What is the safer alternative for viagra?

Dr Flo,
What is the best medication for erectile dysfunction or the inability to maintain an erection? It seems sildenafil is highly dangerous to humans hence the many deaths reported. Is there any other medication?
M K

Dear M K,
Being unable to achieve an erection once in a while is not a cause of concern. However, if it persists, it may be due to either a physical and/or a psychological issue. It may be due to psychological issues like stress, anxiety, depression, relationship issues, performance anxiety among others. You may also have a physical problem affecting the quality of your erections such as reduced testosterone levels, heart disease, high cholesterol levels, blocked blood vessels (atherosclerosis), diabetes mellitus, hypertension, nerve problems, some hypertension medicine, sleep disorders, obesity, alcoholism, smoking or other drugs, injuries to the spinal cord or pelvic region or peyronie’s disease (formation of scar tissue in the penis).

You should see a urologist, for proper examination and relevant tests, so that the exact source of the problem can be identified and dealt with. It may also be beneficial to see a mental health professional to explore any possible psychological causes of the dysfunction. Your partner also needs to be very supportive, and they may be included in the sessions. In the meantime, maintain a healthy diet, exercise regularly, get adequate sleep (seven to eight hours a day), avoid alcohol and cigarettes, and find a way to manage the stress. You may also benefit from pelvic floor exercises: contract the pelvic muscles as though you are stopping the flow of urine. You can practise this to identify the specific muscles by stopping the urine mid flow when you are urinating. Contract these muscles for about 10 seconds, 10 times in one set, six to 10 sets in a day.
Sildenafil, popularly known as Viagra, increases blood flow to the penis, therefore helping in achieving and maintaining an erection. It is also useful in managing pulmonary hypertension. Like any other medication, it has side effects, most of which are minor. However, those with heart disease, diabetes, high cholesterol, high blood pressure, smokers, and those over 50 years of age are at a higher risk of more severe side effects. That is why sildenafil should only be prescribed by a doctor after evaluating the cause of erectile dysfunction and all other risk factors, including any other medication you may be taking. Additional treatment for erectile dysfunction other than oral tablets include injections, urethral suppositories, use of a penis pump or surgery to fit implants, depending on the underlying cause.

Dr Flo,
I have been finding it hard to fall asleep for the past three weeks. Initially, it was due to stress at work. But I am still experiencing sleep problems despite the work issue being resolved. I find myself tired and yawning throughout the day. Is there something I can take for this?
Insomniac

Dear Insomniac,
Every once in a while almost every individual will experience problems either falling asleep or staying asleep. This is usually because something causes hyper-arousal – emotional, physical or psychological. In most cases, it is temporary and resolves on its own. Sometimes the situation is prolonged and can even become a habit. There are short term and long term health effects of inadequate sleep including headache, muscle aches, obesity, fatigue, poor mood regulation, impaired memory, difficulties with concentration and decision making, hyperactivity and aggression. You can get medication on prescription to help you fall asleep. While it is tempting to pop a pill to induce sleep, this works in the short term, but may cause problems like dependence on the medication to fall asleep and poor quality of sleep. It is best to have good sleep hygiene and therefore develop good sleep habits.

Sleep hygiene refers to practices that improve quality of night time sleep and contribute to alertness during the day. These include:
Make your bedroom a relaxing place with a good bed, and find a way to block out noise and light for instance by using heavy curtains.
Sleep at the same time and wake up at the same time every day, whether it is a work day, weekend, leave day or holiday.
Try to sleep when you are tired or sleepy, to avoid spending too much time awake trying to fall asleep.
If you are unable to fall asleep after 20 or more minutes, wake up and do something boring or calming, with the lights dimmed, until you feel sleepy again. Avoid bright light and gadgets (like TV, computer and phone) or anything very stimulating.
A well timed bath (one to two hours before bedtime) may help you sleep better.
Develop and follow a sleep time ritual for instance every day I shower at 9pm then I read a book for 30 minutes then I pray for 10 minutes in the dark in my bedroom before I get into bed.
Keep your day time routine the same, whether you had enough sleep or not. Hopefully, by evening, you will be tired enough to have a good night’s sleep. Avoiding your day time activities or sleeping during the day may worsen the insomnia.
Expose yourself to natural light during the day and keep the bedroom dark at night. The light and darkness will help your internal clock with the sleep-awake cycle.
Avoid using the bed or bedroom for work or watching TV, using the laptop or the phone.
Avoid caffeine or tea before sleep, as they can be stimulating. Do not take a heavy meal just before bed time. Milk has tryptophan which is a natural sleep inducer, so taking a cup of it may be helpful. Also avoid alcohol about four to six hours before bed as it interferes with the quality of sleep.
Avoid sleeping during the day. If you have to, take one 20 to 30 minutes day time nap before 3pm.
Do not look at the clock when you are unable to sleep. It adds to your stress and makes it more difficult to sleep. If this is a problem for you, hide the clock.

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