Love Drugs: facts and fictions

cialis, dynamic, levitra, placebo, viagra - By Better Sex on Wednesday, May 12, 2010 - 14:18

For thousands of years, people have sought out substances reputed to increase sexual potency and desire. Known as aphrodisiacs, these have ranged from powdered rhinoceros horn to ginseng root, from particular foods (oysters, grapes, chocolate) to the dangerous, often deadly dried-beetle concoction known as Spanish fly.

Cupid In A Bottle: Introduction

Today we have Viagra, Levitra, and Cialis: pharmaceutical agents that promote erections for men. But these drugs are not a solution for everyone: They don’t work in all men, they are not recommended for people taking certain medications – and, while usually effective in triggering male erection, they do nothing to increase sexual desire in men or women. Sexual desire is different than sexual potency.

However, there are now literally dozens of products, sold in drug and health food stores or via the Internet, that claim to improve sexual functioning and libido (sex drive). While the majority of these are designed for men – said to increase desire, erectile ability or staying power – several are geared to enhance desire, arousal, and orgasm in women. Containing various mixes of herbal and other ingredients including vitamins, minerals, enzymes or amino acids, these formulas are said to work by acting on the circulatory, nervous or hormone systems. Most of the preparations are taken orally, as dietary supplements, though some are topical creams, gels or oils, applied directly to the skin. Touting "all natural" ingredients, these products claim to deliver results safely, with few or no side effects.

But are these non-perscripton "love drugs" really safe? And do they actually work?

Safety First

When considering questions of safety and efficacy, "keep in mind that these preparations are not classified as drugs, which means they are not regulated to the same extent by the Food and Drug Administration (FDA)," says Drogo Montague, M.D., a urologist and director of the Center for Sexual Function at the Cleveland Clinic in Ohio .

The FDA is responsible for taking action against any unsafe dietary supplement once it is commercially available, but not for regulating safety of the product before it reaches the market. Unlike with prescription drugs, makers of supplements do not have to prove that their products are effective or safe before marketing them. These preparations are not subjected to the rigorous scientific testing that drugs must undergo to receive FDA approval: lengthy clinical trials involving hundreds or thousands of patients for each drug tested.

Another possible cause for concern: Preparations do not necessarily contain all the ingredients listed on the package or in advertisements for the product. Worse, the products may contain ingredients that aren’t listed - and potentially dangerous. In early 2004, for example, physicians at Toronto ’s Princess Margaret Hospital purchased seven different products said to treat erectile dysfunction. Analyzing the contents, the doctors found that two of the so-called "herbal" products contained significant levels of sildenafil, the active ingredient in Viagra, or tadalafil, the active ingredient in Cialis - both of which can be fatal if taken with nitrate-containing heart medications.

More recently, the FDA issued a warning for men to avoid two dietary supplements sold on the Internet to treat erectile dysfunction and enhance sexual performance. The supplements, sold under the names Actra-Rx and Yilishen, were found to contain prescription-strength sildenafil.

Even if supplements do not contain any unlisted pharmaceutical ingredients, buyers should be aware that botanical ingredients themselves may cause problems in some users. "Certain herbs can interact adversely with certain drugs," says Scott Pescatore, Pharm.D., a former fellow at the University of North Carolina at Chapel Hill division of pharmacotherapy. Anyone considering an herbal product should make a list of medications and any other drugs you take, including alcohol, "and go over it with your pharmacist, to see what’s safe and what isn’t."

Pescatore also advises caution regarding products that contain yohimbe - an African tree bark extract said to promote sexual function by acting on nerves and blood vessels in the penis. Yohimbe has been shown to elevate blood pressure, as well as causing dizziness and nausea, in some users.

Generally, it’s best to be employ caution when considering any supplement touted as a sex enhancer. Before purchasing a product, check to see if there have been any reports of adverse reactions. The FDA posts product alerts and warnings on its web site (www.cfsan.fda.gov/~dms/ds-warn.html). Other sources to check include the Better Business Bureau and the office of your State Attorney General.

If you do decide to try a supplement, use your common sense. Never take more than the recommended dosage. And if you experience adverse effects with any product, stop taking it and see your doctor.

The Placebo Effect?

It has often been said that the best aphrodisiac is the mind. After all, human sexuality is driven by thoughts and feelings that originate in the brain. What’s more, research has consistently shown that the mind can powerfully affect the body.

So, it’s not surprising that many of the people who experience improved sexual desire and functioning after taking a "sex enhancing" supplement have this reaction because of a phenomenon called the placebo effect. This occurs when a person responds positively to an inert substance (known as a placebo) because of the psychological expectation that the substance is an effective remedy.

The placebo effect is fairly common, experts say. Even in large, well-controlled drug studies, there is often a high rate of positive response among patients who are given a placebo instead of the drug. "In many clinical trials, including those for Viagra, the response rate of the placebo group tends to range from 20 to 40 percent," says Ira Sharlip, M.D., a private-practice urologist and assistant clinical professor of urology at the University of California at San Francisco .

The late sexologist Bernie Zilbergeld, Ph.D., in his book The New Male Sexuality (Bantam, 1999), described the placebo effect this way: "If I lined up a hundred men with erection problems and had them all drink a cup of organic camel urine daily for a week, at least ten or twenty would probably report that their erection problems had vanished. While this is not sufficient to demonstrate that camel urine is a reliable cure for erection problems, those who benefited won’t care."

It’s a good point: If you believe that a particular substance will help you - and it does - then there isn’t any problem. But as Zilbergeld suggests, if you try a substance and it doesn’t help, you may want to consider "something with more scientific backing."

Choosing Products: A Guide for Consumers

Many of the products marketed as sex enhancers contain vitamins and minerals along with botanical ingredients that are said to work by increasing circulation to the genitals, enhancing nervous system activity, or boosting the body’s natural production of the hormone testosterone. Some of the botanicals commonly used are gingko biloba, saw palmetto, avena sativa (wild oat extract), muira puama (from the South American rain forest), ginseng and other Chinese herbs.

With so many products available, all of them promising success, how does one make a choice?

First, know what to avoid. Rule out any products that have been reported ineffective or unsafe. Also steer clear of those that use a "snake oil" marketing approach with outlandish-sounding claims, such as promising to deliver the erectile response of an 18-year-old. Go with your gut feeling: If something sounds too good to be true, it probably is.

Also, don’t assume that a physician’s name appearing in an advertisement is any guarantee of a superior product. "I knew of a doctor, a member of the American Urological Association, who endorsed a product and happened to own the company that made it," says Dr. Sharlip. In addition, some companies will include a physician’s name in their advertising "even though he has no relationship with the product advertised. He may have done research on a compound similar to the product or one of its ingredients, so the company will use his name. This type of thing should be controlled by the government in some manner, but because these products don’t require government approval, it isn’t."

Attempting to choose a product based on its ingredients isn’t particularly useful. For one thing, although many of the same ingredients turn up in these formulas, not all formulas are equally effective. Besides, as mentioned above, certain ingredients listed on the package may not actually be present in the product.

Even if you have seen studies demonstrating the effectiveness of a particular substance, such as yohimbe, that does not necessarily indicate that a product containing the substance will produce the same results. And since clinical testing of herbal products is not required the government, it is rare to find instances of these products being tested in their market-ready form. To date, the Sinclair Institute has only come across two products that have undergone such testing and had results published in medical journals: ArginMax, a dietary supplement for men and women, and Zestra, a lubricant for women. (see more information below about Zestra).

Dennis Sugrue, Ph.D., a psychologist and former president of the American Association of Sex Educators, Counselors and Therapists, advises: "Though none of these products are FDA-approved, consumers can still make an informed choice based on certain guidelines." According to Dr. Sugrue, these guidelines can be divided into three categories. In ascending order of credibility, they are as follows:

• The product has been praised via customer testimonials and other anecdotal reports
• There has been some clinical research indicating that the product is effective
• Rigorous published clinical research indicates that the product is effective

Product Praise

Products in this category have not been subjected to empirical research, but many people who use the product have reported success via word-of-mouth (including Internet forums), as well as customer testimonials that appear in advertising. Products in this category include Frixion, a topical lubricant that is said to improve sexual energy in men. Its ingredients include yohimbe, avena sativa (a wild oat extract associated with increased libido), and the amino acid L-arginine, which has been shown to facilitate blood circulation to the genitals.

Also in this category are two products for women: Viacreme and O’My Clitoral Stimulating Gel. Both these of these topical products are applied directly to the clitoris. Both contain the same two active ingredients – L-arginine and menthol – and are reputed to increase sexual sensation in women who use them. L-arginine increases blood flow to the clitoris, resulting in engorgement and heightened arousal; the menthol gives a tingling effect that adds to sexual sensation. Use of these products is also said to help increase the likelihood, frequency, or intensity of women’s orgasm by triggering the physical condition of arousal in the clitoris. However, women using these products, and their partners, should be aware that clitoral engorgement, while a key component of female arousal, is not in itself enough to trigger orgasm: Most women also need to feel mental arousal and to receive continuous, satisfactory clitoral stimulation - via hand, mouth, penis or vibrator.

There has been some clinical research indicating that the product is effective.

An example of a product fitting this criterion is Deferol Climax Control Supplement, a dietary supplement shown to increase men’s "staying power" during intercourse. The product was developed based on scientific evidence that increasing levels of serotonin (a neurotransmitter) in the body improves ejaculatory control in men. In addition to increasing bodily levels of serotonin, the product’s combination of botanical, micronutrient and vitamin ingredients work to reduce anxiety, which is often a factor in early ejaculation, and to minimize the effect of the neurotransmitter dopamine. (Elevated levels of dopamine are also associated with early ejaculation.)

The product was tested in a randomized double-blind placebo-controlled study (subjects did not know if they were receiving Deferol or a placebo), the results of which appear on Deferol’s Web site (www.deferol.com/study_results.html). The study, completed by 29 men, showed that those taking Deferol experienced a significant increase in duration of intercourse compared with the group on placebo. Men with self-reported intercourse times of less than 15 minutes showed an average 40 percent increase in intercourse duration on Deferol. Additional studies of the product’s effectiveness are underway.

Rigorous published clinical research indicates that the product is effective.

To date, we have found only two products that qualify for this category. The first is ArginMax, a dietary supplement in formulas for men and women. Available in capsule form or as a powdered drink mix, ArginMax’s ingredients include L-arginine along with a variety of herbs, vitamins, and minerals. L-arginine, an amino acid that naturally occurs in the body, acts as a building block for the production of nitric oxide: a substance that enhances circulation, dilates blood vessels, and relaxes smooth muscle (the type of muscle found in the penis and clitoris). Nitric oxide facilitates erection in men, and clitoral engorgement and vaginal lubrication in women.

Several physician-directed studies have been conducted on ArginMax for Men, including a double-blind placebo-controlled study of 48 men, published in the Hawaii Medical Journal. After four weeks, 87 percent of the men receiving ArginMax reported that they were better able to maintain an erection during intercourse, compared with 22 percent of the men receiving placebo. Seventy-five percent of those in the ArginMax group said they felt more overall satisfaction with their sex life.

ArginMax for Women is also shown to be effective. In a double-blind placebo-controlled study of 77 women with sexual dysfunction, published in the Journal of Sex and Marital Therapy, 70 percent of the women taking Arginmax said they felt more sexual desire. Seventy-three percent reported an increase in sexual satisfaction, and almost half (47 percent) said they were having more frequent orgasms.

ArginMax does not work immediately: Most users need to take the supplement for at least two weeks before they see any benefit.

Zestra, a botanical lubricant for women containing evening primrose oil, borage seed oil, plant extracts and vitamins, is designed to increase genital blood flow and nerve sensation when applied to the vulva, thereby enhancing a woman’s arousal and sexual pleasure. In a double-blind placebo-controlled study published in 2003 in the Journal of Sex and Marital Therapy, women both with and without sexual arousal problems experienced positive results on Zestra. Both groups of women taking Zestra reported a significant improvement in levels of desire and arousal, sexual pleasure, and the ability to have orgasms.

Whatever product you decide to try, remember that even an effective sex-enhancing supplement can only do so much. Never underestimate the importance of good sex basics: Expressing yourself to your partner, being responsive to his or her desires, and fully enjoying the moment rather than focusing on what "should" happen.

If you have any ongoing sexual difficulty, like erectile dysfunction, anorgasmia, or low desire, and find that supplements are not effective against the problem, talk to a physician.

GLOSSARY

Testosterone: A hormone involved in male sexual development, functioning, and desire. Testosterone is also present, at lower levels, in women: As with men, the hormone drives sexual desire in women.

Erectile dysfunction: The chronic inability to get an erection satisfactory for sexual intercourse.

Anorgasmia: The chronic absence of orgasm in sexual relations.

Photo by: sonyaseattle