London - For men with mild erectile dysfunction, a change in diet and increased physical activity may be all that’s needed to reverse the problem, a major US study revealed last week.
But even so, drug treatments do have a role. In their review of research from six clinical trials, scientists found the benefits were even greater if the men were given medication as well as adopting lifestyle changes.
It’s estimated that 40 percent of men will suffer erectile dysfunction by the age of 40, rising to 65 percent of the over-60s.
The launch of Viagra 13 years ago revolutionised treatment for the condition, however, while the success rate of the little blue pill (and its competitors, Cialis and Levitra) is between 70 and 80 percent, not everyone can take it - for example, men with angina or very high blood pressure.
There are also potential side-effects such as nausea, headaches and hearing problems.
With men’s sexual dysfunction a huge and lucrative market, it is little surprise that scientists have been scrambling to find alternatives to Viagra.
Meanwhile, the hunt is on for the female version. It’s claimed that up to 40 percent of women suffer from sexual problems, including pain and low libido - collectively known as Female Sexual Dysfunction (although some experts question whether women need medication for issues that are often largely to do with the psychological aspects of their relationship.)
So what’s in the pipeline? Here, we reveal some of the major new developments for the treatment of sex problems.
FOR HIM
“VIAGRA” CONDOM
Men who experience erectile dysfunction when using condoms may soon benefit from the “Viagra” condom - which is lined with a special gel that boosts blood flow.
The name is slightly misleading as it actually works in a different way from the popular drug; for while Viagra blocks a chemical that reverses erections, the condom contains an angina drug that increases blood flow. It has been developed for men who find it difficult to maintain erections while wearing condoms, which is essentially a psychological issue.
In a double-blind clinical study by the pharmaceutical company Futura Medical, the “Viagra” condom was compared against a standard one - a significant number of both men and women reported improvements in the man’s erection when using the new type.
It’s also hoped the new product will encourage more men to use condoms, reducing the spread of sexually transmitted infections.
“It may psychologically help men who have ‘first night nerves’ and worry about wearing a condom in case it causes erectile dysfunction,” says Dr John Tomlinson of the Sexual Advice Association. “And anything that encourages safe sex can only be a good thing.”
AVAILABLE: In British pharmacies in the next few months, under the Durex label.
SHOCKWAVE TREATMENT
Israeli doctors are pioneering a new technique to tackle erectile dysfunction using low-frequency shockwaves (a bit like intense ultrasound); the aim is to alter the tissues inside the penis to allow sufficient blood to flow in for an erection.
This might be helpful for men with erectile dysfunction caused by heart disease or diabetes. Professor Yoram Vardi, a urologist at the Rambam Healthcare Campus in Haifa, Israel, says the treatment is completely painless and could cure the problem, unlike Viagra which simply deals with the symptoms.
In a study published last year in the European Journal of Urology, 20 middle-aged men (with an average age 56) who had suffered erectile dysfunction for more than six months were treated with shockwave therapy - 18 had risk factors for heart disease.
Even six months after treatment, the men reported signiÞcant increases in the duration and strength of erections. Half no longer needed Viagra.
“Although there is only data from a single centre at the moment the results do seem promising,” says Ian Eardley, consultant urologist specialising in sexual dysfunction at Leeds Teaching Hospitals NHS Trust. “It would appear that some of the men are being cured.”
The treatment is also said to be painless and no side-effects were reported during the trial.
AVAILABLE: Within 10 years.
DELAY SPRAY
A spray that has an anaesthetising effect on the penis - therefore delaying orgasm - has gone on sale for men suffering from premature ejaculation. It contains 9.6 percent lidocaine, a local anaesthetic which reduces skin sensitivity.
The manufacturer claims that three to eight sprays applied to the penis five to 15 minutes before intercourse can help prolong the time taken to reach climax. “This is definitely one of the better options for premature ejaculation,” says Wendy Hurn, urology nurse consultant at Bristol Royal Infirmary.
“I imagine the spray”s effects will last between five and 20 minutes. You do need quite a lot - nearer the eight than three sprays, in my opinion, to achieve the level of numbness required.
“And as with anything applied to skin, you need to be aware of allergic reactions.
“Not everyone has had a form of anaesthetic before and you never know how you’re going to react. Spray a small amount on your arm the day before to be on the safe side. If you have been using condoms to try to delay ejaculation then this could be an alternative, but always practise safe sex.”
AVAILABLE: Now in British pharmacies
INJECTIONS
An estimated one percent of men suffer from Peyronie’s disease, where a plaque, or hard lump of collagen, forms causing the penis to curve during erection, often interfering with or preventing intercourse and causing pain.
Surgery is available but a new, less invasive treatment also appears promising. Xiaflex is an injected treatment of a substance called collagenase, an enzyme that softens and breaks down existing scar tissue.
A study published in The Journal Of Sexual Medicine found that more than 50 percent of patients considered themselves “much improved” having had the treatment. The product is at stage three of four trials in the US British centres are also involved.
AVAILABLE: In around five years.
SURGERY
Doctors are now using heart implants to treat erectile dysfunction. A cardiologist in Cardiff has carried out the first such procedure in Europe, which involves implanting a stent - a tiny metal tube that helps widen an artery - into the penis.
This improves blood flow and the team hope the operation could be used to treat nearly a third of patients with the condition. A common cause of erectile dysfunction is the furring of the arteries, which restricts blood flow to the groin. Under a local anaesthetic the stent is inserted with a deflated balloon on a wire that is pushed to the narrowed area of the artery.
The balloon is pumped up to allow the stent to expand and lodge in place. The balloon and wire are then removed. The procedure, which costs between £4,000 and £7,000, takes up to three hours.
AVAILABLE: Now.
VIAGRA-TYPE DRUGS
Drugs such as Viagra are known as PDE5 inhibitors, and work by stopping a chemical that triggers the end of an erection.
New versions of these drugs are being developed - the one British men are likely to see first is Udenafil, at present licensed only in South Korea, but being reviewed in the US It is long acting - up to eight hours, so would be a competitor for longer acting tablets such as Cialis (effects can last up to 36 hours, with Viagra it’s four hours).
However potential side-effects - a headache and facial flushing - are more common than with Viagra.
Another drug, Avanafil, is undergoing the last stage of trials before manufacture. It’s said to work very quickly - within minutes (Viagra takes up to an hour, Cialis can work after around 15 minutes in some men), but no data has yet been published. “So far all that’s known is the success rate is 64 percent,” says Dr Tomlinson.
There is also Mirodenafil, also available only in South Korea, which seems to have a better success rate (69 percent) in diabetics with mild erectile dysfunction than any others, although it’s not clear why.
AVAILABLE: Potentially in the next five years.
FOR HER
STEROIDS
Vaginorm, or prasterone, is a pessary said to boost a naturally-occurring steroid in women’s bodies to treat postmenopausal dryness. Its key ingredient is dehydroepiandrosterone (DHEA), a precursor of female sex hormones.
Around 45 percent of postmenopausal women experience atrophy, causing vaginal dryness, itching and burning, and pain on intercourse. A trial published in The Journal Of The North America Menopause Society reported that after 12 weeks, women taking the drug reported a 49 percent improvement in quality of life, 68 percent improvement in arousal and sensation and 57 percent improvement in dryness.
“There’s a lot of excitement in America about the potential benefits of DHEA,” says Claudine Domoney, a spokesperson in psychosexual medicine for the Royal College Of Obstetricians And Gynaecologists. “There are some interesting studies into its use and it may have the same effect as androgens (male hormones such as testosterone) on energy and libido.”
AVAILABLE: In five years.
TESTOSTERONE GEL
Low sexual desire in women has been linked to low levels of the male sex hormone testosterone, which declines with age.
Now American drug firm BioSante Pharmaceuticals appears to be winning the race to develop the first testosterone gel specifically for women. LibiGel is currently undergoing late-stage trials for the treatment of hypoactive sexual desire disorder (a lack of desire) in postmenopausal women.
The gel is applied on the upper arm and absorbed through the skin. It’s claimed the gel can increase testosterone in these women to the levels of younger, premenopausal women. In a previous clinical trial, the company says LibiGel “significantly increased the number of satisfying sexual events in women with low desire by 238 percent”.
“The treatment itself is nothing new,” says Claudine Domoney. “Women suffering from low testosterone can already benefit from a small dose of the same testosterone gel men are given when they have low levels of the hormone.
“However, it’s not licensed for women so some GPs are reluctant to prescribe it, but a specialist probably will.”
AVAILABLE: Within five years. - Daily Mail