new treatments for impotence
by John Illman
As the first oral treatment for impotence or erectile dysfunction (ED), Viagra ranks as one of the most astonishing success stories in pharmaceutical history. When it was launched in 1998, it became the world's fastest selling medicinal drug ever, outstripping even Prozac, the 'sunshine' anti-depressant pill launched 10 years earlier.
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Doctors and journalists were racing to see who could write the word 'Viagra' most frequently. Every TV and radio chat show seemed to be interviewing satisfied customers, ending the long-held taboo about men talking about impotence in public.
Viagra was also the most highly publicised of the new so-called 'lifestyle drugs' – drugs taken by people who are not seriously ill in an attempt to improve the quality of their lives.
finding out what's best
But many men cannot take Viagra and others simply don't like it. It can cause a life-threatening drop in blood pressure in those taking nitrate drugs for chest pain. In some men, it can result in bluish or blurred vision, or sensitivity to light. Moreover, it doesn't work at all in 15% of men.
But new rival treatments will soon enable men with ED to try out various pharmaceutical treatments to find out what works best for them. This will make ED more like other conditions, such as arthritis or depression, where trial and error is often the key to successful therapy.
Drugs for ED are available on prescription from your doctor. They are also on sale on the internet, but it's best not to buy them in this way. It could increase the risk of an adverse reaction. All drugs have side effects and these are no exception.
promoting sexual spontaneity
Uprima, already available in the UK, is being promoted as a means of promoting sexual spontaneity. While Viagra takes up to an hour to work, Uprima produces an erection within 18-19 minutes, on average.
It is placed under the tongue where it dissolves and is absorbed into the blood; because it is not absorbed through the stomach like a standard pill (such as Viagra) it does not interact with food. You can take Viagra within a short time of eating, but the manufacturers, Pfizer, warn: 'Taking Viagra after a high-fat meal (such as a cheeseburger and French fries) may cause the medication to take a little longer to start working.'
This does not mean that Uprima is better than Viagra. Some men may try both preparations and prefer Viagra. There are all kinds of subtle differences in the way different people respond to different drugs – hence the need for trial and error.
Men taking nitrate drugs, which dilate small arteries, can take Uprima, but the UK distributor, Abbot Laboratories, warns, 'Caution still needs to be exercised.' You must avoid it, they say, if you have severe unstable angina, high blood pressure, or after a recent heart attack or severe heart failure.
In clinical trials of Uprima, most side effects were 'mild to moderate in nature, self-limiting and decreased with continuing use of the drug.' The most frequently reported, each affecting less than one in ten patients, were nausea, headache and dizziness. Similarly, with Viagra, side effects often decrease with time.
first 'morning after' pill for men
Uprima may soon be followed by Cialis – the so-called first 'morning after' pill for men. In clinical trials, men taking Cilias achieved erections within 20 minutes. The effects were found to last for at least 24 hours, so they could have sex at night and again on waking in the morning. In contrast, the effects of Viagra last for about four hours. Uprima reaches peak concentration within 30 minutes.
Cialis is still undergoing trials and is not yet generally available. But in common with other treatments, it won't help everyone with ED. In a study reported recently to the 96th annual meeting of the American Urological Association, 85% of men taking Cialis (20mg) reported improved erections.
Doctors believe that treatment advances will encourage more men to seek help, dispelling the myths that can isolate men, resulting in severe depression and even divorce and suicide.
it's not 'all in the mind'
Fact: Recent research suggests that up to 70% of cases have a physical and not a psychological cause. Common physical causes include:
- Atherosclerosis (clogged-up blood vessels) which inhibits blood flow to the penis. Clogged up blood vessels are also a risk factor for heart disease and stroke.
- Smoking (a cause of atherosceleris).
- Diabetes affects blood vessels and accounts for about 40% of ED.
- Abdominal surgery, which can cause nerve damage and impair penile blood flow.
- Spinal cord injury.
the age factor
Fact: ED does increase with age, but it is not a normal consequence of ageing. In one major study, about 52% of men between the ages of 40 and 70 were estimated to suffer from some degree of ED. Of these cases, 33% were classified as minimal, 48% as moderate and 19% as complete. In men with diabetes, prevalence of ED is estimated to be as high as 35 to 50%.
other treatment options
Fact: Thanks to recent scientific advances, as many as 95% of sufferers can now be effectively treated. Your GP should be able to advise you further – as should the bodies listed in the help and info section below. Treatment options include:
- Psychosexual counselling. This can be particularly effective if there are relationship or communication problems.
- Vacuum therapy: air is pumped out of cylinder held over the penis to create a vacuum that increases blood flow and causes an erection.
- Injections into the penis 10 to 15 minutes before sexual activity.
- Surgically implanted penile protheses.
- Hormone treatment. This is used only when there is a diagnosed hormonal problem.
- Transurethral therapy in which a tablet is inserted into the urethra (the narrow passage that runs through the centre of the penis).
- Oral therapy such as Viagra.
Injections and transurethral therapy are likely to be the main 'second-line' options in men who cannot tolerate oral treatments or who cannot take them because of other illnesses.
'gold standard' injections
The idea of injecting a drug into their penises will appall most men, but injection therapy was the 'gold standard' in impotence treatment before Viagra. A former Cambridge professor, Giles Brindley, pioneered it. He immortalised his own penis at the annual meeting of the American Urological Association by dropping his trousers before an audience of hundreds of doctors to reveal his own injection-induced erection.
help and info
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organisations
Sexual Dysfunction Association
Windmill Place Business Centre
2-4 Windmill Lane
Southall UB2 4NJ
Helpline: 0870 7743571 (Mon-Fri 9am-5pm)
E-mail: info@sda.uk.net
Website: www.sda.uk.net
A charitable organisation set up to help men and women who suffer from some sort of sexual dysfunction. The main focus is on impotence but they also have information and factsheets on a range of other sexual problems. Callers to the helpline can request general or specific information and a list of specialists in their area.
Medical Advisory Service
PO Box 3087
London W4 4ZP
General Medical Helpline: 020 8994 9874 (Mon-Fri 6-8pm)
Men's Health Helpline: 020 8995 4448 (Mon,Tues,Thurs 7-9pm)
E-mail: info@medicaladvisoryservice.org.uk
Website: www.medicaladvisoryservice.org.uk
Telephone advice and information service for all general medical enquiries.
Relate
Herbert Gray College
Little Church Street
Rugby CV21 3AP
Tel: 0845 456 1310 (to find your nearest Relate)
Relateline: 0845 130 4010 (Mon-Fri 9.30am-4pm)
Relate Direct appointments line: 0845 130 4016 (Mon-Fri 9am-5pm)
E-mail: enquiries@relate.org.uk
Website: www.relate.org.uk
The largest relationship counselling organisation in the UK. Offers counselling,
psychosexual therapy, and other services to help those experiencing difficulties in any
adult couple relationship. Some branches of Relate offer individual counselling to
young people. Relateline is for couples experiencing emotional crisis who wish to talk
things through with an experienced Relate counsellor. Relate Direct is a telephone
counselling service (see website for more details, including costs).
websites
Impotence
www.embarrassingproblems.co.uk/pages2/impotence.htm
Dispels myths surrounding impotence, and discusses factors that may cause impotence, and how to approach your doctor, different types of treatments available and further contacts.
Impotence – Your Questions Answered
http://www.impotence–help.co.uk/index2.htm
Produced by Schwarz Pharma. Describes what impotence is, the causes, and treatments available. Discusses what may happen when you visit the doctor, and what you might be asked. Features personal experiences and frequently asked questions.
Impotence (erectile dysfunction)
www.netdoctor.co.uk/diseases/facts/impotence.htm
Part of the NetDoctor website, this article discusses impotence, what causes it and how to treat it.
Impotence Resource Center
www.impotence.org
US-based website, sponsored by the Sexual Function Health Council of the American Foundation for Urologic Disease. Contains extensive information on impotence – causes, common myths, diagnosis, how to talk to your doctor, treatments and advice for partners.
Sorted in 10
www.sortedin10.co.uk
Offers information about erectile dysfunction and gives advice on how to approach your doctor, treatments available and dealing with impotence for partners. Aims to help men and their partners understand that they are not alone and there is help available.
Pfizer
www.pfizer.com/hml/ed/ed.html
US-based website of the pharmaceutical company Pfizer, marketing authorisation holder of Viagra. Contains details about Pfizer, and a section on Viagra and erectile dysfunction.
UrologyHealth.org
www.auanet.org
The American Urological Association's online patient information resource has been written and reviewed by urology experts. Visitors can search for information on a variety of conditions. Content is accompanied by medical illustrations when appropriate.
reading
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Overcoming Impotence by Mary Williams (Sheldon Press, 2003) |
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Sexual Health for Men – The Complete Guide by Richard Spark (Da Capo Press, 2000) |
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(October 2001, resources updated February 2005)
