By Dr David Delvin

A Revolution in Treatment

One of the most extraordinary medical advances of the last few years has been the development of really effective treatments for people who need help with their sex lives.

Indeed, the massive publicity surrounding Viagra has suddenly made the whole subject of sexual dysfunction mentionable! Although people are always joking about Viagra, it is a good thing that at last the topic of impotence is out in the open.

And make no mistake: Impotence ('erectile dysfunction') and other types of sexual difficulty are extremely common, particularly in the over-50s. If you have such a problem, you don't have to 'suffer in silence' any more. Do get yourself some help.

Until quite recently, very little could be done for people who had severe sex problems. But today, thank heavens, all that is changing fast. For instance, I myself have seen literally hundreds of men (mostly of retirement age) whose lives have been transformed by Viagra. Here are some of the things they've said to me:

· "I was in despair till I went on the Viagra".
· "Those pills have saved my marriage".
· "After 10 years of misery, I feel a man again".
· "If you hadn't put me on the pills, I think I'd have topped myself".

So let's look at recent advances in treatment of sexual problems. We'll begin by dealing with male dysfunctions - and then move on to those which affect women.

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Men and Their Problems

In the over 50s, difficulties with erection are extremely common and this is usually very upsetting for the man, and for his partner as well. Indeed, I've often seen 'erectile dysfunction' (ED) break up marriages.

Until recent years, the main treatment, which was available, was counseling/psychotherapy. Frankly, this wasn't awfully successful, except in younger men. Then in the 1990s, several new treatments came in. These included:

· Injections into the penis;
· Putting special pellets into the penis;
· Vacuum cylinders which 'suck' the penis into erection;
· Surgically inserted splints.

These treatments were moderately successful. Then in 1998 came the first of the oral drug treatments; Viagra. Another drug was released in June 2001 (see below) and there are several others on the way. Oral agents have now become the most popular treatment.

Let's just look at these drugs:

Viagra.  

These little blue diamond-shaped pills work for four out of five men who have potency problems, though unfortunately the success rate is a little lower in diabetics.

The drug works by opening up the blood vessels (that is, the tubes), which supply blood to the penis. It has no effect on sexual desire.

Minor side-effects are very common, but they only rarely stop a man from using the drug. They include:

· Flushing/fullness of the face;
· Headache;
· Stuffy nose;
· Indigestion;
· Dizziness;
· Green or blue vision.

But (and it's a very big 'but') it's important to realise that some men have died while on Viagra. This does not necessarily mean that the drug actually caused the deaths. But please note that you should be medically screened before going on these pills. Why? Because Viagra could be dangerous for some men, particularly guys with certain heart (or eye) conditions. It is very risky if you are taking some heart drugs, and even certain fruit juices.

So do not use it unless a doctor has said it's safe for you to do so.

Viagra and the NHS. Unfortunately, in the UK the Government only allows free Viagra to certain categories of men (and even then, it's rationed!). The biggest such categories are:

· Diabetics;
· People with Parkinson's
· Men who have had prostate cancer or a prostate removal.

For details of other categories, consult your GP. However, the great majority of people have to see a doctor who's willing to give them a private prescription for Viagra. They then need to take it to a chemist and pay her/him for the tablets.

I cannot over emphasise the fact that pharmacists are entitled to charge whatever they like for such a private prescription, provided that you are willing to pay it. For instance, some of my patients have been asked to pay £16 for a tablet, which they could get elsewhere for about seven quid! So it's actually worthwhile 'shopping around'.

How do you use it? Now, how do you use it? Viagra takes an average time of about one hour to work, so you need to swallow the little 'blue diamond' about 60 minutes before you want to have sex. This takes a bit of planning. And it's best to let your partner know what you're doing!

Viagra on it's own cannot do the entire 'job' of producing an erection; you do need a little penile stimulation as well. After you've taken it, it's usually active in the body for about four hours.

One or two other matters concerning Viagra are dealt with in the 'Q & A' section at the end of this month's feature.

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Uprima. 

This is the second oral anti-impotence drug to be released in the UK. It was launched in June 2001, but with very little publicity, so that remarkably few men have so far heard of it.

Nonetheless, it is a useful alternative to Viagra, and is particularly helpful for the one in five males in whom Viagra doesn't work. It's big advantage is that it takes effect much more quickly than Viagra (usually in about 20 minutes) simply because you put it under your tongue, rather than swallowing it.

Uprima works in a totally different way; it stimulates a brain centre which is involved with erection. However, like Viagra it does not affect sexual desire.

Because Uprima is a much newer drug, we still don't know a lot about it's long-term side-effects, or it's interactions with other medications. Before starting on it, you should read the (already long) list of possible adverse effects listed on the package insert.

Among the commonest side-effects are: nausea, headache, giddiness, yawning, nasal inflammation, sore throat and sleepiness. Please do not take Uprima unless you've first been screened by an experienced doctor. Under the NHS, it's use is very restricted (just like Viagra), so most men have to get PRIVATE prescriptions for it. At the time of writing, chemists are charging remarkably variable prices for the little red pills, so my advice is to get 'quotes' from several pharmacies before you buy!

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Other Anti-Impotence Drugs.

Several other anti-ED drugs have now been invented. But they're still undergoing trials, and have not yet reached the British market. Ones which may be available soon include Cialis (IC351) and Vardenafil.

However, please bear in mind that any drug for treating erectile dysfunction is bound to have side-effects. Think carefully before deciding to go on one.

Having given that warning, I must say that the outlook for older men with sexual difficulties has never been better.

Women and Their Problems

I wish I could say that advances in the treatment of Women's sexual difficulties had been quite as dramatic - but they haven't. Nonetheless, there have been some useful developments.

In particular, the drug companies are working flat out to develop new therapies which could:

· Help women who are suffering from lack of libido;
· Help women who have difficulty reaching an orgasm.

The reason why they are doing all this research is that worldwide there are literally millions of women who would be very grateful for these products. My information is that the researchers are likely to achieve their aim within the next few years.

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Viagra For Women? 

In the last few months there have been staggeringly silly headlines in some newspapers, suggesting that 'Now Viagra works just as well for women!' and 'Viagra to be available on the NHS for Women'. Neither of these statements are true. At the moment, Viagra is not licensed for use in women. I think it is likely that it will prove a help to some female patients. But the scientific trials of the drug in females have so far been a bit disappointing. At the moment, the probability is that it may increase lubrication and genital blood flow in certain women - and (with luck) improve enjoyment.

Other Drugs

A drug called 'alprostadil' is undergoing trial, and has produced some promising results. There have also been repeated trials of the male hormone testosterone. But although certain newspapers have reported that it is very effective in stimulating female libido, I have not found it helpful in any of my patients.

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Hormone Replacement Therapy (HRT)

During and after the menopause, the majority of women notice a degree of vaginal dryness and this can cause considerable sex difficulties. Hormone Replacement Therapy will usually help this condition. It is often worth using female hormone cream, which rapidly restores the vagina to its pre-menopausal state. But the cream can have side-effects (just like oral HRT), so it's use must be monitored by a doctor.

The New Sex Lubricants

In the last couple of years, a number of new sex lubricants have become available - through chemists and sex shops, and by mail order. They've proved immensely useful - especially for couples over the age of 50.

Devices

There has been a lot of publicity in the newspapers about new devices which are alleged to help women reach orgasm, and to treat what the Americans call 'Female Sexual Arousal Disorder' (FSAD). I can't say that any of these things is a magic cure. But they do seem to be helpful to quite a few couples. The best known are:

· The Medtronic Nerve Stimulator. Recently invented in the USA (but not yet on the market), this is an electrical device which stimulates the nerves at the base of the spine, and so makes it easier to reach orgasm.

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The Eros Clitoral Therapy Device (Eros-CTD). 

This was recently approved by the US Food and Drugs Administrations as a treatment for FSAD. It's now available in the UK, at a cost of about £185. Basically, it's a battery-operated suction device which fits over the woman's clitoris; the idea is that it will increase blood flow to this area.

Vibrators. 

Millions of these have now been sold, and there's no doubt that they have helped many women reach orgasm. These days, lots are sold through 'Female Only' stores run by women for women - such as Sssh! And Passion-8.

A final practical point: if you are a woman who is experiencing some form of sex difficulty, I would strongly recommend that your first stop should be your local Family Planning Clinic. Britain is fortunate in having a network of hundreds of such clinics, and many of the women doctors who work there have done special voluntary training in dealing with female sex problems. More details from the Family Planning Information Service on 0207 310 1334.

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Q. I'm a company director, aged 58. I have managed to get a Viagra prescription from a private doctor. But I am really embarrassed about the idea of taking it to our village chemist - as I'm sure people would talk. They gossip a lot in that shop.
A. Then don't take it to your local chemist. You can go to any pharmacist you like - for instance, one in London or in your nearest large city. Also, there's an excellent pharmacy that runs a reliable and discreet postal service - though you have to pay for the Special Delivery. Ring the pharmacist on 01603 434890, and talk it over with him. Please note that the Law requires that you post him the prescription before he can send you any pills.

Q. I'm a retired businesswoman, and I've been taking HRT for five years. It certainly helps my love life! But how long can I go on using it for?
A. As long as you like. In the USA, there are women who are still taking it in the 80s! But you should have regular check-ups from a doctor. Also because the risk of breast cancer is slightly increased on HRT, you should check your breasts regularly, and take advantage of your local mammography (Breast Screening) service.

Q. I am 60, male, and need a little help in bed. I've been offered the chance of buying Viagra through the Internet. The people say that if I pay them £100, they'll send me eight tablets. Should I accept?
A. No. For a start, this is outrageous overcharging! These days, you should be able to get Viagra for roughly £7 a tablet. Secondly, selling prescription drugs via the internet is illegal. And thirdly, you should see a doctor before you go on this fairly powerful drug!

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