JRSM >
Volume 95, Number 8 >
Pp. 402-403
Department of Otolaryngology, St George's Hospital, Blackshaw Road, London SW17 0QT, UK
Correspondence to: L A Hicklin E-mail: lhicklin{at}doctors.org.uk
Sildenafil (Viagra) enhances penile erection by relaxing smooth muscle in the corpus cavernosum. Erectile tissues elsewhere may be affected by this drug.
CASE HISTORIES
Case 1
A man in his late 50s was admitted from the emergency department with heavy
prolonged epistaxis. Attempts to control the bleeding with cautery, sponge
packs and BIPP (bismuth iodoform paraffin paste) impregnated gauze had been
unsuccessful. Haemostasis was eventually secured with bilateral postnasal
space balloons and anterior BIPP gauze packing. There was a history of
hypertension, well controlled with nifedipine and lisinopril. During the
admission the patient volunteered that, in the hours before his first
nose-bleed, he had been engaging in energetic sexual activity. To enhance his
sexual performance he had taken 50 mg sildenafil. Over the subsequent few days
he had had several short but heavy epistaxes, and on the day of admission
bleeding had continued for 6 hours without stopping. With packing and bed rest
the bleeding gradually settled and he was discharged after six days.
Case 2
A man in his early 70s was admitted from the emergency department after 5
hours of epistaxis. He had taken sildenafil to enhance his sexual performance
in the morning before his epistaxis. Haemostasis was secured with bilateral
BIPP packing. This was his first nose-bleed requiring medical attention. His
history included hypertension well controlled with amlodipine. The pack was
removed after two days and he was discharged home with no further
epistaxis.
COMMENT
Severe epistaxis particularly affects the elderly, people with hypertension or clotting disorders and those taking medications such as aspirin or warfarin1. Venous engorgement is believed to be a causal factor2. The turbinates of the nose contain erectile tissue3 and nasal stuffiness during sexual activity is a well known phenomenon (‘honeymoon rhinitis’)4. Nasal stuffiness is also listed as a side-effect of sildenafil5. In the two patients here we surmise that venous engorgement due to sildenafil was a factor in the severe epistaxes after sexual activity. This phenomenon does not seem to have been reported elsewhere. There has been no obvious increase in epistaxis since the introduction of sildenafil; this effect, however, might be under-reported because of the disinclination of most patients to discuss sexual matters in public, especially those relating to sexual dysfunction.
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  S. R J Bott, I. Shergill, and M. Arya Epistaxis after sildenafil J R Soc Med, January 10, 2002; 95(10): 528 - 528. [Full Text] [PDF]
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