Sex-enhancing drugs


Question: What are the differences between Viagra, Cialis, and Levitra?

Michael Perelman: I am privileged, actually, to be an advisor to all three of these companies and there are remarkable similarities between these drugs because they are all in the same class of medication and they all work in the same way. Essentially they help blood accumulate in the penis by diminishing the outflow; it does not go back to the rest of the body quite as fast as it might otherwise. We walk around normally flaccid as men, without an erection, because there is an enzyme, phosphoridesterades [ph?] that degrades the potential for erection normally, so these drugs all block that enzyme. So it is as if you have pulled the plug in the bathtub and then you stuff it up with Kleenex and it kind of goes out more slowly. So if you have water coming in and the water is going out more slowly, the bathtub gets filled up quite nicely, and, in fact, would even overflow. So how do these drugs work? The drugs all work very similarly in that they affect that enzyme. Cyalis has a longer duration of action. What that means is it lasts from 24 to 48 hours verses the other drugs last a less long period of time. Because each of these molecules is unique, even though they are part of the same class of drugs, they have slightly different side effects. So while Levitra and Viagra would remain within the system, within the body, a shorter amount of time than Cyalis, in many cases that would be desirable and in some cases that would not be desirable, so this is important that the patient have a conversation with his physician as to really what’s best for them, and there are reasons to consider one drug over another as what to try first. In fact, Cyalis, for instance, has just been approved for daily dosing, so smaller amounts of the drug are used on a daily basis, almost like a male vitamin, to keep a certain level of arousal, capacity for arousal I should say in place with less side effect, and yet the other two drugs that are used on what is called a PRN basis and as needed basis, or do not last in the body as long a period of time. So the side effect profile, which is something that you do not see advertised on television and discussed in a serious way, is more, again, the stuff of late night jokes, long-lasting erections. The other aspects or side effects are something that you need to discuss with your physician, and that will help determine which drug is best for you, and that can be a trial and error experiment with some guidance from your doctor as to this notion of duration of action. Do you want a drug that has more availability for more spontaneity or do you want a drug that you know is going to work for you that you are comfortable using? And in that sense, Viagra, having been first to market, is many people’s choice only because, like Kleenex, we do not think of a facial tissue, we frequently will use the name Kleenex, the same has been true for Viagra, but there are definite advantages and sometimes superiority to the other drugs. It’s a complex answer to what would seem to be a simple question, but that’s why each person who is unique, go back to the sexual tipping point model, needs to discuss this with their physician.

Quesiton: What are the drawbacks to taking these drugs?

Michael Perelman: I think the biggest downside to these drugs is they can provide men with an erroneous sense of their level of arousal, which can cause its own problems.  So you take a drug like this and you find your body more responsive than it was, and that is a very good thing, but sometimes, for some men, this can cause difficulty in their relationships because they are really not being sensitive to their partner’s level of arousal.  So if she is responding normally for her, that may not be as quickly as it now is for him, being pharmaceutically enhanced, and that can cause some tension.  It changes the equilibrium in their relationship.  So relationship problems can sometimes occur as a consequence of the use of these drugs, and that’s really where I think there is a lot of opportunity for mental health professionals like myself, to help people learn how to learn these drugs in a way that enhances their life, if spontaneously that doesn’t happen already.  And we know half the people using these drugs are really very content and continue using these drugs; but we also know that half the people who try them choose not to continue using them for a variety of reasons, some of those reasons being side effects; some of those reasons being lack of efficacy, it does not work as well as they hoped; sometimes, though, it’s the negative impact it has on the relationship.  And then, finally, if a man thinks he is more aroused than he really is, he may find that it’s difficult to reach orgasm because he really is not that turned on to begin with.  He is pharmaceutically assisted in obtaining and maintaining his erection, and most of us, as guys, sort of think, well, if I have an erection, I must be turned on, but in reality, that’s not true, being turned on, if you will, is a very complex psycho physiological process; it is in the mind and the body again, back to that sexual tipping point.  So you are turned on, you think, because you have an erection, and yet you’re really not as turned on as you might be so you have difficult reaching orgasm, and that can become very distressing, both to the man and his partner, and I have seen a slight increase in that particular problem both with our aging population and with men using these drugs.

Question: Can alternative therapies cure sexual dysfunction?

Michael Perelman: Sure.  I try and find, you know, really a lot of what I do, I think of myself sometimes as a  detective.  I am asking questions, detailed questions, about whatever the presenting problem is that someone suggests to me that they are concerned about.  And it’s in the asking of these questions I find the most amazing answers and solutions because we have a society that, in general, has not looked at this in detail in this kind of precise way.  While men, we kidded around sex, for years, you know, locker room jokes, and women would talk to their friends perhaps even more than men did about their sex lives, detailed questions and answers, which is the way that you solve any problem, was not done.  So, in my office, I ask very specific questions.  It is not out of prurient interest, but the way you solve problems is you find out what is going on.  I am also going to find out what else helps you relax, so if historically you have taken walks or you have jogged, and that helps you feel good and keep in shape, I am going to encourage you to do that.  If meditations works for you historically, I’ll encourage you to go back to that, because frequently, if somebody is having a central problem, they become depressed and anxious and they stop doing a lot of things that have been helpful and healthy to them.  So when I talk about things like this, people will frequently say, “Oh, I’ve done that already, it didn’t help.”  But we’ll talk about you have to get all ten of your ducks lined up facing the same direction, you can’t just try getting a good night’s sleep, oh, that didn’t make a difference, and cutting down on your alcohol, that did not make a difference, you need your cut down on your alcohol, be more careful, be more in tune with what you are experiencing.  Now, an interesting movement within mental health in general is this whole notional of mindfulness, sort of an integration of East/West philosophy, and the same thing can be true of sex.  If you think again of that sexual tipping point, sexual fantasy, which could be erotic thoughts about others, but it could just be remembering the best time that you had with your wife two years ago.  It does not have to be about other people.  Sexual fantasy can also be being in the moment and eroticizing your experience, being aware of what you are feeling that feels good and being able to screen out distraction so, you know, the siren goes off on the car that just got bumped outside, you hear the garbage truck going by, you know, some kids are laughing or a dog is barking, that you are able to keep your focus on the sexual experience and not be distracted, and there are all kinds of ways of learning how to do that that are really very similar to other ways we learn how to discipline and control our mind.  It’s just people don’t think about that as necessary, because when they were younger, they did not have to think about all these things, it just worked in much the same way as when I was younger I didn’t have to stretch before I played tennis, it did not matter; but now I better do that or I am going to get hurt.

Michael Perelman says there are a host of options out there, including alternative therapies, but it all depends on your sexual tipping point.

Are we really addicted to technology?

Fear that new technologies are addictive isn't a modern phenomenon.

Credit: Rodion Kutsaev via Unsplash
Technology & Innovation

This article was originally published on our sister site, Freethink, which has partnered with the Build for Tomorrow podcast to go inside new episodes each month. Subscribe here to learn more about the crazy, curious things from history that shaped us, and how we can shape the future.

In many ways, technology has made our lives better. Through smartphones, apps, and social media platforms we can now work more efficiently and connect in ways that would have been unimaginable just decades ago.

But as we've grown to rely on technology for a lot of our professional and personal needs, most of us are asking tough questions about the role technology plays in our own lives. Are we becoming too dependent on technology to the point that it's actually harming us?

In the latest episode of Build for Tomorrow, host and Entrepreneur Editor-in-Chief Jason Feifer takes on the thorny question: is technology addictive?

Popularizing medical language

What makes something addictive rather than just engaging? It's a meaningful distinction because if technology is addictive, the next question could be: are the creators of popular digital technologies, like smartphones and social media apps, intentionally creating things that are addictive? If so, should they be held responsible?

To answer those questions, we've first got to agree on a definition of "addiction." As it turns out, that's not quite as easy as it sounds.

If we don't have a good definition of what we're talking about, then we can't properly help people.


"Over the past few decades, a lot of effort has gone into destigmatizing conversations about mental health, which of course is a very good thing," Feifer explains. It also means that medical language has entered into our vernacular —we're now more comfortable using clinical words outside of a specific diagnosis.

"We've all got that one friend who says, 'Oh, I'm a little bit OCD' or that friend who says, 'Oh, this is my big PTSD moment,'" Liam Satchell, a lecturer in psychology at the University of Winchester and guest on the podcast, says. He's concerned about how the word "addiction" gets tossed around by people with no background in mental health. An increased concern surrounding "tech addiction" isn't actually being driven by concern among psychiatric professionals, he says.

"These sorts of concerns about things like internet use or social media use haven't come from the psychiatric community as much," Satchell says. "They've come from people who are interested in technology first."

The casual use of medical language can lead to confusion about what is actually a mental health concern. We need a reliable standard for recognizing, discussing, and ultimately treating psychological conditions.

"If we don't have a good definition of what we're talking about, then we can't properly help people," Satchell says. That's why, according to Satchell, the psychiatric definition of addiction being based around experiencing distress or significant family, social, or occupational disruption needs to be included in any definition of addiction we may use.

Too much reading causes... heat rashes?

But as Feifer points out in his podcast, both popularizing medical language and the fear that new technologies are addictive aren't totally modern phenomena.

Take, for instance, the concept of "reading mania."

In the 18th Century, an author named J. G. Heinzmann claimed that people who read too many novels could experience something called "reading mania." This condition, Heinzmann explained, could cause many symptoms, including: "weakening of the eyes, heat rashes, gout, arthritis, hemorrhoids, asthma, apoplexy, pulmonary disease, indigestion, blocking of the bowels, nervous disorder, migraines, epilepsy, hypochondria, and melancholy."

"That is all very specific! But really, even the term 'reading mania' is medical," Feifer says.

"Manic episodes are not a joke, folks. But this didn't stop people a century later from applying the same term to wristwatches."

Indeed, an 1889 piece in the Newcastle Weekly Courant declared: "The watch mania, as it is called, is certainly excessive; indeed it becomes rabid."

Similar concerns have echoed throughout history about the radio, telephone, TV, and video games.

"It may sound comical in our modern context, but back then, when those new technologies were the latest distraction, they were probably really engaging. People spent too much time doing them," Feifer says. "And what can we say about that now, having seen it play out over and over and over again? We can say it's common. It's a common behavior. Doesn't mean it's the healthiest one. It's just not a medical problem."

Few today would argue that novels are in-and-of-themselves addictive — regardless of how voraciously you may have consumed your last favorite novel. So, what happened? Were these things ever addictive — and if not, what was happening in these moments of concern?

People are complicated, our relationship with new technology is complicated, and addiction is complicated — and our efforts to simplify very complex things, and make generalizations across broad portions of the population, can lead to real harm.


There's a risk of pathologizing normal behavior, says Joel Billieux, professor of clinical psychology and psychological assessment at the University of Lausanne in Switzerland, and guest on the podcast. He's on a mission to understand how we can suss out what is truly addictive behavior versus what is normal behavior that we're calling addictive.

For Billieux and other professionals, this isn't just a rhetorical game. He uses the example of gaming addiction, which has come under increased scrutiny over the past half-decade. The language used around the subject of gaming addiction will determine how behaviors of potential patients are analyzed — and ultimately what treatment is recommended.

"For a lot of people you can realize that the gaming is actually a coping (mechanism for) social anxiety or trauma or depression," says Billieux.

"Those cases, of course, you will not necessarily target gaming per se. You will target what caused depression. And then as a result, If you succeed, gaming will diminish."

In some instances, a person might legitimately be addicted to gaming or technology, and require the corresponding treatment — but that treatment might be the wrong answer for another person.

"None of this is to discount that for some people, technology is a factor in a mental health problem," says Feifer.

"I am also not discounting that individual people can use technology such as smartphones or social media to a degree where it has a genuine negative impact on their lives. But the point here to understand is that people are complicated, our relationship with new technology is complicated, and addiction is complicated — and our efforts to simplify very complex things, and make generalizations across broad portions of the population, can lead to real harm."

Behavioral addiction is a notoriously complex thing for professionals to diagnose — even more so since the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the book professionals use to classify mental disorders, introduced a new idea about addiction in 2013.

"The DSM-5 grouped substance addiction with gambling addiction — this is the first time that substance addiction was directly categorized with any kind of behavioral addiction," Feifer says.

"And then, the DSM-5 went a tiny bit further — and proposed that other potentially addictive behaviors require further study."

This might not sound like that big of a deal to laypeople, but its effect was massive in medicine.

"Researchers started launching studies — not to see if a behavior like social media use can be addictive, but rather, to start with the assumption that social media use is addictive, and then to see how many people have the addiction," says Feifer.

Learned helplessness

The assumption that a lot of us are addicted to technology may itself be harming us by undermining our autonomy and belief that we have agency to create change in our own lives. That's what Nir Eyal, author of the books Hooked and Indistractable, calls 'learned helplessness.'

"The price of living in a world with so many good things in it is that sometimes we have to learn these new skills, these new behaviors to moderate our use," Eyal says. "One surefire way to not do anything is to believe you are powerless. That's what learned helplessness is all about."

So if it's not an addiction that most of us are experiencing when we check our phones 90 times a day or are wondering about what our followers are saying on Twitter — then what is it?

"A choice, a willful choice, and perhaps some people would not agree or would criticize your choices. But I think we cannot consider that as something that is pathological in the clinical sense," says Billieux.

Of course, for some people technology can be addictive.

"If something is genuinely interfering with your social or occupational life, and you have no ability to control it, then please seek help," says Feifer.

But for the vast majority of people, thinking about our use of technology as a choice — albeit not always a healthy one — can be the first step to overcoming unwanted habits.

For more, be sure to check out the Build for Tomorrow episode here.

Why the U.S. and Belgium are culture buddies

The Inglehart-Welzel World Cultural map replaces geographic accuracy with closeness in terms of values.

Credit: World Values Survey, public domain.
Strange Maps
  • This map replaces geography with another type of closeness: cultural values.
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CT scans of shark intestines find Nikola Tesla’s one-way valve

Evolution proves to be just about as ingenious as Nikola Tesla

Credit: Gerald Schömbs / Unsplash
Surprising Science
  • For the first time, scientists developed 3D scans of shark intestines to learn how they digest what they eat.
  • The scans reveal an intestinal structure that looks awfully familiar — it looks like a Tesla valve.
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Mammals dream about the world they are entering even before birth

A study finds that baby mammals dream about the world they are about to experience to prepare their senses.

Michael C. Crair et al, Science, 2021.
Surprising Science
  • Researchers find that babies of mammals dream about the world they are entering.
  • The study focused on neonatal waves in mice before they first opened their eyes.
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