Ronald Virag

Biography

He was born in Metz, in 1938, from Hungarian parents who became French citizens before his birth. His father is a former professional soccer player, known as Edmond Weiskopf (1911–1996). After his school and college in the Ecole des Roches and Lycée Janson de Sailly, in Paris, he enters the Faculty of Sciences, then Medicine, of Paris. He was received as intern, subsequently as resident in Parisian Assistance Publique Hospitals. Afterwards, he is appointed Chief Resident at the Faculty and specializes in cardiovascular surgery. He creates several cardiovascular surgery units in private institutions before taking an interest in male sexual dysfunction caused by vascular diseases. He develops specific techniques to explore penile hemodynamics and designs various original surgical interventions, such as the penis dorsal vein arterialization which is named after him. In 1982, he discovers, almost by chance that an old medication, papaverine injected directly into the penis is able to provoke a long lasting erection Thus, he develops the technique of intracavernous injection used worldwide since 1983 to treat erectile dysfunction. He was appointed as a consultant at Harvard Medical School. He also teaches within the different structures of French and foreign medical societies. He is a permanent member of the French National Academy of Surgery.

On Impotence (now called erectile dysfunction)

Until the last third of the 20th century, medicine had little interest in treating erectile difficulties. When he was consulted, the urologist received the unfortunate “impotents” between two urinary tract infections, prescribed a male hormone cure which most often came to a sudden end, then sent them back to the psychiatrist. For a number of them, under the influence of Dr. Freud, the sexuality issues were only related to neurosis. However, we knew since the 16th century, under the influence of the Italian anatomists (Varolio, Leonardo da Vinci) that the erection is a vascular phenomenon. It was not until the 70s that some pioneers (among them the Czech surgeon Vaclav Michal) designed surgical then medical techniques to restore vigor to the “impotent”. Amongst these pioneers, Ronald Virag, still a young chief resident at the Hospital Broussais, took an interest in the erectile dysfunctions occurring to the patients affected by the Leriche’s syndrome (obstruction of the lower part of the aorta which results in limbs claudication and decrease of the erection). Their legs were well treated but not their penises. Urged by their despair the young researcher will henceforth have a passion for this issue and devote most of his professional life to it. A small international group will then gather, combining the Europeans, more focused on physiology, and the Americans, who developed the penile implants techniques. This group will create a new medical Society which is nowadays: the International Society for Sexual Medecine (ISSM), reach of now over a thousand members.

The intracavernous mini injection

The papavérine intracavernous injection was a turning point in the history of the treatment of erectile dysfunction. It has been, from everyone’s opinion, a decisive progress in the approach and the treatment of an illness affecting millions of men. Active member, in one of the most renowned unit of cardiovascular surgery in Europe, Ronald Virag already developed an intervention aiming at improving the blood flow in the penis. His intervention called “dorsal vein arterialization” is known in the United States as the “Virag’s procedure”. In 1981, during a surgical procedure on the penis, he discovered that an old medication extracted from poppies, and used since the late 19th century to dilate blood vessels, could induce an erection when injected into the penis. After a year of observing the effects of papaverine on volunteers, among which himself, the discovery is being published in the famous medical journal “Lancet”. From then on nothing will ever be the same again, neither in the treatment, as quite rapidly a thousand of patients will benefit from it, or in research as the intracavernous injection will now be the reference and the means of triggering the erection when needed to be studied. Since then, the technique was improved, for the comfort of the patients who may now use an automatic injector. Today, “more than ten years after the Viagra© outbreak, the intracavernous mini injection remains the most efficient and reliable medical treatment for erectile dysfunction.”

Viagra and Virag

When the American pharmaceutic company Pfizer realises that a molecule tested against heart failure has positive effects on erection, Ronald Virag is immediately consulted for a first assessment which will decide upon launching research on the topic. Afterwards, with a Norwegian colleague, he will lead the first European preliminary study of the medicine. « Viagra » the name of the small blue diamond-shaped logo presenting some strange similarities with that of the French surgeon, will raise a number of interrogations. In 1999, he was part of the task force appointed by the French Ministry of Health. He is also consulted that same year by the National Ethics Advisory Council.

Prizes and awards

In 1985, the American Urology Association presented him the John Lattimer prize (unique fact for a doctor non specialized in urology and non American), awarding a discovery that changed the course of the specialty. The association then made his discovery of the intracavernous injection figure as one of the most important discovery of the century in the urology and andrology fields. In 1997, he is honored by the European Society for Sexual Medicine, for the entirety of his works. Brazilian, Portuguese, Spanish and Greek medical societies honored him as well. He was elected associate member, then permanent member of the French National Surgery Academy (2012).