SEX FOR ’40 something'

BY MACON RAMOS-ARANETA

SOME men in their ’40 something’ may encounter difficulties in gaining full erection or have lost sex drives.

Based on the survey entitled “Ideal Sex in Asia,” conducted by Harris Interactive Asia, a full-service global market research firm, erection hardness has been considered a significant factor to attain the ideal sexual experience with a sex partner.

The European Association of Urology developed a scale which measures erection hardness and quality, known as the Erection Hardness Score (ERS).

A Grade 1 score depicts a penis that is larger, but not hard. For Grade 2, the penis is hard, but not hard enough for penetration while Grade 3 is a penis that is hard enough for penetration, but not completely hard. Grade 4 ultimately is a penis which is completely hard and fully rigid.

EHS Grade 4 erection hardness is correlated with better health and higher feelings of self-worth than EHS Grade 3 erections.

However, not all men are capable of reaching “optimal erection” such as Grade 4 because some men have erection problems hindering the nerves or blood vessels that play an important role in the sexual arousal process.

The erection problem is known as Erectile Dysfunction (ED). This pertains to men’s inability to achieve or maintain an erection sufficient for mutual sexual satisfaction.

ED is commonly caused by diabetes, high-blood pressure, liver disease, obesity, stroke as well as psychological factors like stress and trauma, and hormonal imbalance, among many others.

DOH Undersecretary Teodoro Herbosa said the most popular brand among the prescribed treatment pills for ED is Viagra, developed and marketed by pharmaceutical company Pfizer Inc.

Viagra is also called the “Blue Pill” due to its color. It is formulated as blue, film-coated rounded-diamond shaped tablets equivalent to 25 mg, 50 mg and 100 mg of sildefanil for oral administration. It is generally taken by men suffering from impotence, thirty minutes or an hour before sexual intercourse.

When the effect of Viagra sets in, a man will be able to engage in sexual activity. In many cases, he can achieve and maintain an erection sufficient for satisfactory sexual activity.

Viagra improves the following aspects of sexual function: frequency, firmness and maintenance of erections; frequency of orgasm and level of desire; frequency, satisfaction and enjoyment of intercourse and overall relationship satisfaction.

Aside from the active ingredient sildenafil citrate, each tablet contains the following inactive ingredients: microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, magnesium stearate, hypromellose, titanium dioxide, lactose, triacetin, and FD & C Blue #2 aluminum lake.

Herbosa however said there other available potency pills for ED like Levitra and Cialis, but they are not so famous as Viagra. He related that Viagra was originally formulated to treat hypertension, but it was later used for ED.

“When the Viagra tablet was undergoing study in the United Kingdom in the 1990s, some men came back for their dose because their sex life improved,” said Herbosa.

Because of this, he said the drug was developed and used as a remedy for ED. But he warned using Viagra without doctor’s prescription especially if a man is hypertensive or diabetic.

He cautioned against using Viagra if one has heart problems or heart-related diseases because it can trigger a heart attack and could even be fatal.

“So one needs to see a doctor before using the drug to ensure that there will be no contraindications,” said the DOH official.

He also said that Viagra and other potency drugs should be approved by the Bureau of Food and Drug Administration (BFAD).

After sildefanil was discovered to treat impotence, Pfizer decided to commercialize the drug as Viagra. It was then patented in 1996 and approved by the US food and Drug Administration as a cure for ED on March 27, 1998.

With this, Viagra became the first oral treatment approved for the use of men with ED in the United States.

Later that year, Viagra was openly sold in the country, and proved to be a huge success. From 1999 to 2011, it recorded sales of more than $1 billion capsules.

Due to this, Pfizer, the world’s largest research-based pharmaceutical firm, launched a full-fledged marketing strategy to promote the use of Viagra (Sildenafil) for ED.

In 2000, the drug swept a whooping 92 percent share of the global market sales of prescribed ED tablets.  But in 2007, the sales of Viagra drastically dropped due to the entry of its rival brands - Cialis and Levitra.

Also, several other counterfeits and clones of Viagra mushroomed in the market. These fake Viagra also had their share in the market.

Pfizer Inc. senior medical manager Dr. James Wee said the prescription-only sildefanil drug or Viagra has helped more than 35 million men around the world improved their sex lives since it became available in 1998.

He said majority of those who took Viagra achieved Grade 4 erections, regardless of their erection grade prior to treatment.

He noted that the drug could cure erection difficulties as it helps re-establish the process of improved blood flow to the penis.

Achievement of a penile erection in males is largely an application of basic principles of hydraulics. Stimulation of the nerves innervating the penis causes the dilation of the deep arteries supplying blood to the penis. The large amount of blood entering the penis engorges the cavernous blood sinuses comprising much of the penis volume. This engorgement in turn acts to compress the veins draining blood from the penis. The increased inflow and decreased outflow of blood causes an erection. Cessation of nervous impulses to the penis acts to abolish the erection.

But Wee  reminded the public that sildefanil drug should be brought only from FDA-licensed pharmacies to protect them from getting the fake ones.

He said counterfeit sildenafil drug in the market may cause serious threat to health. He said patients may experience unexpected side effects, allergic reactions and worsening of their medical condition. He said it could even cause death.

Pfizer has repeatedly called on the public to be more vigilant in the use of impotence drugs due to the proliferation of counterfeits. One example is the MagnaRX drugs, which are being sold in drugstores in Binondo and Ongpin, Manila.

MagnaRX, similar to Viagra, appears to be sourced from China and purports to treat erectile dysfunction (ED).

The cost of Viagra are the following: P880.50 for 100 mg; P685, 50 mg and P511.50, 25 mg. Cialis comes in only one preparation, 20 mg and amounts to P796.75 per tablet. A 20-mg Levitra tablet costs P787.50 and 10 mg, P615.50.

WHO Essential Medicines and Pharmaceutical Policies Technical officer Catherine Dauphin said more than 50 percent of medicines purchased over the internet, which is fast becoming an ‘emerging market” for fake drugs, are counterfeit.

She averred using fake drugs could adversely affect treatment failure or result to death, increased resistances and erosion of public confidence in health regulators, services and professionals.

While many people died due to the use of counterfeit medicines, she said these cases are not reported.

Dauphin’s views were supported by Pharmaceutical and Healthcare Association of the Philippines (PHAP) president Reiner W. Gloor pointed out that the counterfeiting of both branded and generic medicines could have grave consequences on health such as drug resistance, disability and death.

Unlike other counterfeit commodities, he said fake medicines pose a direct threat to the lives and health of Filipino patients.

Counterfeit medicines, he said, contain active ingredients that are either too strong or weak or may not contain any active ingredients at all. Many of these fake pharmaceutical products also have hazardous contents such as toxic and contaminated chemicals, pain, and floor wax.

Pfizer Global Security senior director for Asia Pacific Scott Davis said 90% of counterfeit medicines in the world at some point have some contract with the internet. .

Although there were deaths due to online medicines which turned out to be fake, Davis admitted ‘tracking is so difficult’ “”Such is a complex issue.”

In 2008, BFAD recalled the sale and distribution of Penrex herbal supplement for men purportedly to attain erection. It was discovered that Penrex contained Sildenafil Citrate, a known active ingredient of prescribed drugs for erectile dysfunction, but the product is marketed as a food supplement.

BFAD said it should not contain any active ingredient for drug products like sildefanil as it will endanger the lives of men who are diabetic, hypertensive or with heart diseases. It could cause rapid heart palpitation.

The other branded drug for ED, Vardenafil is sold under the Levitra. It is co-marketed by Bayer Pharmaceuticals, GlaxoSmithKline and Schering-Plough.

As of 2005, the co-promotion rights of GSK on Levitra have been returned to Bayer in many markets outside the U.S. In Italy, Bayer sells vardenafil as Levitra and GSK sells it as Vivanza.

The recommended dose of Levitra is 10 mg per day taken an hour before intercourse. If no side effects are experienced the dosage can be increased up to 20 mg. In case of adverse effects the dose is reduced to 5 mg daily. Do not take more than one tab of Levitra a day.

The third available branded drug is Tadalafil, currently marketed in pill form for treating under the name Cialis. It initially was developed by the biotechnology company ICOS, and then again developed and marketed world-wide by Lilly ICOS, LLC, the joint venture of ICOS Corporation and Eli Lilly and Company. The yellow, film-coated and almond-shaped tablet comes in 5 mg, 10 mg, and 20 mg doses, but 20 mg is the only preparation available in the country’s biggest chain of drugstores.

Tadalafil is also manufactured and sold under the name of Tadacip by the Indian pharmaceutical company Ciplain. It comes in doses of 10 mg and 20 mg.

On November 21, 2003 the US Food and Drug Administration approved its sale in the country as the third third ED prescription drug pill.

Cialis's 36-hour effectiveness earned it the nickname, "The Weekend Pill"; like sildenafil and vardenafil, tadalafil is recommended as an 'as needed' medication. Cialis is the only one of the three that is also offered as a once-daily medication.

Former DOH secretary, Dr. Jaime Tan Galvez,  said at  present there are only two FAD-approved herbal medicines for ED available in the local market. These are Enduranz and Monster Excyte.

He admitted though these herbal cure, which are marketed as food supplement, cannot be at par with the branded potency drugs in terms of effectivity. “The effect of branded potency pills for ED is instant unlike their herbal counterparts,” said Galvez Tan.

However, he said Enduranz and Monster Excyte do not have any side effects because they are purely made of herbs. “Since they are pure herbal, they have no side effects,” said Galvez Tan who practices intergrative medicine.

Enduranz, which comes in 350 mg capsule, has been described as a multi-herb product containing banaba (Lagerstroemia speciosa), malunggay (Moringa oleifera), takip kuhol or gotu kola (Centella asiatica).

Gotu kola is also known to be an “aphrodisiac” because it enhances mental abilities, strengthens blood vessels, and improves circulation, wound healing, anti-stress and works against rehumatism, among others.

Malunggay is known to have potent anti-oxidant properties. It has high calcium content.Banaba is known to improve glucose and lipid metabolism.

Tongkat ali or long jack (Eurycoma longifolia) is the active ingredient of Enduranz. It is the herbal supplement that has a unique property to bring back to normal the testosterone level that has declined with age.

It all appears to stimulate the availability of natural testosterone which otherwise is not available as a result of advancing age. It can also help in male infertility problems, morphology, activity (motility) and improve sperms count.

Studies have shown that Tongkat ali can produce arousal, libido and sexual motivation. The overall effect of Tongkat ali is gradual and safe

Enduranz is sold at P20.50 per capsule. It is advised that to get the best results, a capsule should be taken daily before breakfast or may even be raised to 2 capsules, one to be taken before breakfast and the other before dinner before strenuous activity.

The other  male enhancement product, sexual booster Monster Excyte is  a dietary supplement which increases stamina, sex drive and virility.  One or two capsules should be taken 45 minutes before any sexual activity.

This dietary supplement removes stress and tension which are the main reasons of erectile dysfunction. Since it is made of all herbal ingredients, it is not harmful.

Monster Excyte promises a longer and harder erection and improved sexual performance.

As the “ideal Sex in Asia” survey stated: “The harder, the better.” (end)