The hard facts on sexual dysfunction remedies
By ROB STOCK
Sunday Star Times (NZ)
7 September 2008
For boys at school PE is something to look forward to, but in adult life it's being billed a threat that will strike down three in 10 men.
PE, in the adult world, is the abbreviation increasingly used for premature ejaculation, and a mini- industry has grown up around it marketing expensive cures for it, and erectile dysfunction.
It's an industry that provides medicines and scientifically unproven herbal remedies to those too ashamed to go to their family doctor for help. And where there's shame, there's a profit to be made as shown by the nearly 50% revenue growth posted for the first quarter of this year by Nasdaq-listed Advanced Medical Institute (AMI), which had revenue of $US13.4 million last year through marketing its erectile drugs in New Zealand, Australia and Asia.
A survey of what's on offer shows men are being asked to pay up to several thousand dollars a year to improve their sex lives, although sex therapists and family doctors say there are better, and cheaper, ways to get help than calling an advertised toll-free number.
There are four main channels for those seeking remedies for premature ejaculation and erectile dysfunction: family doctors, specialist men's clinics, sex shops, and the internet.
The internet is the home of online drug sales, particularly the legion of herbal pills and capsules promising improved sexual function, each based on a plant source that is believed to hold medicinal qualities, although regulation is so light that claims do not have to be scientifically proven.
Netpharmacy, for example, had more than 30 listings for different remedies said to help, or support male sexual function. The ingredients in the herbal remedies range from Siberian ginseng (50 tablets for $20.50), the herb tribulus (60 tablets for $33.70), deer velvet (60 capsules for $37), rhodiola root (60 capsules for $49.95), to saw palmetto berries (100 capsules for $42.60). Ignite Aphrodisiacc capsules (90 capsules for $49.95) are made from wild oats, and there are pills based on the claimed properties of horny goat weed (60 capsules for $40.70).
These herbal remedies, many of which carry health warnings, are sold to be taken daily - like vitamin pills - rather than per sexual encounter, which means costs soon add up. A 365-day supply of rhodiola root capsules, for example, would cost just over $300, although it could be argued that if it works, and there is no scientific evidence that it does, that's better value than a subscription for Sky TV.
By contrast, the prescription-only medicine Viagra, which sells in pharmacies for around $90 for four pills, is taken only before sex.
Because regulation of such remedies is light, problems emerge from time to time, and just last month Medsafe issued a warning about the erectile dysfunction/sexual enhancement pills Rize 2 the Occasion, Rose 4 Her and Viapro which were found to contain an undisclosed substance called thiomethisosildenafil, a copy of the active substance in Viagra.
Some of the men's clinics also sell some herbal remedies. Danny Wolf, of the Men's Health Clinic in Auckland, said 20 or 30 such remedies had been marketed to him. He said those his clinic was interested in were handed out for free to willing patients to see whether they had any effect. "We go more by what people say. Some people need to put it under the microscope. We need to see it in use," he said.
The clinic recommends SZM Formula For Men, containing the amino acid arginine which helps support blood flow to the penis, costing $85 for 10 tablets, and like Viagra these are taken before sex, in this case around one hour before.
Many also attempt to buy prescription drugs such as Viagra in response to spam emails, but end up buying fake Viagra from overseas. Customs regularly intercepts parcels from overseas, and tests show the active ingredient is sometimes not there, or present in low dosages.
For those who do not want to experiment with herbal pseudo-medicines, prescription medications offer a very high likelihood of solving their problems, and many seek them through specialist men's health clinics, preferring not to confess to problems with their regular doctor.
Some, such as AMI, do not even require a face-to-face meeting, instead doing consultations over the phone with doctors in Australia. As the person calling has already self-diagnosed their problem, the process is simple.
As well as the prescription medicines Viagra and Cialis, the clinics often prescribe anti-depressants such as clomipramine which were found to have the side effect of reducing sensitivity in the penis, thereby slowing down ejaculation, often in the form of a foul-tasting lozenge to be taken before sex. They can also prescribe drugs such as sildenafil and tadalafil, the generic versions of Viagra and Cialis, which work by allowing blood vessels to relax.
There is also an injectable medication, administered with a little gun- like instrument into the side of the penis, which causes an erection, which often lasts for two hours. But it also makes it harder to ejaculate.
To test the advice and cost of treatments being marketed, I contacted two Auckland clinics.
The first was the New Zealand Men's Clinic in Parnell, run by Dr Chris Paltridge. I posed as a 37-year-old who had problems getting an erection.
The $90 consultation took about 10 minutes, though I had filled in a form stating I did not have medical conditions like diabetes and heart disease. (A GP consultation costs about $50.)
I had indicated I did no exercise, and felt I was under stress, and implied I had been with my wife for a "long, long time". Like smoking, all of these can be factors in penile dysfunction. There was little discussion of these topics however, and soon Paltridge asked whether I would consent to a test-dose of the injectable medication, which I refused.
I was then sent through to speak to a non-medical "consultant" colleague of Paltridge to discuss which medication I would like. The injections would have cost me $300 for medication (which is kept in the fridge) sufficient for 10 injections, but lozenges would have cost $125 for a starter pack of five at the clinic.
A clomipramine nasal spray would have cost $350 for a three to four month supply - around $1400 a year. That, the consultant told me, was cheap compared to the costs for the nasal spray marketed by rival AMI, which I said I was planning to call later the same day.
Calling AMI proved to be a strange experience. The doctor I spoke to was impatient to the point of rudeness. It was hard to shake the impression that he needed me off the phone as soon as possible. I said I wanted to be able to perform repeatedly in the same session and was told for that there were "insulin-like" injections available, but AMI specialises in selling a nasal spray that helps people get an erection and delays premature ejaculation.
When I said it sounded like AMI couldn't help me, the doctor agreed and the call was ended to the relief of both. I called back later to find out what the spray would cost, but the sales consultant would not tell me.
Wolf said there were problems with the penile dysfunction industry in New Zealand, not least that it dished out drugs too easily to people, often quite young, who wanted to "enhance" their sex lives with drugs, perhaps because they wanted to have sex a number of times in a single night, sometimes after a big night out.
Wolf said some clinics also appeared to ignore indications that counselling or therapy would be a viable option for patients to try before turning to drugs.
Robyn Salisbury, director of Sex Therapy New Zealand, said medical treatments often did not solve the core psychological problems that were spoiling people's sex lives. As a result, people told her they had spent a lot on treatments that did not work. "One spent $1800 on what is an anti- depressant in a nasal spray. It didn't work and he ended up with me," Salisbury said.
By contrast, sex therapy sessions with Sex Therapy New Zealand cost $120-$180 an hour. "You are learning skills that will last your lifetime, not becoming dependent on a drug," she said.
NZMA chairman Dr Peter Foley said the place to seek medical treatment was from your family doctor. "These men's health clinics do have some medical input, but it is disappointing that patients feel they need to go to them when they can achieve the same results in a more holistic way with their state-funded GP," he said. "I can almost predict what the treatment would be in 90% of cases."
Most were available at lower cost through GPs.
* The most famous impotence pill, Viagra, which is a prescription-only drug and is not funded by Pharmac, costs around $90 for four from a pharmacy, although online pharmacies are cheaper, and more discreet. Rival Cialis costs around the same.
* A year's supply of nasal spray to delay ejaculation can cost more than $1000, sometimes $2000, from men's clinics. There is often also a consultation fee.
* Lozenges to delay ejaculation cost about $125 for five, but the more you buy the cheaper they are.
* Self-administered injections to get a strong erection, and to delay premature ejaculation, start at around $300 for enough for 10 sex-sessions.
* Sex therapy sessions cost in the region of $120-$180 an hour.