Photo by Joseph Rafferty
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Lust and Found
By Melissa Gotthardt, November-December 2003
Hot new sex drugs that reignite desire (and only two of them are for men)
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Viagra is Elvis in pill form: Sexy yet safe, maker of corporate millions,
the undisputed king. Doctors have scribbled 133 million Viagra prescriptions
since Pfizer launched the pill in 1998, and sales in 2002 alone reached $1.7
billion. So it's no surprise that other companies want a slice of the
impotence pie. There's an anti-impotence nasal spray in the works, and
candy maker Wrigley recently received a patent for anti-impotence gum.
(Don't rush to the vending machine just yet: It's years away.) The
biggest developments are two new Viagra-like pills—Bayer's and
GlaxoSmithKline's Levitra (vardenafil), approved by the FDA in August, and
Eli Lilly's Cialis (tadalafil), which is close to being on the market. Drug
companies are also feverishly developing treatments for the estimated 43
percent of women who suffer some degree of sexual dysfunction (in fact, one of
the most promising treatments for women is—surprise!—Viagra).
Here's what's new for men and women:
Sex Rx for Men
>Levitra A close chemical cousin to the little blue pill, Levitra
is being touted as more vigorous than Viagra.
Staying Power: "It's six to nine times more potent, so men
can have sex for up to 24 hours after taking it," says Levitra clinical
trial researcher Myron Murdock, M.D., medical director for hisandherhealth.com.
(Before you get too excited, let's clarify: The drug's effects work for
24 hours. It's not like you'll be performing that long.)
Speed: One-quarter of Levitra users are ready for intercourse in 15
minutes; the rest, within 45. Viagra's numbers are similar.
Performance: Levitra works for about 82 percent of men—about
the same as Viagra. Side effects are similar, too: headache, facial flushing,
upset stomach, and nasal congestion (though a stuffy nose is a small price to
pay). One big difference: Levitra doesn't cause the blurry vision and other
temporary eye troubles a small percent of Viagra users experience. Also, you
can take Levitra with or without food (Viagra is best on an empty stomach).
>Cialis Already available in Europe, Cialis is known as "the
weekender" for its long-lasting strength.
Staying Power: In one recent trial, 60.4 percent of men who took
Cialis succeeded in having sex up to 36 hours later. And Cialis isn't
affected by food, so you don't have to sacrifice rigatoni for romance.
"This is heaven for the man who wants spontaneity," says Francois
Eid, M.D., clinical assistant professor of urology at Weill Medical College of
Cornell University. "He can take it at the beginning of the weekend, eat
whatever he wants, and have sex when the opportunity arises."
Speed: Cialis kicks in for some men within 16 minutes and for most
within about 30.
Performance: In clinical trials Cialis' success rate ranged from
64 to 92 percent—similar to the competition. And it also shares many of
the same side effects (headache, facial flushing, upset stomach, nasal
congestion—but no blurry-vision problems.) One difference: It has
produced back pain in a small number of cases.
Cialis and Levitra may cause Pfizer some pain, but don't expect Viagra
to run from the competition. For many doctors, the blue pill is still gold.
"When doctors make a treatment decision, will they go with the drug
that's treated millions of people or will they take a shot in the
dark?" asks Viagra researcher Michael Sweeney, M.D., senior medical
director for urology at Pfizer.
The drugs are all chemically similar, so it's unlikely the new ones will
help the 20 percent of men who get no help from Viagra (though the Levitra team
disputes this). Nor are they any more likely than Viagra to help men with nerve
damage—usually caused by end-stage diabetes or prostate removal
surgery—or impotence caused by psychological problems. But there's no
harm in trying. "Until these drugs have coexisted on the market for a few
years, it's tough to tell if one will do the job when another
hasn't," says Larry Lipshultz, M.D., professor of urology at Baylor
College of Medicine in Houston. "But they're low-risk
treatments—it makes sense to exhaust the possibilities."
Sex Rx for Women
If you're a woman with a low sex drive, you're probably asking,
"Where's my pill?" The short answer is, don't hold your
breath—but don't give up hope, either. The most promising
treatments:
>Viagra The Viagra-for-women idea isn't new: Irwin Goldstein,
M.D., director of the Institute for Sexual Medicine at Boston University School
of Medicine, found it enhanced clitoral blood flow in rabbits way back in 1998.
More recently, a study in the European Journal of Obstetrics and
Gynecology found that women treated with Viagra for four weeks reported
marked improvement in arousal, orgasm, and sexual enjoyment (side effects were
similar to those reported in men). So why aren't women hoarding their
partners' pills?
"Drugs for erectile dysfunction work well for many men because they
typically want to have sex but can't," Goldstein explains. "For
women there's often a different problem: In many cases what's missing
is the desire." A woman's sexuality is more complicated than a
man's—big surprise there—which means that boosting desire may
require something other than improving circulation. For women, Viagra will
likely have a better success rate for lubrication problems than libido
problems, since these are less about blood flow and more about hormones and
psychology.
>Estrogen Therapy It's well known that estrogen shortages can
lower libido and trigger such problems as vaginal dryness. Events such as
childbirth, hysterectomy, and menopause can all cause imbalances, but so can
drugs like antidepressants and, ironically, birth control pills. If eliminating
problematic prescriptions doesn't correct estrogen imbalances, a woman may
need estrogen replacement. For women who've been rattled by the recent
controversy over estrogen pills and patches, alternatives include locally
applied creams like Premarin and Estrace, and vaginally inserted drugs like
Estring and Vagifem.
>Androgen Therapy Estrogen imbalance isn't even half the
problem, explains Goldstein. "There are 10 sex steroids in all, and only
three are estrogens; the other seven are androgens, which most people think of
as the male sex hormones. We're finding that three out of four women who
see us for lack of desire have serious androgen shortages."
Therapy typically focuses on upping female levels of testosterone. For
women, topical formulations are the most common delivery method. Creams have
been marketed for men for years, but gels such as Testim and AndroGel get top
marks from Goldstein. The big reason: They're more effective and much
easier to use. Androgens are also available in pill form—one product,
Estratest, combines a type of testosterone with estrogen—but the most
exciting news may be the buzz about dehydroepiandrosterone (DHEA), a chemical
cousin of estrogen and testosterone. Goldstein's research has found that
women who take DHEA show substantial improvements in their self-evaluated
sexual performance—though he's quick to warn that women shouldn't
take it on their own. "It's sold as a supplement, but DHEA is a drug,
and we don't totally understand it yet," explains Goldstein. While
side effects of topical and oral testosterone therapy can include weight gain,
clitoral enlargement, and unwanted hair growth, DHEA use has been linked to
even scarier problems including birth defects and cancer.
>Talking Cure A wide range of psychological factors, including
depression, anxiety, a history of physical and emotional abuse, and an array of
interpersonal relationship problems, can drain a woman's interest in sex.
"While we never want to say that problems with sex are all in
someone's head, the psychological factors are undeniable and may even be
more profound in women than they are in men," says Goldstein. That's
the reason all of his patients consult with a psychologist as well as a
physician—and why anyone who's not enjoying sex should, too.
>Bottom Line Women may eventually have as many drugs to choose
from as their pill-popping partners. But before there's a cure, there has
to be research. Think of it as pharmaceutical foreplay. "The really
effective medications for men were developed once we understood the physiology
of male erections," explains Goldstein. "We won't have a similar
answer for women until we have that same understanding of female
physiology."
Melissa Gotthardt is a regular contributor to AARP The Magazine.
Listen to the Prime Time Focus radio version of this story.
Part 1 | Part 2
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