Victory: Pfizer kicked off a promotional campaign for Viagra in March with a global "victory" theme.

Ditka: Bayer hired football coach Mike Ditka to encourage men with erectile dysfunction to take the "Levitra Challenge."

Staff: Three Men’s Clinics specializing in men’s sexual performance have opened in Vancouver, Ottawa and Toronto, where David Colapinto (left) works as a support counsellor and Dr. John Aquino offers treatment to patients. (Men’s Clinic photo).

With Cialis and Levitra now approved for use in Canada, the increasing number of options for treatment of the serious problem of erectile dysfunction spells good news for millions men.

Five years ago, the "little blue pill" hit the market in Canada, causing a tidal wave of prescriptions for men suffering erectile dysfunction. Hailed as a "magic bullet," the distinctive diamond-shaped Viagra tablet from Pfizer Pharmaceuticals has become one of the most recognizable medications in the 21st-century marketplace.

But the inevitable competitors have risen to the challenge, vying to unseat the king of potency. Blue has been joined by yellow and orange.

Late last year, Cialis, from Eli Lilly, was approved for use by Canadians and, now in March, Levitra, from Bayer and GlaxoSmithKline, made its appearance.

All belong to the same family of drugs and work by blocking an enzyme that can prevent the blood flow to the penis that enables men to achieve and maintain an erection. But there are differences between them that make the trio a menage a trois of options for ED sufferers.

"All are very effective but the new drugs bring other options for the patients," says Dr. Miguel Llano, an andrologist (specialist in problems relating to the male reproductive system) at the Canadian Men’s Clinic in Toronto.

The newest arrival, Levitra, has proven quite effective for men who did not respond to Viagra, says Llano. The two are alike in that both offer a five-hour window of opportunity to work and have similar potential side effects, including headache, facial flushing and a blueish tinge to vision.

Cialis has a couple of distinct advantages, says Llano. It lasts up to 36 hours – and thus has been dubbed in some circles "le weekender" – and its effect is not diminished by food, whereas the other two work best when not taken on a full stomach.

"So the man can go out on a date and very easily combine the Cialis without any problem," Llano says. "The other advantage is the long-acting effect which allows for a lot of leeway in when to take the medication. It brings a lot of spontaneity to the sexual activity."

Both these advantages are appreciated by Brian (who prefers his real name not be used), a Toronto husband and father who was taking Viagra for about a year and a half and has now switched to Cialis.

The other advantage for him is the lack of side effects. With Viagra, he would experience a headache and a feeling "like being in a mental fog" for much of the following day. Thus, he would only use it when there seemed to be a good possibility it would be needed.

"But we all know that sometimes your wife isn’t in the same mood you are and, if she’s not in the mood, and you’ve taken the pill – well sorry. You’ve wasted 12 bucks and all those expectations. And you know you’re in for it the next day."

With Cialis’s 36-hour window, he says "the stress is off for my wife and I.

"Most people will tell you that one of the factors that impacts erectile dysfunction is stress," he adds. "When you remove the stress, everything begins to happen more naturally. You don’t have to worry about whether or not you’re going to be able to ‘perform.’"

While Viagra opened doors for men experiencing problems with ED and encouraged many to come out of the closet and discuss options with their doctors, "we’re still seeing just the tip of the iceberg," Llano says. Statistics indicate there are three-million Canadian men suffering this problem but only about 10 per cent have come forward for help.

And, the doctor adds, there are treatments that can help a good 90 per cent of those men. The oral medications, which are the easiest to take, can benefit 70 to 80 per cent of patients. "But there is still a significant number of men who will need some other treatment and there are options for them," Llano says. These range from injections to vacuum pumps to surgery.

"This is a very treatable condition," he says. "It is very common and affects all age groups, from those in their later teens to people in their 80s. It affects a whole spectrum of men and there are solutions for their problems."

What men with these problems should know is that there is help available and that the problems are not "all in their head" or a natural result of aging, comments Jody Bresgi, spokesperson for the Canadian Men’s Clinics, which has three locations, in Toronto, Ottawa and Vancouver, focusing specifically on issues of sexual performance, such as impotence, premature ejaculation or low sex drive. (At the clinics, privacy is paramount to the point where each patient has a private waiting room.)

It’s important to have these issues assessed, since they can sometimes be early symptoms of more serious illnesses, such as heart disease or prostate disease. Bresgi adds. A blockage in the blood flow, which can presage such problems, might well show up first in the small arteries such as those in the penis.

Because of this, she says, more doctors are asking their patients about sexual health and many are gaining experience in treating sexual dysfunction or are quicker to refer to a specialist, such as a urologist.