Can better sex come with a pill? The nineties' impotence cure

1 Comment | Insight on the News, Dec 15, 1997 | by Leslie Alan Horvitz

A trio of new drugs promises to help men suffering from impotence, a condition that affects millions of Americans. But some doctors fear the pills may will be abused by men seeking instant virility.

Approximately 52 percent of men worldwide between the ages of 40 and 70 experience some level of impotence -- what health experts now call erectile dysfunction, or ED. In the United States, ED also affects 10 percent of men in their twenties and thirties. As the population ages, impotence will become an increasingly common complaint.

The good news: Nearly all cases are treatable. Impotence can be corrected by a variety of means, from injections to surgical implants. But three new drugs under review by the Food and Drug Administration portend an easy fix for ED. Viagra, Vasomax and Apomorphine differ in significant respects, but the drugs have one thing in common -- they can be taken orally. Curing impotence may be as simple as swallowing a pill.

"They're not an aphrodisiac; they don't alter the libido," says Harin Padma-Nathan, director of the Male Clinic in Santa Monica, Calif. "These drugs work in the presence of sexual stimulation. They treat, but don't cure, impotence."

Most health experts now " believe that most ED cases are organic in origin, not psychological. "Several years ago, it was thought that sexual dysfunction was 90 percent in your head. Now it has gone to the other extreme," says Bernie Ziebergeld, a sex therapist practicing in Oakland, Calif.

Whatever the cause, however, only 5 percent of men experiencing impotence seek help. "People who suffer from all sorts of illnesses don't seek treatment, men especially," Ziebergeld tells Insight. "They won't go to doctors unless they're bleeding."

Ignorance is one factor, according to Ridwan Shabsigh, a urologist at New York's Columbia Presbyterian Hospital. "People think that it's the normal consequence of age," says Shabsigh. "They don't know they can receive help."

To make makers worse, he adds, many primary-care physicians aren't experienced enough or adequately trained to handle sexual dysfunction. And, of course, some treatment options -- injecting chemicals into the penis prior to sex, for example -- turn patients off. But that situation could change dramatically as early as next year.

The new miracle drugs have proved themselves in worldwide studies. In tests on 4,500 subjects, Viagra, manufactured by Pfizer, had a success rate of 40 to 80 percent. Vasomax, produced by Texas-based Zonagan, and Apomorphine, made by Tap Pharmaceutical, also have performed well in clinical trials. The drugs have shown some side effects, mainly flushing and mild headaches.

"Some of these drugs are very potent," adds Padma-Nathan, who conducted tests on the three drugs. "We could combine them in a cocktail ... some to work in the brain and some to work locally for the best effect."

Viagra's salutary effect on ED was discovered accidentally. The drug originally was designed to help patients with cardiovascular problems, but it failed during those clinical tests. Even so, recalls George Christ, a researcher at New York's Albert Einstein Hospital, patients wanted to continue taking the medicine -- it seemed to help them sustain erections.

Understandably, skepticism has dogged the discovery of these drugs. In an official statement, the American Urology Association, or AUA, acknowledged that oral drugs have shown some promise in men with no known organic cause of impotence, but it did not foresee the drugs "as a viable alternative for patients with organic erectile dysfunction." Researchers caution that even under the best circumstances, these drugs will not work for everyone. It's estimated that about 30 percent of men with ED will need other types of treatment.

Padma-Nathan takes exception to this view. "I have one patient who was unable to have an erection because of a prostate operation who now says that he can perform like he did at 30." Other patients who've suffered impotence because of diabetes or spinal injury also have benefited.

Certainly, AUA disclaimers haven't dampened excitement about the drugs on Wall Street. Investors already have rewarded Pfizer for spending $400 million to develop Viagra -- its stock is up nearly 75 percent. Some financial analysts expect Viagra to be a billion-dollar drug, a far cry from the $117 million men have spent this year for drugs to treat ED.

What causes impotence? The penis contains two chambers, called the corpora cavernosa, filled with smooth muscles, fibrous tissues, veins and arteries. To achieve an erection, the smooth muscles must relax, allowing blood to fill the open spaces and expand the penis. Any illness or disorder that interferes with the normal function of the circulatory system can lead to impotence.

Heart disease, diabetes, stroke, kidney disease, chronic alcoholism, atherosclerosis and vascular disease are implicated in 70 percent of cases. (Impotence occurs in 39 percent of patients treated for heart disease and affects up to 60 percent of diabetic men with impaired circulatory system.) Smoking is a particularly grave factor since it impedes circulation over time.