Not rising to the occasion


Americans are obsessed with sex. All you have to do is turn on the television in the middle of the day and you will see steamy scenes on the soap operas. "Desperate Housewives" is one of the more popular prime-time shows, and sex is an underlying theme.

Given our national preoccupation with sex, you would think that the drugs designed to facilitate intercourse would be blockbusters and would practically sell themselves. That has obviously not been the case. Manufacturers spend hundreds of millions of dollars each year advertising their erectile-dysfunction drugs on television, in newspapers and in magazines.

Viagra did become a household word almost overnight. Sales were initially strong. Some Wall Street analysts predicted that worldwide revenue for this drug alone would exceed $2 billion in 2000 and $4 billion by 2004.

That never happened. Combined sales for all three ED drugs (Viagra, Cialis and Levitra) reached $2.5 billion in 2004. Despite intense marketing, sales are flat or even declining. Prescriptions dropped 10 percent between October of 2004 and October of 2005.

The reasons for this disappointing performance are complex, but one might be that marketing has created unrealistic expectations. Television advertising for these products is often suggestive, and some viewers might conclude these pills act as aphrodisiacs.

ED medications can help only with vascular problems due to poor circulation. They don't work for everyone, however. Up to one-third of the men who take them are not satisfied with the results.

In addition, these drugs have no impact on libido, so people who anticipate that they will increase sexual desire will be sorely disappointed.

Some men may have hoped that drugs like Cialis would make them better lovers. The warning on TV commercials about the dangers of a prolonged erection may have seemed like an enticement for men who wanted such drugs to enhance their performance or endurance.

In truth, those who do not suffer from impotence do not benefit from these medications. The drugs can't make up for poor technique or lack of romance.

The manufacturers may have overlooked the fact that satisfying intercourse requires a positive relationship. Drugs by themselves can't improve communication.

Most men affected with erectile dysfunction are middle-aged and older, and their partners are also aging. Wives may also suffer with sexual dysfunction. Menopausal symptoms, lower libido or physical conditions like arthritis can make intercourse uncomfortable.

Other downsides to ED medications are high cost and side effects. Some men find that the headache and flushing that can result make sexual activity uncomfortable. Others must avoid all ED drugs because of dangerous interactions with other medications.

For many men with erectile problems, however, these drugs can be helpful. When used appropriately with realistic expectations, they can help a couple maintain a satisfying sexual relationship into a ripe old age.

In their column, Joe and Teresa Graedon answer questions from readers. E-mail them via their Web site: Their newest book is "The People's Pharmacy Guide to Home and Herbal Remedies" (St. Martin's Press).

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