Sexual dysfunction
Men especially susceptible to the quick drug fix


DRUG BUST by Alan Cassels

Success breeds success, right?

In the last decade, we’ve seen the incredible success of sexual performance enhancing prescription drugs for men. Gears are shifting and we’re now seeing drug makers getting all hot and bothered about marketing new pills to the other half of the population. Already, the race to discover the first treatments for female sexual dysfunction, dubbed the “pink Viagra,” is creating a mini-industry unto itself, most notably in grist for talk shows, documentary films and books, one of which is featured in these pages this month. I haven’t read it yet, but I imagine Ray Moynihan and Barbara Mintzes’ new book Sex, Lies and Pharmaceuticals will soak the reader in stories of scandal and outrage, as they document the drug industry’s efforts to medicalize and medicate the libidos of women around the world.

Trying to capitalize on women’s fears of what is considered “sexually normal” will prove to be a daunting task for the drug industry. If the marketing wizards in the drug industry are modelling their efforts on past attempts to medicate male sexuality – with testosterone, Viagra or other treatments – they’re in for a big surprise in applying this wisdom to women. At the risk of stating the obvious, let’s just say sex is a lot more ‘complicated’ for women and, as a group, they are a lot less likely to be receptive to having their libidos turned into markets.

Developing drugs and markets for male sexual problems seems very basic, the targets being one of two things – desire or plumbing. The desire part deals with low energy or low libido, the plumbing part with erection or ejaculation. Basically, when it comes to treatments to enhance the sex lives of men, we men are only interested in three questions: Can it get me interested? Can it make my equipment “work?” Can it help me “complete” the job? If a drug answers “yes’’ to any of these, it’ll sell. Compared to the vast terrain of female sexuality, we men are mere putty in the hands of the marketers.

In terms of sexual interest, is this often a problem for men? I’d say the opposite. If anything, men who are overly libidinous are a million times more common than men lacking in sexual desire. If women were running pharmaceutical research labs, they’d probably put their research efforts into products that reduce, rather than increase, male sexual desire. They’d then market those products to women, but let’s leave that one for another day.

For sure, some men who lack energy or sexual desire would certainly welcome a drug to restore them to the prowess and sexual energy they had when they were 25-years-old. Currently, the most common treatment sold is testosterone replacement. The condition of “low T” – “andropause” – is a reality for many men as they age and their levels of testosterone drop, causing them to be more grumpy, more tired, more in need of naps and, of course, less efficient in bed.

For some men, curing “low T” is as simple as rubbing a bit of testosterone gel on their chest or swallowing a pill. Ads selling testosterone drugs use the classic checklist approach, the type that plants the seeds of self-doubt and gets you to see a doctor. They ask, “Are you tired? Moody? Have little sexual interest?” That checklist pretty well sums up most guys my age but it’s the ad’s tagline that will capture us in the net: “Getting old is natural. The goal is... to make feeling old optional.” I’ll have a bucket of that.

Like any mongered disease, there are a few men with extremely low testosterone who may really benefit from testosterone replacement, even as the jury is still out on its long-term effects. It is worth remembering the fact that it took society nearly 40 years to discover that Hormone Replacement Therapy for women was not helpful, but actually dangerous when taken over the long term.

But on to the plumbing problems. We might think that male sexual problems didn’t exist before the invention of Pfizer’s “Riser” Viagra – Hugh Hefner’s suggestion for the drug’s street name – which came to the market in 1998, but they did. We just called it impotence. We never talked about it and we certainly wouldn’t have asked our doctor about it. Yet before the drug arrived on the scene, impotence got a makeover and the nice, new medical-sounding term “Erectile Dysfunction” was developed. Now, it was OK to bring it up with the doctor.

About 10 years ago, I interviewed an official at a big Manhattan public relations firm, which helped create the Viagra marketing campaign. She recounted a story about former presidential candidate Bob Dole’s backstage conversation with Larry King a few minutes before he was to appear on Larry King Live. When chatting about what was going on in his life, he told Larry about a clinical trial he was participating in for an erectile dysfunction drug. Larry asked, “You don’t want to talk about that, do you?” “Sure,” Dole replied. The rest is history, with Bob Dole helping kick off a national campaign urging men across the country to seek help for this dysfunction. Hired to front for Pfizer on the Viagra file, Dole was later dumped in a corporate decision to target younger men in Pfizer ads. After all, you wouldn’t want impotent-looking old men as the public face of your exciting new drug, would you?

This leads me to a skill testing question: Which Canadian province spends 25 percent less per capita on prescription medication than the rest of the country, except for prescription drugs for erectile dysfunction, where it spends 13 percent more? If you guessed British Columbia, you’d be right.

If you know why this is, please let me know. I’m collecting theories and I refuse to believe the “BC Bud” theory, which says that men in BC have more impotence than the rest of the country because they consume so much BC Bud. Is this true? I dunno but it sounds vaguely plausible.

In the fast pace world of marketing, Erectile Dysfunction is already becoming passé and we men are now facing a new and growing condition that could affect up to 40 percent of the male population. Yes, I’m talking about premature ejaculation (PE) the hottest new disease to almost hit the comedy stage.

Back in 2004, drug maker Johnson & Johnson approached the FDA in the US to get approval for dapoxetine, its exciting, new, experimental drug for PE. The company stated dapoxetine “increased intra-vaginal ejaculatory latency (IEL) time” (use your imagination to figure out what that means) better than a placebo. They even had two 12-week, randomized, placebo-controlled studies involving about 2,600 men. The FDA gave Johnson & Johnson the thumbs down; the drug is not approved yet in Canada either, though it has been approved in a number of European countries.

Dapoxetine, which is in the same family of SSRI antidepressants as Prozac and Paxil, was actually a reconstituted antidepressant. Researchers and physicians have known for many years that one of the side effects of SSRIs is delayed ejaculation. In the brazen and bizarre world of drug marketing, the side effect becomes the effect.

That hasn’t stopped the industry from creating other PE drugs, such as PSD502, a spray-on drug that is to be applied five minutes before intercourse. It consists of a prilocaine-lidocaine, which is basically an anaesthetic cream, the kind your dentist might use to numb your gums prior to dental surgery. While it’s not yet approved, I’m sure it’s only a matter of time.

I think there are certainly some men out there who actually do have a serious problem with PE, which is affecting their life and their relationships, I can accept that. And they deserve any potentially useful drugs the industry can discover. But before they dive right away for the drugs, I think the concept of “premature” needs to be unpacked a little bit. Maybe it even needs to be something you discuss with your partner before seeking out the chemical fix?

Drugs for PE have the drug companies really excited because the PE market is potentially gargantuan. In fact, some ‘research’ suggests that as many as 30 to 40 percent of guys of all ages could be “sufferers” and in need of treatment. In comparison, the market for ED drugs is tiny, affecting only 10 to 12 percent of the male population, of which the majority are usually older males.

Before you dismiss me as being insouciant about male sexual problems, let me reiterate there are a number of physical and psychological causes for male sexual difficulties. Many medical problems such as diabetes, heart or blood vessel problems as well as certain medications, including some antidepressant drugs, can affect sexual desire and function. Then there’s the usual litany of anxiety, stress and relationship problems, any of which can affect men and their enjoyment in sex. The bottom line is that sexual problems aren’t often primarily medical problems, but they sometimes are.

While women will vigorously resent having their levels of sexual desire crammed into a medical definition and pushed towards a pharmaceutical solution, we men seem more accepting of drugs for our sexual function, making it that much easier to seek out a pharmaceutical enhancement. After all, popping a pill fits the “just fix it” mentality of many men, certainly a lot easier and less messy than talking through relationship problems.

The market for male sexual dysfunction is not yet tapped out and while the industry is vigorously working to marketize drugs and medicate women for their sexual problems, we shouldn’t expect the industry to leave us men alone anytime soon.

Alan Cassels is a drug policy researcher at the University of Victoria. Read his other writings at