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In reality, the question misstates the process. First, the mind has to accept the situation as involving sexual stimulation. If, for some reason, the mind is not engaged, there will be no effective or lasting sexual response to the stimulation. For this reason, viagra is not always successful when there is a serious depressive disorder or some confusion about sexuality. But if the mind is willing, it will send a chemical messenger to the smooth muscles in the walls of the arteries leading into the penis and inside the corpus cavernosum. While at rest, the arteries are contracted and take only a small supply of blood from the main vessels. As the arteries dilate, more blood flows into the penis. Inside, the corpus acts like a sponge and, as its arteries expand, it swells to absorb the flow. This swelling pinches the veins that would otherwise allow the blood to circulate out of the penis. The result is a gradual stiffening until the full erection is produced. So long as the blood pressure remains constant, the erection will remain until orgasm or the mind loses interest, e.g. you are interrupted.

Under normal circumstances, you reach the end of the immediate period of sexual activity and, with the mind and body in agreement, phosphodiesterase type 5 (PDE5) is released. This triggers the contraction of the arterial walls and the erection is lost as the blood drains back into the body’s main system. But, if this sequence is disrupted, PDE5 can be released prematurely forcing the loss of the erection. This is embarrassing and frustrating. Viagra works by slowing the effect of the PDE5. You therefore produce the erection as a natural response to the stimulation and, even if PDE5 is released early, it does not force the loss of the erection.

This is a chemical messenger used in different parts of the body to control the way in which the arteries dilate or contract. There are twelve different types, each one specific to a location. So, for example, PDE6 controls the way in which the retina works in your eye. In general, viagra is specific to PDE5 but, in some cases, the effect can spread to other types of phosphodiesterase. For this reason, some men using viagra can find there is a small effect on their eyesight. A different version of viagra has been produced that is specific to PDE3, the arterial system leading through the chest and lungs to the heart. Under a different brand name, this drug treats pulmonary arterial hypertension and reduces an involuntary contraction of the primary arteries.