Erectile Dysfunction drugs such as Viagra, Cialis, and Levitra have made huge strides in treating male sexual dysfunction — but have women been left behind? At this writing (September 2009), no treatment has been approved by the FDA for Female Sexual Dysfunctions (FSD), which are estimated by the Journal of the American Medical Association to affect 43% of American women (about 40 million) at some point in their lives.

It’s not for lack of trying. Pharmaceutical makers would love to tap into a market that’s the other 50% of the population. They are assertively researching the problem. So why has a result not come forward?

One issue is that, with men, “sexual dysfunction,” no matter whether the cause is mental or physical, is likely to respond as a pretty straightforward plumbing problem: Viagra and its counterparts, the Phosphodiesterase Type 5 Inhibitors, are vasodilators, meaning that they open up blood flow to the area, allowing an erection to be achieved and retained more easily. (More information on the effects of these vasodilators on women is below.)

But women’s sexuality is more complex and less understood, often caused by a range of physical, emotional, and psychological conditions. Simple manipulation of bloodflow only goes so far. Another element is that women have unique hormone issues, which often cause low libido, as they age. Finally, some researchers are experimenting with methods that place sexuality in the mind.

The good news is that research IS progressing. Here’s an update on where the various methods are:

THE BIG THREE (Viagra, Cialis, Levitra)

Researchers are looking into using male ED drugs on women suffering from FSD. In April of this year, a study by the American Physiological Society was described that compared the effects of three drugs used for erectile dysfunction (Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil)) on female rats. The researchers discovered that these drugs significantly increased blood flow to female sexual organs, and show promise for treating similar conditions in human women. Another study has shown that Viagra can help with orgasms in women who are taking SSRIs and suffering sexual dysfunction as a side effect.

There is promise here, but it is all forward-looking. The FDA has not approved these medications for use by women. We will be closely following the progress of this research.

HORMONAL TREATMENTS

The hormone testosterone drives sexual desire, and as women age, they typically lose some of both. There are some doctors that prescribe testosterone off-label to women to help with low desire, but this process is not approved by the FDA. There have been flops along the way to a hormonal treatment. Intrinsa, a testosterone patch for women, was turned down by the FDA in 2004 due to worries about long-term safety, and PT-141 was a nasal spray that was being tested to raise desire in both men and women when it was quashed by the FDA for having possible blood-pressure-related side effects.

In upcoming news, though, BioSante Pharmaceuticals of Illinois is in late-stage studies of a testosterone gel intended to remedy libido loss after menopause. The product, called LibiGel, is smeared on the upper arm and promotes a long, slow build-up of testosterone in women. We’ll be eagerly watching to see if LibiGel is approved by the FDA.

NEUROTRANSMITTER ADJUSTMENTS

A nonhormonal treatment for FSD is in late-stage testing. Boehringer Ingelheim’s Flibanserin, a pill to be taken daily, acts on serotonin receptors in the brain. Early reports suggest that the medication was not useful for treating depression (its intended use), but had the curious side effect of increasing desire in females. The company is now researching the drug’s effects directly in younger, premenopausal women who are suffering from low desire.

The reality is that there is no approved pharmaceutical treatment on the market for a condition that troubles millions of women. The good news is that there are a few promising treatments on the horizon, and we encourage women to follow issues like this in the news so that they will know when relief becomes available. Some of the companies mentioned in this article are conducting clinical trials of these medications, so if you are deeply interested and want to participate, that is a possibility, too. We should see some major changes in the field in the next few years.

There are differences among the three medications, but they are relatively minor. Viagra came on the scene first, so it’s helped more people and has a longer track record. Levitra begins working the fastest, and Cialis lasts the longest — up to 36 hours, compared to four for Viagra.

Often, a doctor might prescribe one of these three pills for you, and if you don’t respond, they will switch you to another. But what happens if Viagra, Cialis and Levitra all fail for you? Or what if you have one of the conditions that don’t allow you to take ED pills — such as heart problems, high blood pressure or diabetes?

There’s actually an effective alternative that relatively few people know about — because it’s been scarcely advertised. It’s called alprostadil, which can be sold as Caverject, Edex or Muse. Alprostadil is a synthetic version of prostaglandin E, a hormone. Like the better-known pills, it relaxes muscle tissue in the penis to enhance blood flow. It even works faster than the pills — in as little as five minutes.

The downside to alprostadil, relative to the oral treatments, is how it’s administered: by needle or suppository. The needle-injection therapies, Caverject or Edex, are generally preferable, because it is a very fine needle and there is little or no pain. It’s also easy to administer yourself.

The suppository treatment (Muse) requires inserting a dosage of alprostadil, about half the size of a grain of rice, into the tip of your penis. Administering Muse can be a little painful.

If you’ve been getting your ED information only from watching TV commercials, we hope we’ve shed light on some options you might not have known about. One of the things I’ve feared, with all the attention devoted to Viagra and Cialis, is that men with ED will downplay their histories of heart disease or other risk factors in order to get their doctor to write a prescription for them. I’m sure this has happened thousands of times, unfortunately.

Now you know you don’t have to take that kind of risk. Ask your doctor about alprostadil as an alternative to the Little Blue Pill.

• Zoloft
• Viagra
• Cialis
• Mirapex (restless leg syndrome)
• Lipitor
• Valtrex

1. Viagra
2. Vytorin
3. Provigil
4. Cialis
5. Synvisc
6. Fosamax
7. Finasteride
8. Amoxicillin
9. Lotrel
10. Wellbutrin
11. Lipitor
12. Lyrica
13. Naproxen
14. Singulair
15. Loestrin
16. Valtrex
17. Yasmin
18. Ibuprofen
19. Quetiapine
20. Allegra-D
21. Lamisil
22. Alendronate
23. Plavix
24. Bactrim
25. Nardil

1. High Blood Pressure
2. Abilify
3. Provigil
4. Yasmin
5. Lipitor
6. Lamisil
7. Synthroid
8. Levitra
9. Phentermine
10. Vytorin
11. Topamax
12. Meridia
13. Zoloft
14. Crestor
15. Xenical
16. Zetia
17. Prevacid
18. Lisinopril
19. Viagra
20. Plavix
21. Cialis
22. Singulair
23. Risperdal
24. Diovan
25. Casodex

The list isn’t a perfect reflection of the most popular drugs purchased online, largely because of Google. For a variety of reasons, eDrugSearch.com appears very high in the organic search results for some drugs, but not as high for others. This obviously skews our results.

With this caveat, however, we hope that over time our results will shed light on trends in online drug sales.

We plan to post our October results in the first week of November.

(Via NFL-Scores.)

The Lunesta moth! Running through fields of flowers! The purple pill! The couple that loves the, er, flexibility of Cialis! Television today is a pharmaceutical wonderland … As I watch those ads, I wonder, is this really a good idea?…

These are all good drugs that help people. But they are also drugs whose use is not considered simple enough for them to on the shelf at your local CVS. If a doctor’s advice is needed to take them, why are they being advertised? I thought the idea was that you went to your doctor and said, “I have ____,” and she or he said, “OK, here’s what I recommend…”

Well, we all know why they are being advertised; for the same reason that toys are advertised to children too young to have actual money to buy things themselves. If people are going to the doctor saying, “I want Cialis!” there will be more prescriptions for it…

And how about the bill for all this? $1.9 billion is a lot of money. In the context of discussion of health care costs, it’s an interesting thing to think about.

Amen, brother.

Here comes Dr. Robert Jarvik … selling Lipitor to lower your cholesterol. The guy looks good. I’m with him all the way, even through the disclaimer part that suggests Lipitor should not be used if you have liver problems, are pregnant or want to become pregnant, drive a 1997 Honda, know a bartender named “Lefty” or ever wanted to become a field-goal kicker for the Cincinnati Bengals.

The ad also strongly suggests you ask your doctor for more information. I’m thinking: “Hey, Jarvik is a doctor. How much is he getting paid to push this drug — and what’s up with all that?

Anyway, I am still feeling fine and watching more football and here comes a commercial for Levitra, a product that among other things warns men of the terrible dangers of a four-hour erection…

I do a little more online research, and the Levitra disclaimer also warns use of the product could result in a sudden decrease or loss of vision in one or both eyes, headaches, flushing and stuffy or runny nose — side effects which, in truth, a lot of guys might consider a small price to pay…

As the TV stations move into the evening news — which always carry a plague of medical ads — I get info on Plavix (fights blood clots) and Flomax (if you have to ask you don’t want to know).

By then I’m feeling even more depressed about the doctor-drug company connections. Virtually all the ads suggest the patient talk to the doctor about the cures.

I’d always thought once you put up the $20 to $40 co-pay it was supposed to work the other way around.

All eDrugSearch pharmacies require original prescriptions from your doctor — which they confirm — before filling your online order. We also encourage you to ask your doctor what medication or treatment is best for you, rather than to start the discussion by bringing up an ad you saw on TV.