This means difficulty in initiating or maintaining an erection for satisfactory intercourse.

Recent studies (The Massachusetts Male Ageing Study) has shown that 40% of men age 40 years rising to 70% of men at 70 years have significant problems- its much more common than previously thought!!

In some men the onset is abrupt whilst in the majority there is often a history of progressive difficulty in erection functioning. Unfortunately once there has been a less than satisfactory outcome many men almost talk themselves into problems the next time around. This so called 'performance anxiety' leads to a vicious circle of anxiety leading to failure leading to even more anxiety.

Although partners are usually supportive initially they often begin to feel they are at fault ('....my partner doesn't find me attractive any more') or worse still they suspect an affair ('.....if he's not getting it here he must be getting it somewhere else'). These secondary factors compound the issue and very soon the topic becomes a no go area.

This needn't happen. A consultation with Dr DeBoyer involves a discussion of the problem and there follows a comprehensive medical assessment to exclude underlying medical problems. Overall a contributing medical factor is found in 60-70% of patients visiting the clinic

Treatment options are discussed in depth and the chosen medication is then discussed in depth in terms of how the medication works, the 'do's and don'ts' and any adverse effects that may arise.

The overall success rates are in the order of 95% irrespective of underlying medical problems or age. Following are listed the various treatment options

Viagra™ (prescription medicine, sildenafil 50mg and 100mg) this is the first orally active tablet shown to be effective in the treatment of ED.

Technically it inhibits an enzyme in the penis (phosphodiesterase -PDE- type 5) which raises the level of an important chemical (cyclic GMP) which literally primes the penis for action. Viagra™ needs to be taken approximately one hour prior to intercourse and needs sexual arousal to achieve an effect.

The drug is absorbed systemically (into the general system) and like any medication may produce side effects. The majority of the side effects are due to increase blood flow (giving rise to facial flushing, headaches etc) which tend to occur in about 30% of users overall and are self limiting and best regarded as being of nuisance value only. Viagra™ must never be used with nitrates prescribed for the treatment of angina.

In general the success rates are in the order of 70%, with reduced efficacy (effectiveness) in patients with diabetes, or those having undergone certain types of prostate surgery.

Caverject™ (prescription medicine alprostadil 10mcg, 20mcg) remains the most effective approved medication for the treatment of ED with success rates of 90% + across the board. Its effects (and any potential side effects) are at the local site of action (ie the penis). This means it must be administered by a virtually painless injection at the base of the penis, well away from the sensitive area (the glans, or head, of the penis)......sounds awful but in reality the technique is unbelievably easy and pain-free. The resulting erection occurs 5-10 minutes after administration and is dose dependent. This means the erection persists until the drug is metabolised (broken down), with the dose being adjusted to give an erection lasting 40-50 minutes. Hence no longer is ejaculation the end point of intercourse, an effect which most men and their partners appreciate!!

Adverse effects are confined to the penis and consist of local bruising (rare and due to poor injection technique), prolonged erection (incorrect dose) or local 'prostaglandin discomfort' (generally a warm/tight feeling lasting a few seconds only).

All patients attending the clinic for Caverject™ receive a test dose administered by the doctor which is deliberately small (sub-therapeutic). The degree of response allows the doctor to plan the dose required on an individual patient basis. There then follows in-depth tuition on how to use Caverject™

M.U.S.E™ (prescription medicine alprostadil 500mcg, 1000mcg)

This stands for medication via the urethral system for erection.

MUSE™ involves a tiny pellet of alprostadil (the same product as in Caverject™) which is introduced into the urethra (the eye of the penis) using a fine plastic cannula.

The introduction is relatively pain-free with the resulting erection occurring 5-10 minutes later. The overall success rate is in the order of 60% with an erection lasting somewhere in the order of 30 minutes.

Unlike Caverject™, which is stable at room temperature, MUSE™ has to be kept refrigerated and as MUSE™ relies on indirect absorption into the main erection chambers of the penis the dose of alprostadil is higher (and therefore the cost is higher).

All patients opting for MUSE™ are given a test dose and taught how to use the product.

Adverse effects are more common with MUSE™, generally because a larger dose of alprostadil is involved compared with Caverject™.

New Developments

Medicine is a rapidly changing field and there is a considerable amount of research gaining momentum in the arena of ED.

Uprima- (prescription medicine apomorphine 2mg, 3mg). This is a tablet designed to be placed under the tongue and left to slowly dissolve over a 15-20 minute period. It increases sexual arousal via stimulating D1 and D2 receptors in the brain, indirectly increasing penile blood flow. Uprima works in the majority of men and is associated with occasional side effects. These include nausea, dizziness, drowsiness and sweating usually affecting <10% of men. These adverse effects tend to occurr at an increased rate if taken in conjunction with anything more than modest alcohol amounts.

For all of the above mediactions a part charge applies as they are not currently available under the government subsidy.

Topical; agents are beginning to look more promising.

Being at the forefront of male health issues, The Male Clinic will embrace all new developments once they are proven to be safe and effective. Using approved medication ensures patients have the security of knowing the products they are using have been adequately researched and have been proven to be effective and safe. Beware of other products their quality, sterility, safety and efficacy may be dubious....ask yourself why are they being promoted?....the answer is usually commercial interests have over-ridden medical and ethical considerations.