but most were just wasting their money.

Things are different now. We have three relatively safe FDA-approved pharmaceuticals that treat erectile dysfunction. They don't work sometimes on a hope and a prayer; they actually affect the body's physiology to produce strong, last erections.

In the face of this new, quite revolutionary, change, how do the pushers of potions and tonics react? They co-opt the name "Viagra" and relabel their stuff "Herbal Viagra". Untested, unregulated, uncontrolled; how is this an improvement over a drug used by millions of men worldwide?

The most incredible fact is that many "Herbal Viagra" products actually contain Viagra! The makers sneak in a generic version of sildenafil citrate. So if your "Herbal Viagra" actually works, you're probably just ingesting knock-off Viagra, of unknown dose and quality.

If you suffer from erectile dysfunction and don't want to take drugs, you can try healthy living, exercise, and a good diet. But it's self-deluding to think that an herbal concoction is going to be safer or more effective than Viagra, Cialis, or Levitra. 

Many men fear that if they try Viagra, and have success with it, they'll never be able to have sex without it again or they will crave it. They fear that they'll somehow become addicted to it.

Though, like anything, Viagra is open to abuse, concern about becoming addicted or dependent on Viagra isn't warranted. For many man, taking Viagra can improve confidence enough to actually let many men have sex without it. Performance anxiety can cause erectile problems which can cause even worse performance anxiety. Viagra can break this cycle, and in the process, make itself unnecessary.

Those with more severe erectile dysfunction may never be able to have sex without Viagra. For them, though, Viagra isn't likely to become anything more than a natural part of their love life. Since there's no high associated with the drug, and since it doesn't create sexual desire, there's no enticement to take it except when you're feeling frisky to begin with.

For some, they feel like such a "superman" when they take Viagra, they're unwilling to have sex the normal way. This is something of a danger, if only because it makes Viagra a necessity where it otherwise might not be. That's why we recommend that men be honest with their partners about when they take Viagra. Then, whether to take Viagra or not becomes a decision you make together, ensuring the best possible experience for both partners.

Periodically the press breathelssly reports about how "Viagra for women" is just around the corner. If you read the details, it generally is just a report on some researchers somewhere doing something that might help women someday. The dream is that someday there will be a "magic blue pill" for women as there is for men.

Reality is a lot more complicated than this myth. Viagra is not approved for use by women, but some women do find some benefit from taking it. Studies have suggested it might help women who take anti-depressants, for instance.

The heart of the confusion comes in the idea that there can possibly be one pill that be as useful for women as Viagra is for men. Viagra has a very specific chemical function; it solves a plumbing problem. It allows men to get an erection. This is a huge benefit to men, because without an erection, intercourse is impossible.

Women, though, suffer from a wider variety of sexual dysfunctions with a wider variety of causes. Some lack interest in sex, some have difficulty getting aroused, some have difficulty with orgasm, etc. Each of these difficulties may have a different cause for a different woman. A single pill won't solve all of these problems because each problem has a different cause in each woman. 

So, though we might see "Viagras for women," a variety of treatments for a variety of causes of female sexual problems, there's never going to be a single "Viagra for women" that helps such a broad class of women like Viagra does for men. Just not going to happen.  

Even though Viagra has a reputation as Grandpa's wonder drug, erectile dysfunction isn't something that only affects older men. Many younger men have erectile difficulties as well.

Men in their 20s and 30s can experience many sorts of erectile problems. Performance anxiety afflicts men of all ages; they may have completely psychological issues for their erectile problems. Viagra can give them the confidence they need. Often using it for a short time is enough to get them over that hump and restore confidence so they no longer need the drug.

Many younger men also take medication, like antidepressants, that can have sexual side effects. Using Viagra can improve performance greatly. People are often hesitant to take antidepressants for this reason, so in this case Viagra is helping them improve their mental health.

From the reports we've received, younger men often find success with much lower doses of the drug. 25mg, and even 12.5mg is often enough to give them a good effect. So we recommend younger men to start with a low dose and work their way up only if necessary.

The pendulum swings. In the old days, if you showed up at a doctor complaining of erectile dysfunction, likely as not they'd recommend you seek therapy for your Oedipal complex. There wasn't a treatment for the physical, so they had no choice but to look to the psychological.

These days, when popping a pill appears to cure *everybody* of erectile dysfunction, the assumption is that it's all physiology. If you have trouble with an erection, the root cause must be something wrong with your plumbing. Treatment for the physical works, so there's no reason to consider anything psychological.

In some cases, it's almost certainly true that it's mainly about physiology. Diabetes, high blood pressure, and the medications people take can cause erectile problems. Simply getting older can have a similar effect.

It's important to remember, though, that psychology often plays a part, both in the problem, and how Viagra can help with the solution. Confidence counts, and Viagra lets people relax, giving them the confidence that they will be able to achieve an erection.

Sex and relationshps are complex. The problems that arise are not simple. Viagra doesn't solve everything, it only puts one missing piece of the puzzle back in place. That's an important piece, to be sure, but for a lot of couples, there's more work to be done beyond that.

For thousands of years human beings have been in search of an aphrodisiac - a substance that can increase sexual desire and performance. Raw oysters, ground up rhinoceros horns, green M&Ms, etc. have all been touted for their ability to heighten sexual interest.

Modern medicine, of course, has finally delivered on the promise of increased sexual performance with the big three PDE5 inhibitors (VLC). However, these truly magical drugs aren't actually aphrodisiacs. They affect the body, not the mind, and this counters a lot of the expectations and beliefs people had about human sexuality.

VL&C don't increase sexual interest, only ability to get and maintain an erection. Taking one of these drugs won't be enough, for most people, to produce an erection. There needs to be some kind of sexual stimulation and/or interest to produce the result. They are inert on the mind, but highly active on the body.

It's important to note, though, that there is a strong feedback effect. The confidence that comes with the ability to get hard can produce the desire, both in yourself and in a partner, for sex. There is a positive feedback loop here that shouldn't be ignored. But mistaking VL&C for aphrodisiacs can lead to much confusion.