It is being used off label all over the place for heart conditions. That’s why i take it. The on label use is actually pretty annoying for the first few months.
No. You get hard easier and it takes longer to go down, but without (mental) stimulation, there is no erection. (for the vast majority of people taking sane dosages)
Not OP, but their statement read as if that effect wears off after the body develops tolerance to the medication. So, yes they did for a while (it was annoying) but no they don't now (for a few months)
There is NO tolerance development, on the contrary, increasing vascular health by long term PDE5 treatment and increasing psychological confidence over time make the treatment more effective with time.
You're taking about slightly different things - you about ED, the other person about "boner all day". They are not the same thing.
Slightly off topic, but this is why I don't really trust these "no tolerance" claims. That claim is usually very specific, while people's understanding of "tolerance" is often quite a bit wider.
I take 3 medications which each make "no tolerance" claims based on scientific studies. But my subjective experience is that all of them do build tolerance in some way - the subjective effect does wear off with time and taking a break does reduce the tolerance. One possible cause is mistaking the intended effect (ED) with side-effects (boner all day).
The first time I took sildenafil I had a bad headache and nausea, the next couple of times I didn't suffer from nausea and the headache wasn't as severe. I don't suffer from any side effects now other than my nose getting a bit stuffy every now and then, so in that sense I developed a tolerance to the medication's side effects. The boner effects still work just as reliably as day one, no tolerance development for me there.
you are lucky, in addition to the migraines and stuffy nose, sildenafil altered my vision making everything looked blue tinted. I tried a couple other drugs in that class but the migraines never went away.
Long term PDE 5 treatment lowers estrogen and increases testosterone. As a consequence of that, and its cardiovasvular effects, it makes it easier for the body to turn fat into energy by fat-browning, to grow muscles and to lose fat.
I don't know how people imagine viagra working - it's not like you take a pill, you continue browsing the internet, reading news, and suddenly, a boner lifts your desk.
Was news to me to read in a sibling that it also requires mental stimulation. I thought it was purely a physical inducement by the drug, as many drugs for other purposes induce a physical response without requiring mental effort.
>it's not like you take a pill, you continue browsing the internet, reading news, and suddenly, a boner lifts your desk.
Aside from the lifting the desk part, that's exactly how I imagine it working - and how it should work. You mean it also requires special sexual arousal? Well, even that it shouldn't be that difficult.
That’s not how it works at all. As someone with recent onset of ED taking viagra regularly, it’s been fantastic but it just makes me function like I should.
It takes about an hour to take effect (usually less for me) and lasts a little over 4 hours with some lingering effects for several hours later, with diminishing effects towards the 4 and above hours.
If I’m sexually stimulated during that time physically and or mentally, everything works like it should (erection). If during that time even when I would normally see peak effects around the 50 min to 90 min mark I’m driving or doing taxes or whatever non-sexually stimulating activity one might do, no erection at all.
> Viagra should make you "pop" regardless of what activity you're doing.
No it doesn't. It simply makes the effect of sexual stimulation more effective. If you body is not trying to engorge the penis it has little to no effect on that part of you.
Tadalafil works well for getting more out of your workouts too (I take that). Gives you an overall feeling of well-being too (better than any cup of joe), I no-bullshit begin my day with it.
I know a former executive of the company that was developing this drug for cardiovascular problems. He told me that they sold it because it had this "side-effect" that they couldn't get rid of. ;-)
Marketing is the key to business success.
(Talking to you, tech people)
Marketing as I was taught in a fortune 500 is the end to end process of delivering a product/service to the target customer.
Good product is the table stakes. (entry requirement)
Everything else is in the marketing plan.
We don't know how many medications actually function. We put them inside of increasingly complex animals and study the results to see what they do (and hope they don't die). Botox was intended to treat muscle spasms. Powerful anti-depressants are regularly prescribed for pain from nerve damage in people with no mental health issues. And MDMA isn't prescribed for anything because the powers that be prematurely decided to ban it based on completely fabricated claims, which I assume is part of a massive hundred-year conspiracy to make sure people... keep dying from alcohol? Not totally sure about that last one, but it's hard to deny the facts.
I work on health equity things in healthcare occasionally. I think this is so dumb. MDMA rejected by panel recently for evaluating rescheduling for use in PTSD.
“ Panelists pointed to flawed studies that could have skewed the results, missing follow-up data on patient outcomes and a lack of diversity among participants. The vast majority of patients were white, with only five Black patients receiving MDMA, raising questions about the generalizability of the results.
“The fact that this study has so many white participants is problematic because I don’t want something to roll out that only helps this one group,” said Elizabeth Joniak-Grant, the group’s patient representative. “
this is the case with almost all drugs. for example almost every antidepressants was the result of a weight loss or something like that.
drug research is worse than training an LLM. you feed it to random people and then compare effects with initial conditions and of something looks good you try with more control.
Just a word to the wise, viagra can cause tinnitus by putting too much blood through tiny vessels in your ears. Be careful of high doses while hydrated and exercising
Depends. The kind of exercise you're thinking can be done vigorously and for a long period -- or, for some people, it could be a quick 5-10 minute thing that feels vigorous but really doesn't involve that much muscular effort.
It's common to have a 1 hour running or a lifting session 3-4 times a week but kudos to you and/or my condolences to your partner if your vigorous exercise lasts that long every time.
It can also be caused by SSRIs and NDRIs and benzos! Great side effect if you're already feeling depressed. Although benzos can also help, depending. I think 80% of cases are a brain thing and not an ear thing, but because ENTs and audiologists have exactly one hammer (hearing aids), we get fuck all for research.
> The OxHARP trial was a meticulously designed double-blind, placebo-controlled study involving 75 participants who had experienced a minor stroke and showed signs of mild to moderate small vessel disease. Each participant received sildenafil, a placebo, and cilostazol (a similar drug) over three-week periods in a randomised order.
I feel like dudes will know if they got Viagra or not? It doesn't seem like cilostazol has the same kind of effects on them, or does it? So is it really a placebo?
Viagra doesn't "make" you hard, you still need sexual stimulus. I've taken it and then the sexual opportunity fell through, so I went back to coding or whatever, and I didn't notice anything different.
I can (at the ripe old age of 78) confirm this completely. Without stimulation, nothing except facial flushing. With stimulation, and only with stimulation, a functioning erection.
It’s not unrelated actually, there is some tissue inside the nose cavity that is similar to the erectile tissue of the penis. That’s why the nose gets “stuffy” from sildenafil, and that’s why you sometimes sneeze when aroused.
Maybe, but maybe not. If I told you I'm either giving you actual viagra or a placebo, you might get more aroused even if given placebo. Because psychologically you'll be thinking "There's at least a chance I took viagra right now"
Viagra doesn't work for everyone; it's not like you take it an get automatically erect, even with sexual stimulus. There are many reasons for ED, some of them in the brain, some of them in hormones. Viagra only helps with cardiovascular ones.
I had a highly intelligent and good looking roommate with ED and it was devastating that at such a young age he couldnt’t maintian an erection even with viagra, cialis. I urged him to see a doctor and it turns out the ‘baloon’ down there that gets filled with blood also has a valve to keep the blood in. He had a misfunctioning valve and blood was leaking out and erection was soft. Sad story, as it seems to have had psychological effects on this person. Not sure it was much they could do at the time other than a manual pump fix. He did have a girlfriend though and they found other ways around it, though I heard she was cheating on him in search for a normal experience.
If this is true they altered zinc metabolism might play a role in dementia since zinc is the cofactor for PDE5, or that people who do not make enough cGMP are prone to dementia (which also means they might be low in GTP and GTP regulates glucose-insulin secretion so...)
So I think they can do better then "here is a pill give me more money".
This is how i figured out NO would help my heart. Eating cereal colored with beet powder. If i understand the magic happens when it combines with saliva. So chewing beets might help.
IIRC the benefit of viagra comes from increased NO in blood. You naturally get no when you breathe from your nose. I'd like to see a research on viagra use and mouthbreathing relation.
Seems high to me, but I've never taken the drug. I assume most people take it just a few times a week for it's intended use? Is anyone aware of research that shows positive benefits to health at recreational doses?
That’s a standard dose. 3X per day is because it has a short half life.
> Is anyone aware of research that shows positive benefits to health at recreational doses?
Recreational doses? What does that mean? Excessive vasodilation isn’t going to be fun. You actually need some vasoconstriction to balance your blood pressure. Too much and you’re just going to get headaches and lightheaded. Excessive vasodilation would be expected to worsen cognition.
Giving the parent the benefit of the doubt, they probably were confused by the idea of people taking these pills to get high. That's generally what is meant by the term "recreational use" when it comes to drugs.
Well. too sad I can't take it. It gives me terrible heartburn (an acute stomach pain, not a heart related condition) that only partially responds to anti-acids such as Alka Seltzer.
Also, extremelly stuffy nose, to the point where basically I need to breath by the mouth. And the red eyes, eyes as red as if had just smoke the biggest and strongest joint ever.
Yes, I tried to use it recreationally a few times. It is not worth the pain for me.
And then the dosage in the study: 50mg 3X times a day? I am not sure I could even survive the first day.
Did I mention the headaches too?
EDIT: Before someone asks... At least the on-label effect works really well in a recreational setting for me. But it is kind of funny to have persistent carbon-steel erections when you're feeling miserable with stomach pain and can't breath well. Doing oral sex with a stuffy nose is... interesting.
Were you taking authentic or internet genetics from China/India?
Ive gone through a decent amount of generics over the years, from several sources, and even though the label is the same, they almost all act differently on me. Some give me a flushed red face. Some cause a dull headache. Some don't cause anything negative thank God. They all work though.
I think the Indian/Chinese ones are laced with garbage and what I feel depends on what else was in there.
The one time I used it over a few weeks was a generic brand. The on-label effect worked, but I had one disturbing side effect: terrible nightmares.
Unscientific conclusion, but the nights I took it when with my new gf at the time, nightmares followed. Binned the remaining pills, nightmares vanished. Possibly the generic additives factor, or maybe the drug itself. Who knows, never tried it again after that.
From my experience taking it hundreds of times over 10+ years, from at least 10 different sources.. since almost every source had a distinctive side effect from the others, while entire packets of some sources had zero side effects for me... I'd blame the shady quality of the genetics more likely than the actual original drug.
I'm sure the real drug has some mild side effects too for some people, but the fact that I can distinctively tell the difference between sources makes me think a lot of other stuff is making it into the generics.
Sildenafil is fairly short acting, so that’s probably the reason for 3x/day (but a better choice if you don’t need a whole day of effects because of its side effects like sinus congestion).
Tadalafil (Cialis) would probably be a better choice, and is used at daily (but reduced) dosing for prostrate issues.
Having tried it recreationally and also getting the stuffy nose, NSAIDs counter that effectively for me. Of course if you also get acute heartburn you want to be careful with combining it with something that can be tough on the stomach...
Talk to your doctor about whether you can combine with a proton pump inhibitor like Omeprazole. There's are downsides (in particular, sustained use can mask other things, including serious issues) but I've not had a single episode of heartburn since I was out on it.
> Also, extremelly stuffy nose, to the point where basically I need to breath by the mouth. And the red eyes, eyes as red as if had just smoke the biggest and strongest joint ever.
Looks like an allergic reaction; it could be not so much in sildenafil itself, but what they use as filler for the pills.
Yeah I occasionally take it or tadalafil for BPH/prostatitis because they have less side effects than alpha blockers. I've got GERD and a hiatal hernia and, man, it really fires it up. Chewing gum sort of helps. I also only take half of a 25mg. I'll sometimes get the stuffy nose and rarely a headache but the stomach issues almost prevent me from using it. I've sort of grown used to tolerating extreme stomach pain though, so I still use it if I really need it.
Man. Based on personal experience at my family. I bet you're carefully keeping tabs on your stomach with a doctor, but if not, don't grow used to tolerate extreme stomach pain.
I've seen stomach cancer in my family, and I would like to encourage you do whatever you can to minimize the risk for you.
Yeah, I know. I need to get another checkup but I've been through the cycle many times.. Get scoped.. Get told to take PPIs.. they make it worse.. At some point I just decided to manage it myself.
Nope. You know that erectile tissue? Well, it's not just in the penis, it's also in the nose as well. Hence the stuffy nose. It's not allergies, it's the same sort of tissue having the same response.
That "pump" in your nose you may feel just prior to a good sneeze? That's those tissues swelling with blood.
Just hijacking to add a public health warning about BPH. Like many men as they get older, I was getting up several times a night to pee. Thought I would just put up with it until it got worse.
I went on a yacht for the weekend, drank quite a few beers and crashed to sleep.
I awoke to find out I couldn't pee at all. I can't describe how painful things were by the time I staggered into the emergency department that evening. Definitely the worst experience of my life. A few weeks later a guy was winched off a boat by helicopter with the same condition - one of his mates had been tasked with catheterising him using the rubber fuel hose from the boat's engine, but was unsuccessful.
If you are having trouble urinating, seek medical attention - don't ignore it.
why on a yacht, though? i have a similar problem. shy bladder plus tense pelvic base. maybe even somewhat increased prostate (i don't know). so peeing is always something i need a little privacy for. but everytime i'm scuba diving plus out with a boat it's like my prostate is locking up completely. extremely weird and uncomfortable feeling. on those small boats there is never a toilet but there are sneaky options that in theory should work but don't. so i'm wondering if the wavy motion might have something to do with this problem.
I do the same because 20 years ago a roadside bomb blew up next to the vehicle I was riding in and caused it to roll over and down an embankment and the repeated impacts compressed my lumbar discs which after about 10 years manifested as degenerative disc disease at L5-S1 and a series of disc bulges and scar tissue build-up up and down my lumbar region that compressed the nerves leading to my genitals and ultimately led to a spinal fusion of that area...
...and a low dose makes it so my penis functions normally.
I always wonder if there is a circular logic flaw in survey studies of recreation and dementia: could it be that the folks who are chasing Viagra or running marathons don't get dementia, because the ones with dementia don't pursue these activities?
This is known as a confounding bias. A quality study should try to eliminate the obvious ones, but of course there may still he an infinite number of hidden confounding variables.
This may be a sincere statement, but I'm not sure it's a helpful one. What data do we have? A 2:1 advantage in published studies that it does help. Since there is no such thing in science as absolute proof of anything, these are pretty good odds. Certainly more work will be done in the future to try to replicate the results and figure out the one negative outcome. But until then, we cannot say that the evidence is in any way "equal" on both sides.
The first one is just a combination of some computer modeling guessing at possibly useful existing drugs and a look at the existing patient data showing that people who were on these seemed to have Alzheimer's less. It's very clear that it's just an initial step that doesn't actually show there's a benefit.
The second is more of that same basic kind of research, but weighing in the opposite direction: it showed no association with Alzheimer's for people with a specific other condition who got these drugs vs. ones with the same condition that didn't (also they did some cell culture testing outside the body that didn't show any effect/improvement).
This new one is an actual double-blind study giving people the drug. Equally important, it's not claiming an effect on Alzheimer's, but vascular dementia, a different form of dementia that's directly related to blood flow and therefore to Viagra's known effects. Of course it's still just really a marker for future research on if this is broadly useful.
They certainly are hard, because dementia is something that develops over years if not decades. Anytime it takes that long to do a single iteration of your experiment, it's hard!
Does it need to be, though? You can survey healthy but senior populations about their habits, and then over the following years track what happens.
If medical records were public, the answers could even be in those for any medicines that are prescription based. You could then make statements like "A% of patients who took drug B within C years did/didn't develop disease D".
That's not a randomized controlled trial though. You might find a correlation, but you couldn't actually establish causation, or eliminate hidden variables.
We have to get over this false meme where people think RCTs prove causation and the rest prove correlation.
An RCT doesn’t prove causation, it only might observe another correlation that contributes to our causal inferences based on the convergence of evidence.
We don’t have RCTs for most things that you take for granted.
That second study didn’t use as robust of methods as the first, and they each used observational data that benefit from advanced methods (propensity score analysis).
With an RCT, the evidence is substantially increased.
I’d conclude sildenafil reduces risk of age-associated cognitive decline
The 3x daily dosage is surprising to me because the one notable warning that comes with the prescription is to never take it more than once in a day. In fact, I would go as far to say that if you've been prescribed Viagra the only things you know about it are: it will help you get boners, you should talk to a doctor if you have a heart condition, and you should never use it more than once a day. The warning seemed extra ominous because it was basically the only warning, so I adhered to it fairly strictly at first.
About a year later I talked to some gay male friends and they all said that was ridiculous, that they freely take it multiple times per day, and I that should too. So now I do (as needed) and it's worked very well. Plus, the subscription I get through Hims sends me a giant bottle of 20mg pills (at an unreasonably high cost) so I am able to easily dose myself instead of being given a one-size-fits-all dosage, like we get with most medications. My low dose is 3 pills and my high dose is 5 pills.
Now there are many options beyond Viagra including a ton of intriguing combination drugs that use multiple erection drugs and/or other drugs with tangential effects. But I like that I know how Viagra works for me personally based on experience. I think we all underestimate how much drugs very from person to person. Plus, now that I think about the lack of warnings that come with Viagra, it actually seems like an unusually benign drug.
A typical dose of Viagra is 25,50 or 100 mg, so your 3-5 doses of 20 mg isn't even atypical. Also, there are plenty of warnings that come with Viagra usage. You may have not taken the time to read them.
It’s more of a testament to a potential beneficial side effect of an already widely used drug for something entirely different.
I (in America) actually exercise 5-6 days a week with regular sauna use afterwards averaging about 2-2.5 hours per total session (20 minutes from sauna). I coincidentally even happen to take long hot baths frequently (3-4 times a week for an hour) as a form of stress relief, relaxation, and it further helps with muscle recovery.
Absolutely none of that helps me to a notable degree with what the specific pill in question does which I also use regularly. In addition, viagra adds an additional say 4 hours per day per pill to my normal weekly routine of increased blood flow that may help reduce risk of dementia when I’m older. That’s a big win in my book if it’s true as it’s something I already do and is additive.
One trial with 62 patients and then "Since we did not meet our sample size due to the loss of funding and could not confirm our primary hypothesis, larger studies of longer duration, likely multi-center, are needed to confirm the findings from this study. "
In the US, it does but the bar is laughably low. For example, you can get a prescription on blewchew.com which gets "reviewed" by their "consulting physicians" and have it in hand in a day or two.
Yes, but how do you know what it really is? Plenty of legit generics have been found to be complete bunk,(1) let alone gray market ED drugs. Other generics have high levels of cancer causing contaminates. Eg TMAO in metformin, chantix, ranitidine, and more. 2
You can also buy these things as research chemical but same question as above.
Always remember, made in USA is likely a misdirection. You buy this stuff in bulk off of Alibaba like sites, buy some made in USA containers, repackage it in the USA and now you can claim the whole thing is “made in USA.”
Some of these places will list chemical analysis of their drugs but who knows what they tested what they send? Also, when did they test, who tested it? Etc. would love to hear if anyone has figured this out.
Just some quick references off the top of my head,
Which is why every package I get from India (to Canada) goes through heavy inspection, to the point that most/all Indian pharmacies just won’t ship here anymore.
In the US, yeah, but arguably it shouldn't be. Probably the only good reason for controlling it is risk of priapism from people using it stupidly, which is an extremely bad "go to the ER now" condition.
ummmmmm... no offense if you have dementia and i have no easy way to ask about it, sorry this question is personal and you could easily just be asking for a friend
It's thought to improve neuronal density in the hippocampus and also (higher p) to increase bone density. A lot of bodybuilders and athletes use it for increased blood flow benefits, partly because it seems to have fewer side effects then sidenafil (which can cause mild retinal damage leading to a blue tint in the vision; probably why Pfizer used a blue tint in all their advertising). I have no personal experience with it but the theory seems sound.
I used to buy it over the counter in Mexico for recreational purposes, now I have some ancient prescription I don’t need that’s renewed annually for free. A stiff breeze will work, it’s actually remarkable. It will totally make your skin flush and make you feel light headed, not surprised by any of this.
Viagra increases the effect of nitric oxide, which is bad stuff when it gets into cytochrome complex iv in the mitochondria (IIRC). I would personally suspect based on that, that its effects on brain health would be negative in spite of blood flow.
Nitric oxide is a crucial part of the biology of life, especially animals. Viagra does not specifically impact the amount of nitric oxide in the body or the nitric oxide cycle mediated by arginine. It instead enhances the effect of NO in the smooth muscle. I would not worry about nitric oxide in general as it’s crucial for the basic functioning of your body.
2. There's no such thing as increasing "the effect" of such a nonspecific chemical as nitrogen oxide. There's tons of effects, and it increases some of them. Also, can the active ingredient get into mitochondria?
Have done regular exercise to improve my Long COVID state for 6 months now. It has helped, but it has its limits too. If I overdo it, I get worse, but I can't always tell until later. And other health issues are limiting what forms of exercise I can do.
Hard problems rarely have one simple solution, or they wouldn't be hard, would they?
> The OxHARP trial was a meticulously designed double-blind, placebo-controlled study involving 75 participants who had experienced a minor stroke and showed signs of mild to moderate small vessel disease.
I mean, I think if going for a walk were a magic bullet for stroke rehabilitation, someone would have noticed by now.
I'm not knowledgeable about stroke rehabilitation specifically, but the benefits of walking are extremely robust. Especially if you're talking about the difference between a totally sedentary lifestyle and one which includes a substantial amount of walking.
of course none of that "increases productivity or GDP" so the ruling class won't consider it. of course when they start dying like Japan with low birth rates, their 'solution' is to have a government funded dating app instead of doing the obvious.
Less air pollution does increase productivity (air pollution is actually really bad for your mental performance, it's a surprisingly strong effect) and it seems to me "the ruling class" does consider it seeing as the Clean Air Act exists.
Btw, Japan has walkable cities of course but also has low inequality (but not so high wealth). Approximately nothing is known to increase birth rates except for being highly religious though; it seems they mostly collapse when people have anything else to do for fun besides have sex. So basically it's caused by being on your phone too much.
Given the opportunity, people will do anything else than have more than 2 children, which is the requirement to increase the population. There’s just better stuff to do than spend multiple years taking care of the baby. Any argument other than “for the greater good” won’t sound reasonable to educated population. Talking to my friends, especially women who already have a child, they keep mentioning the opportunity loss when you go through pregnancy and birth (career, vacations, personal growth and etc.). You can call it selfish, but it’s the reality and nobody wants to fall behind. Everything you mentioned is great, and I support it, but I doubt it’ll convince young people to sacrifice at the very minimum 6 years of their life (pregnancy + first year).
Are people really saying they missed out on "personal growth" when they had kids?
Taking care of kids is not that hard or much of a sacrifice really. It would be super easy if things were even more communal. There's just really not that much great stuff that you are missing out on after like 35/40+. In truth most of the stuff geared to people in that age range is designed for people with kids. I think a lot of people would prefer to have more than 2 kids. The major issue is that SO much stuff is designed for the family of four. Yeah there's 3rd row seating, but it's annoying. Furniture that comes in 2 packs, theme parks, restaurant tables, vacation accommodations, etc. Because of modern life and the things we are accustomed to the logistical management burden of more than two children is very significant.
Not 35+, think of mid/late 20s as it used to be about 20 years ago. Peak health, some disposable income, educated, but also good age to bear a child. If you start having children at 35-40, it’ll be harder for you to have 3+ children, but now for health reasons.
Up here in Canada, according to statistics, only 20% of couples want to have 3+ children. If I recall it correctly, it’s not that they have it, but plan to, which might not even happen due to socioeconomic reasons.
I don’t think majority of young people want to have 3 children though, as you mentioned. Even if I do an extremely unscientific look around in my circles, the number of couples who want that is 0. I obviously might be in a bubble, but it’s a fairly common sentiment especially for my age group.
For me having kids has been massive personal growth. In some ways having kids is synergistic with many of life’s goals and personal growth. Career, less so, but I can a more capable human for being a parent.
You’re most likely right, but people achieve the same result with having one or two children as well. It’s having minimum of 3 children that is needed to have a population growth, and that’s sometimes a bad life choice for a young woman nowadays. Again, back to opportunity loss.
It’s way easier for me to babble, because if I was a father I wouldn’t have to go through pregnancy period. Statistically it also shows men want more children than women, and that’s fair because it affects our physical health way less.
It also seems to cause melanoma, so... Pomergranate/beetroot/garlic seem safer. Arginine/citrulline perhaps as well (all of them increase NO in the blood).
"In 2014, a study published in JAMA Internal Medicine found that the use of sildenafil, more commonly known by its brand name Viagra, within 3 months prior to the study’s start increased the likelihood of developing melanoma by as much as 84 percent.'
Still, it's a food for thought. I know correlation is not causation but there might be some link that hits some folks unexpectedly hard. I was taking sildenafil to improve brain hypoperfusion from long covid and one day a fast growing mole appeared on my arm that reached 2cm diameter in a few days - the suspicion was on nodular melanoma or pyogenic granuloma and it turned out to be the latter. I stopped taking sildenafil immediately. I am in the socioeconomic group they mentioned.
