How does Viagra work and when might it not be effective?
Viagra and similar medications work by inhibiting the enzyme phosphodiesterase type 5, which enhances the conversion of guanylate cyclase to cyclic guanosine monophosphate (cGMP), leading to relaxation of blood vessels and erection. However, Viagra will not work if there is no nerve impulse, such as when a person is intoxicated or experiencing anxiety about sexual performance.
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This is one answer. The complete system — the psychology, the biology, and the method — is in the book.
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