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The hormone testosterone is the driving force behind libido; a man with little or no testosterone will not have any desire to have sex, Viagra or no.

Moreover, even with normal amounts of testosterone, "Viagra does not just instantly give a man an erection," says Abraham Morgentaler, MD, associate clinical professor of urology at Harvard Medical School and author of The Viagra Myth.

Essentially, ED drugs work like this: What gives a man an erection is blood flow to the penis. They can also diminish a man's refractory time, meaning that after orgasm he can more quickly get an erection again.

The one thing most people know about Viagra and its cohorts is that they are not supposed to be used by men who take nitroglycerin, a common medication for heart patients that also dilates the blood vessels. That little piece of knowledge has translated into "Viagra is bad if you have a heart condition." Not so, says Arthur S.

In my practice, I spend a lot of time reassuring them that this isn't the case — and I tell men they must reassure the women too." Another big issue for many women: ED drugs drastically shorten the interval between climaxing and achieving another erection. There are, too, single women who worry that men with new-and-improved sexual abilities will be less likely to commit to marriage, and wives who worry that their husbands will be more apt to look outside the marriage for sex.

"A partner's Viagra use is now another reason some women give when I ask why they've come to see me," says Miami plastic surgeon Lee Gibstein, MD, who has performed breast implants, face-lifts, and even vaginal rejuvenation on women concerned about turning back the clock.

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This leads to misuse — not so much life-threatening as knuckleheaded. ED drugs inhibit that enzyme, allowing dilation to occur more easily and last longer.

Agatston, MD, a cardiologist and associate professor of medicine at the University of Miami Miller School of Medicine and Prevention editorial advisory board member. Agatston says, because Viagra keeps the blood vessels from becoming "sticky" and helps blood flow through them smoothly, not just in the penis but throughout the body, in the future, many of us—women included—may end up taking some small amount of Viagra daily, the way we take baby aspirin, which has the same nonsticking effect on blood itself.

So when a man takes Viagra, he has to avoid anything that dilates the blood vessels, not just nitroglycerides. Viagra won't give him a heart attack, but, taken with too much alcohol, it could make him pass out, Dr. Perhaps more damaging than ignorance of the physical ramifications of ED drugs is ignorance of their potential interpersonal blowback.

Certainly this was the case for Marjorie P., a 60-something woman who complained about the drugs on a 50 Web site: "Men have been saved from their middle-age sexual issues by Viagra and Cialis.

They can be thirty again, while I have to deal with the sexual issues of being my age.

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