London - British researchers have revealed that impotence drugs such as Viagra might cause sudden hearing loss - which is worrying news for the estimated 2.3 million men in Britain who suffer from erectile dysfunction.
It is thought that a chain of chemical reactions triggered by Viagra may affect the inner ear.
Though erectile dysfunction is more common in older men - around 65 percent of the over-60s suffer from it - around 40 percent of men will have suffered from the problem by the age of 40.
There are many physical causes for it, explains Dr Arun Ghosh, a GP specialising in sexual health at the Spire Liverpool Hospital.
It can be caused by nerve damage from diabetes, or surgery for prostate cancer. Another cause is reduced blood flow due to smoking, raised cholesterol levels or high blood pressure. Common medications such as anti-depressants and blood pressure tablets can also hamper performance, as can stress and even regular cycling.
Dr Ghosh says the problem is also closely bound up with flagging libido: “A lot of these men are suffering from testosterone deficiency syndrome, due to reaching their 40s and putting on weight around the stomach.
“This causes testosterone levels to drop, resulting in a loss of libido and erectile function. It’s worth asking for a blood test if you hit 40 and start developing these symptoms.”
As well as the problem of mechanics, there is a psychological component to erectile dysfunction.
“If you’ve had a problem even once before, then you’re always going to be worried it will happen again,” explains Dr Ghosh.
“In fact, one of the main roles of any treatment is to give men a psychological boost. It’s vitally important to use treatment alongside some kind of sexual counselling or therapy, even if the cause is due to something physical such as diabetes.
“A man’s partner will often say: ‘Don’t worry about it’ - but even if he’s trying not to think about his performance, he will think about not thinking about it. And before you know it, performance anxiety has kicked in.
“Anxiety and stress stop the pituitary gland secreting the hormones needed for sex. The body goes into ‘fight or flight’ mode, shutting down all non-essential functions - with sex being one of them.”
With the latest news about Viagra, many will be tempted to try other options. So what are the best alternatives, whether bought over-the-counter or prescribed by your doctor?
We asked the leading experts for their views on the pills, potions and gadgets that promise to pep up a man’s libido or assist with erectile dysfunction. We then rated them...
INJECTIONS
Contain: The drug Caverject or Viridal Duo (alprostadil).
You inject the drug into the spongy parts of the penis (on either side at the base). This prescription-only treatment works by preventing blood from leaving after it flows into the penis, creating an erection. An erection occurs after about 15 minutes and then lasts for 30 to 45 minutes.
Expert comment: “Understandably, a lot of men are daunted by this, but it can be a very effective treatment, even in men with extreme nerve damage after diabetes or surgery,” says Dr Ghosh.
“The needle is tiny and your doctor will show you how to use it the first time. After that, you just self-administer at home.
“There are complications - sometimes the penis can become bent if you inject too much into one side, or the erection will not subside.
“But on the plus side, injections are good if you have no libido as you don’t need to be aroused for them to work. However, you still need to seek psychological help to address that aspect.”
6/10
HERBAL REMEDIES
Golden ginseng
Contains: Ginseng root.
May help erectile dysfunction and low libido by boosting testosterone levels, according to a study published in the Journal Of Sexual Medicine.
Male mice given a ginseng extract displayed an increased amount of sexual behaviour.
A second study of 28 women given either a ginseng capsule or placebo found the former group had “significantly elevated arousal levels”.
Expert comment: “I don’t believe there is any such thing as a herbal aphrodisiac, so you’re better off saving your money,” says David Colquhoun, professor of pharmacology at University College London.
“Animal studies are irrelevant for this sort of thing, because men are not mice (especially when it comes to things like libido, with complicated psychological elements). The other trial was small and has not been replicated.”
2/10
PRESCRIPTION DRUGS
Viagra is one of a group of drugs known as PDE5 inhibitors. If you want to avoid Viagra, other options include tadalafil (brand name Cialis) and vardenafil (Levitra). They work by relaxing the blood vessels, allowing blood flow for an erection.
Expert comment: These drugs are good in that they address both the physical and psychological cause of erectile dysfunction, says Dr Ghosh.
“Taking one will give you more confidence and, providing you’re in the mood and there’s foreplay, it’ll help physically, too (the drugs need these to work).
“I tend to prescribe Cialis the most because, unlike Viagra, it’s not affected by fatty food or alcohol. Viagra is an older drug and has a different coating that doesn’t break down so well in the stomach, especially where’s food in there as well.
“The effects of Cialis last for up to 24 hours, so there’s not so much pressure to perform in a given time frame, whereas with Viagra you only have an hour-long window.
“It’s been found that giving diabetics or other men with poor blood flow to the genitals a low dose (2.5mg) of Cialis daily can actually help improve blood flow to the area generally, so the next time they take the full dose (10mg) their erections are stronger.
“I also believe Levitra is better than Viagra - again, because it lasts for 24 hours.
“However these drugs are unsuitable for men with angina or very high blood pressure. Side-effects include heartburn, nausea and headaches.”
8/10
TESTOSTERONE PATCHES AND GELS
Contains: 1 percent testosterone.
Low libido and erectile dysfunction can be treated with testosterone therapy, available in various forms such as tablets, patches and gels - but only on prescription.
The most commonly prescribed products include Testim and Testogel gels. These are usually applied to a large area of skin, such as the chest or thigh.
Expert comment: “The andropause - or male menopause - is a recognised cause of low libido and erectile dysfunction,” says Suks Minhas, consultant urologist at University College Hospital London.
“There have been concerns that giving a testosterone supplement such as a gel may increase the risk of prostate cancer, but the latest research suggests this may not be the case. These gels can be very effective.”
7.5/10
DEVICES
VACUUM PUMPS
These are available on prescription or over-the-counter in pharmacies.
A plastic cylinder goes over the penis and a battery pump or hand pump is used to create a vacuum. This draws blood into the penis; the blood is kept in place with a ring to stop it flowing out.
Vacuum pumps are often used in conjunction with prescription drugs (PDE5 inhibitors) after surgery for prostate cancer, but a pump can be used on its own if the drugs have no effect or there is no nerve function left.
Expert comment: “This is a good option for people who can”t take drugs such as Cialis, are allergic to the medicine in tablets or injections, or who simply want a drug-free alternative,” says Dr Ghosh.
“Be careful not to use it for more than 30 minutes, though, or you could damage the tissues and blood vessels, or cause a blood clot to form. Between 30 and 80 percent of men find it effective.”
4/10
RUBBER RING
This is placed at the base of the penis to stop blood flowing out once erection has been achieved. Available from pharmacies.
Expert commentt: “These do work and can be helpful for men with premature ejaculation, or for older men who find their erections aren”t as strong as they used to be, says Dr Ghosh.
“They can also be very successful for those with mild erectile dysfunction, who find they can get an erection but can”t sustain it. They are cheap and easily available. I”ve even seen some in Tesco.
“Be careful not to wear the device for more than 30 minutes, though, or you may cause tissue damage.”
5/10
PELLETS
Contains: The drug alprostadil.
The same drug used in the injections is also available in pellet form. Inserted by the man or his partner into the urethra using a disposable applicator, the pellet melts and is absorbed into the body.
It stops the blood flowing out of the penis so that it gradually gets bigger. An erection should follow within five to 15 minutes, and last between 30 and 60 minutes.
Expert comment: “Some people prefer the idea of these to an injection,” says Dr Ghosh. “But on the whole, they don”t provide such strong erections as the injections and tend not to last as long, because injections target the exact spot. You also need to be careful inserting them as they can cause blockages in the urethra, interrupting urine flow.
“Side-effects include dizziness, headache and localised pain in the penis or surrounding area.”
5/10
SURGICAL TREATMENT
These are typically a last resort. The one most often used involves an inflatable device. Two cylinders are placed either side in the tissue and these are connected to a pump in the scrotum. Squeezing the pump fills the cylinders with fluid kept in a reservoir in the abdomen.
Expert comment: “This tends to be used by men with serious spinal injuries or those with very bad diabetes (where all the blood vessels have gone), who still want to maintain a sex life,” says Dr Ghosh.
“It can be very successful and save sexual relations when all else has failed. There are some risks attached to the operation, though, including infection and damage to the penis.”
8/10
Information: Sexual Advice Association: 020 7486 7262 (helpline) or sexualadviceassociation.co.uk - Daily Mail