Studies show that, depending on the definition, between 2% and 23% of men are suffering from premature ejaculation. Adding insult to injury, a large number of those men also suffer from erectile dysfunction. To make matters worse, the only medical treatment available has long since been strong anti-depressants, like Prozak, and such drugs have serious side-effects, including an increased risk of suicide. That could all change, according to Ampio Pharmaceuticals.

Ampio Pharmaceuticals has been putting their drug Zertane through Phase III testing as a premature ejaculation treatment and it is now looking for local distributors to market the drug worldwide. Ampio themselves state of the drug that it “has an excellent safety record established during 30 years of human use.” In their Phase II testing, “no serious side-effects were caused by Zertane” and only rarely did men stop taking the drug for less serious side-effects.

Zertane lasts up to 4 hours

Zertane is meant to be taken before intercourse and is effective for up to 4 hours. The downside is that it needs to be taken 8 hours prior to intercourse, so the window for sexual activity lies between 8 and 12 hours after taking the pill. A man wishing to delay ejaculation with Zertane needs to plan well.

But does it actually work? The figures presented by Ampio certainly seem to indicate that it does. Clinical trials have shown that Zertane produces a 2.4 fold increase in average staying power compared to the control group. A critical eye will note, however, that in the real world this does not necessarily translate to a full-blown cure.

In trials Men lasted almost 2 minutes longer

It was reported at the 2006 Congress of the European Society for Sexual Medicine that men with premature ejaculations can last on average 1.8 minutes during intercourse. With Zertane, the average might be 4.3 minutes. Men without premature ejaculations, however, can last on average 7.3 minutes. Potential Zertane-users need to be aware that while a 2.4 fold increase is a significant improvement and can greatly enrich their sex lives, there is a limit to what the drug can do.

As for the men who struggle with both erectile dysfunction and premature ejaculation, Ampio are looking into a combination pill to treat both. The company has stated that they will study next the interaction between Zertane and PDE-5 inhibitors, used in drugs such as Viagra, Cialis, and Levitra. Anticipating a large market one third of men with impotence also struggle with premature ejaculations –  Ampio has applied for and received two patents in Canada  for combining Zertane with a PDE-5 inhibitor. Many similar patent applications are also pending worldwide.

More information on treating Premature Ejaculation:

EDGuider Forum: Erectile Dysfunction and Premature Ejaculation

EDGuider Forum: VIGAMED for the treatment of premature ejaculation

EDGuider News: PSD502 Tempe Spray for PE helps men last 6 times longer

Treating erectile dysfunction can be a long and difficult process. Although popular erectile pills, such as Viagra and Cialis, help many men there are also many cases where they fail. It is a matter of personal chemistry and the causes of the dysfunction. Sometimes the nerves of the penis are so damaged there is no possible chemical aid – whether pills, creams or injections.

It is in these seemingly hopeless cases that penile implants excel. Even when the chemicals fail or provide unreliable results, surgery promises erections without fail. It is just a matter of getting over the stigma of needing surgery and fear of the knife. Many men will not even consider it.

“What many don’t realize is that the medications we see advertised so often don’t work for about 30 percent of men who try them, and far too many give up when the pills fail,” commented Dr. Craig Donatucci of Duke University Medical Center.

The companies who make the implants are now realising that they need to reach out to their potential clients. American Medical Systems, the leading penile implant provider, recently launched a new informational website, EDcure. Whitney Erickson, senior vice-president for Men’s Health at American Medical Systems, said of the website launch:

“ED can be embarrassing for some men and they may have a difficult time discussing it with their partners. We have designed this site to provide a comprehensive resource for anyone who is concerned about ED, including both the man and his partner.”

EDGuider Blog: What Are Inflatable Penile Prosthesis Implants and how do they work?

Several options for surgery

Once the fear and the stigma are gone, however, men will find that there are several options when it comes to surgery. There are malleable prostheses which are inserted into the penis and allow a man to simply lift and straighten the penis into an erect position, without the need for a pump. The more common type of prosthesis, however, is the inflatable kind which comes with a pump implanted in the scrotum. It does, however, require a certain level of finger dexterity to operate. The deluxe version has a fluid reservoir implanted into the abdomen, meaning that an erection is easily achieved with a single squeeze of the pump. Even length and girth expansion can be controlled.

Natural erections will no longer be possible after surgery

There may be some scarring, but since the implants are entirely concealed within the body no one should be able to tell that a man has gotten an implant. Nor should the sensation be any different. But men who are hoping to get an implant should be aware that it is a permanent procedure and will make natural erections, or erections induced by pills such as Viagra, impossible to achieve. Men with lupus, allergies to silicone and men who are on certain medications are also not able to use an implant.

EDGuider Blog: Complete List of ED Treatment Options, Surgery, Supplements, Viagra, Psychotherapy

And because surgery is involved, there is also a recuperation period of six to eight weeks to consider. While it may seem like a minor wait after years of ED, it can be difficult. As one formerly frustrated spouse put it: “It was like having a Ferrari in the garage, and I couldn’t even take it for a test drive.”

A topically applied erectile therapy cream is one step closer to reality. The commercial launch of Vitaros by Apricus Biosciences, the world’s first topically applied prescription drug for impotence, is scheduled for November of this year in Canada. The cream is also likely to reach European pharmacy shelves by the end of next year.

With annual erectile dysfunction drug sales at $4.9 billion globally and an aging population, translating into increasing demand, any newcomer on the impotence market has the chance of making it big. Vitaros in particular is a promising competitor, having two major innovations going for it: its topical application and its uncommon active ingredient.

One Drop of Vitaros will work in about 6 minutes!

With a single-use applicator a drop of Vitaros is placed on the tip of the penis. The active ingredient, PDE1, also known as alprostadil, is then absorbed through the skin through Vitaros’s high absorption molecules. The effects are measurable within six minutes. Because alprostadil works differently from the PDE5-inhibitors in most common impotence pills it could be a viable alternative for those who have tried other therapies with limited success. The topical application is also associated with fewer side-effects. Alprostadil is currently available as penile injections (Caverject) and urethral suppositories, but having the chemical absorbed through the skin is no doubt more pleasant.

EDGuider News: Vitaros ED Cream by Apricus Bio Works Within 5 Minutes

In its current formula, Vitaros has one major setback: it must be stored in a refrigerator. That makes sex less spontaneous and travel more difficult. Apricus is aware of this and is currently working on developing a new formula that can be stored in room temperature.

How much will Vitaros Cost?

As for the price, Vitaros is expected to enter the market at between $10 and $12 per dose, similar to competitors.

Whether Vitaros will be a major success, though, remains to be seen. Expert opinions diverge: “I think it can certainly enter the market as a fourth or fifth drug and grow sales significantly,” said Robert Wasserman, a Dawson James Securities stock analyst. Dr. Irwin Goldstein, a San Diego urologist who helped develop Viagra, on the other hand believes that Vitaros will enter the market as a niche treatment.

EDGuider Forum: Talk about Vitaros with others

Regardless of the experts, there is no denying that Apricus takes its entry onto the sexual dysfunctions market seriously. The company is already in phase three clinical testing of a new drug called Femprox to treat sexual arousal disorder in women.

Easy access to internet pornography has certainly brought about a great number of changes. It has changed our sexual tastes, our viewing habits, and now scientists suggest that it has changed our brains. As a result, a man’s internet porn habits may directly affect his ability to achieve and maintain an erection.

Internet pornography is quite unlike traditional pornography. There is greater variety and greater quantities at higher speeds, which increases the likelihood of the kind of super-stimulation that can lead to addiction.  And just like the drug addict needs subsequently bigger or stronger doses to achieve the same level of high, the internet porn addict needs more and more potent pornography to get aroused. The addict needs new porn, new genres, and new more outrageous sex acts. In the end, real life sexual partners cannot live up to the rush of internet porn and erectile dysfunction sets in.

The Science of Porn-Induced ED

The science behind the phenomenon is identical to other addictions. The sense of pleasure we feel, whether from eating something sweet or thinking about sex, comes from a neurotransmitter called dopamine, which also happens to be a major player in creating an erection. When we over-stimulate ourselves, such as with excessive use of internet porn, the brain responds by turning off some of the dopamine receptors in the central nervous system to cope. Despite increasing the amount of dopamine, the pleasure level remains the same since there are now fewer receptors to interpret the signal. Next time we over-stimulate, more receptors turn off and more and more dopamine is needed to reach the regular level of arousal. Meanwhile, the pornography is desensitizing and yesterday’s porn no longer produces the same level of dopamine that it used to. The porn needs to get newer, faster and better.

RELATED POST: Can Watching too Much Porn Give you Erectile Dysfunction?

But the problem is threefold. In addition to dopamine levels and dopamine receptors becoming depleted, the porn addict is wiring his brain to connect masturbation and orgasm with porn. It is an old scientific adage: nerve cells that fire together wire together. Not only cannot a real sexual partner compete with the dopamine levels of pornography, the brain is not expecting to connect a real sex act with penile pleasure.

Young Men Afflicted World-Wide
With internet pornography so easily accessible it is becoming a widespread problem, especially among the younger demographic whose youth and health should naturally make them the least likely to suffer from impotence.

EDGuider Blog More Young Men under 30 with Erectile Dysfunction Using Viagra

Psychology Today pointed, in September 2010, towards recent research that suggests 17% of all individuals who view porn online meet criteria for sexual compulsivity. When 90% the young male population of North America view internet porn, as Psychology Today claim, that translates to a huge potential problem.

In tech-savvy and sex-industry-friendly Japan, The Japan Times reported on January 14 that more than a third of men ages 16 to 19 have no interest in having sex. That number is twice as high as two years ago. Similarly, a French study from 2008 showed that more than 20% of young French men have no interest in sex with a partner.

The Italian Society of Andrology and Sexual Medicine (SIAMS http://www.essm.org/society/affiliated/siams.html) recently found through a survey that "excessive consumption" of porn sites in Italy begins as early as age 14 and that, by their early to mid-20s, the men who viewed porn daily had become inured to "even the most violent" porn. A full 70% of Italian men seeking medical aid for sexual performance are habitual internet porn users. Carlo Foresta, head of SIAMS commented: "It starts with lower reactions to porn sites, then there is a general drop in libido and in the end it becomes impossible to get an erection".

A Cure for Porn-Induced Erectile Dysfunction
Once an internet porn habit starts, it is hard to stop. There is even withdrawal. When there is a dopamine imbalance, our emotions can become instable. One becomes susceptible to false moods which are easily relieved with more pornography.

EDGuider News: Can Porn Lead to Erectile Dysfunction?

For men wanting to quit internet porn, there are now support forums. By giving up porn, temporarily giving up masturbation and increasing social contacts men are reprogramming their brains. As with all forms of addiction it is a sometimes painful process, but by pushing through the discomfort of withdrawal the body’s dopamine receptors increase and arousal returns.

EDGuider Forum: Visit the ED and Addicted to Porn thread

Because there is little awareness about the influence of hard fast internet porn on male sexuality, few men have any alternatives to going it alone with the help of an online support forum. But alternatives are being developed. In the September 2010 issue of Behavior Therapy, the first controlled study on how to address problematic internet pornography was published. Participants were taught to accept their urges, watch them rise and fall in a mindful way, to look upon themselves kindly and to direct their energies towards highly valued actions. As a result, obsessive thinking was relieved and positive commitments increased.  

Viagra, the little blue pill that started it all, is today nearly synonymous with erectile dysfunction treatment. It is easy to forget that Viagra is not the be-all and end-all in treating impotence. And with warnings resurfacing in the past moth about Viagra’s more potent side-effects, vision and hearing loss, many men may be wondering exactly what options they have. In the jungle of erectile dysfunction therapies, not all treatments are equal.

Prescription Drugs
Viagra is only one of several medicines in the group known as PDE5 inhibitors, which work by relaxing the muscles in the penis which constrict blood flow and thus allow blood to flow freely into the erectile tissues. Popular alternatives include Cialis and Levitra. Both are effective quicker and longer than Viagra and are therefore favoured by many men and doctors.

EDGuider: Viagra Cialis and levitra to treat Erectile dysfunction

Choosing to go with a prescription drug to treat erectile dysfunction means a high rate of success. Pharmaceuticals have been tested and the way they work is mostly underpinned by science. They do, however, come with side-effects and it should be noted that both Cialis and Levitra, along with Viagra, came under scrutiny in 2007 for potentially causing hearing loss.

Injections
Self-injections are a very quick and effective means of dealing with erectile dysfunction and often work even in men with significant nerve damage. It does require a man willing to administer injections into the soft tissue of his penis, which may be both difficult and slightly painful for some. Most injections also need to be refrigerated, and pulling out a needle and wandering to the fridge certainly puts a damper on sexual spontaneity. Unlike prescription pills, injections will usually produce an erection with or without mental and physical stimulation.

EDGuider News: Erectile Dysfunction Gel TriMix Travel No Injections Needed

Testosterone
If a man’s erectile problems are caused by a low libido, then testosterone therapy is a possible solution. This hormone is associated with high sex drives in both men and women. Both prescription gels and patches can give erections a significant boost.

EDGuider Forum: Testosterone and ED

Urethral Suppository
Most urethral suppositories work in much the same way as the erectile dysfunction pills, the difference lies in how the drug is administered and which active ingredients cause the muscles to relax. After urination, the man gently squeezes the tip of his penis to open the urethra and inserts a small pellet with an applicator, after which he massages the penis for a short while to help ensure that the pellet is fully dissolved. The side effects are similar to those of pills and though suppositories are fairly quick to work, they do not produce quite as strong erections as injections.

EDGuider Forum: Caverject (Alprostadil) "MUSE"

Herbal Supplements
From ginseng to horny goat weed, the herbal supplements aisle is vast! Even though many remedies have been tested with positive results in peer-reviewed publications, there are still many doctors who simply do not “believe” in the existence of herbal aphrodisiacs. Men interested in trying herbal supplements should do so with care and buy from companies with certificates of authenticity and analysis. Remember too that neither “herbal” nor “natural” means “safe” – some of the most potent poisons in the world are natural – so speak to your doctor to ensure that the supplements do not interact negatively with any prescription drugs.

So what are the 3 most used herbal remedies for ED

Pumps
Some men swear by them. Others view them as weird antiquated torture devices. Penis pumps work by creating a vacuum around the penis so that blood is drawn in. In order to ensure that the erection does not subside the moment the vacuum is released, a rubber ring is placed at the bottom of the shaft to cut off blood flow. Figures vary widely on just how effective it is, but it is certainly an option for men who for one reason or another do not want to use pharmaceuticals. Effect is immediate, although it could be harmful to maintain an erection like this for more than 30 minutes.

Cockrings
For men who can get an erection, but have trouble maintaining it, a cockring may be an option. This simple device is usually made from plastic, rubber, silicone or leather and is placed on the bottom of the shaft once an erection is reached. By restricting the blood flow out of the penis it ensures that the erection does not subside. Note that damage can be caused if an erection is maintained this way for longer than 30 minutes.

Lifestyle Change
For many men impotence is a side-effect of a greater condition of deteriorating health. Among other things, it may be related to cardiac and vascular health, energy levels, or diabetes. By reversing those issues with a healthy lifestyle, beginning erectile dysfunction issues can often be resolved too. Consult your doctor for the best natural way to treat your condition.

Surgery
For the men who have tried everything else, there is also surgery. Inflatable devices are placed in the penis and connected to a pump in the scrotum and a reservoir of fluid in the abdomen. When the pump is squeezed, the fluid is released into the inflation devices causing the penis to become erect. Surgery is very effective, but of course also very invasive.

EDGuider Forum: Penile Revascularization Surgery

More related posts and articles on other possible treatments:

EDGuider Blog: Complete List of ED Treatment Options, Surgery, Supplements, Viagra, Psychotherapy

EDGuider Forum: Concise List with Scientific Data of Every Currently Available Treatment

Competition has long been fierce between the three leading erectile dysfunction pills, Viagra, Levitra and Cialis, but with the availability and affordability of generics, and the steadily approaching expiration of patents, the pressure is reaching new heights.

EDGuider News: Brand new chewable version of Viagra Jet GUM?

The American medical giant Pfizer, patent-holder for Viagra for yet another year, has responded to the pressure by coming out with a new soft and chewable erectile dysfunction pill called Viagra Jet. It was released in Mexico earlier this year, in response to surveys indicating that a large portion of Mexican men find the regular Viagra hard to swallow. There is currently only one chewable ED medication that comes from India, called "Chewable Kamagra". However it is not approved for sale in the US.

Bayer comes up with Melt in your mouth Levitra

Bayer, in turn, started selling a new melt-in-your-mouth (Levitra Orodispersible) version of their popular erectile dysfunction medicine, Levitra, in nine European countries. More than just an aid for men who have trouble swallowing tablets, it was aimed towards those who want to be discreet about their erectile difficulties. It even comes in a small black box. "It’s pocket-friendly, discreet and gives the product a playful edge over its competitors," said Thomas Proske, brand manager for Levitra. In other words, it gives Levitra a sleek and sexy brand image.

EDGuider News: Bayer also develops Staxyn  which contains 10mg of Vardenafil HCI

Cialis has enough success with their 36 hour weekend pill

And brand image is important in this new world of erectile aids. Cialis was quite possibly first to realise this. Their famous "weekender" pill, for example, has been sold since 2009 and was designed and marketed as a more potent and long-lasting pill for couples sharing a romantic or sexy weekend together. It did so well for the Cialis brand that the company is steadily increasing its market share, despite not even trying to keep up with the innovations of Pfizer and Bayer.

With the market recently passing $5 billion annually, after a growth of nearly 7% last year, there is much to be gained for these companies by increasing their market share. There is, of course, also the motivation to grow the market. The erectile dysfunction market is far from living up to its full potential. In the UK alone 90% of the men who suffer from some form of erectile dysfunction are currently going untreated.

"A newer product, less expensive, and a new form of taking it – all that might convince more people to try it," said Dr. Joseph P. Alukal, director of reproductive health at New York University School of Medicine. While he did not want to refer to the new variations of well-known drugs as ‘gimmicks’, he did note that brand image is obviously going to be important in increasing both the market and the individual market shares.

Regardless of how many new variations of popular drugs these pharmaceutical giants put out, however, price is going to be an important factor. Generics are still significantly cheaper than brand drugs and some of them offer innovative solutions as well, such as soft tablets and liquid gels. Rumour has it that Bayer will be coping by putting out new variations on Levitra under a different, more competitively priced, brand name in the US. Whether the original little blue pill will come down in price after its patents expire in 2012 remains to be seen.

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3 Upcoming ED treatments: Avanafil, Zoraxel, and Zydena?

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EDGuider Forum: Avanafil, Zanifil, Bremelanotide all in the works

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Last month we blogged about an interesting new concept of treating erectile dysfunction through an online consultation with a doctor. While this is not substituted for a face to face consultation, it can provide some insight and help for men who are too embarrassed to face a doctor personally.

The EDGuider staff organized a test with one of our EDGuider forum members (wants to remain anonymous, but let’s call him “Steve”) who has “performance anxiety”. This particular test focuses on Erectile Dysfunction in young men, which is mostly due to hypertension, performance anxiety or another related psychological problem.

“Steve” says his case is not extreme and he takes 20mg Cialis 2 times a month to be able to have intercourse with his wife. Although the Cialis is effective he wants to know if he can lean off it and try to get erections back naturally.

We set “Steve” up with Dr. Rynne from Ireland, who is known for treating ED in younger men. We did a report about him last month; you can read up on it here:

Treating ED Caused By Performance Anxiety In Young Men

Now, Dr. Rynne offers several different consolations for sexual dysfunctions, they are:

* Erectile Problems in Older Men
* Erectile Problems in Young Men
* Excessive Pre-Ejaculation Help
* Premature Ejaculation Treatment
* Delayed Ejaculation Treatment
* Retrograde Ejaculation Treatment
* Propecia Erectile Problems
* Testosterone Replacement Therapy

More helpfull resources:

Erectile Problems in Young Men
Viagra vs Cialis
Ask Men Performance Anxiety
Psychological Erectile Dysfunction and Performance Anxiety

“Steve” is only 29 and would be considered a young man so he went with “Erectile Problems in Young Men”. The below information is the step-by-step procedure Steve underwent with Dr. Rynne:

STEP 1 download the eBook (3 pages)

1. Steve ordered the consolation from Dr. Rynne and received a PDF guide “introduction” on “Erectile Dysfunction in Men under 50”. It consisted of an overview of its incidence, causes, consequences, management, and potential treatment. This eBook provided a 3 step guide on:
1. Incidence, Causes, and Consequences of Erectile Dysfunction
2. Medical Management of Erectile Dysfunction
3. Your Online Consultation

STEP 2 the Questionnaire:

1. Questionnaire. Once finished with the eBook, Steve proceeded to the questionnaire where he was presented with these questions:

Once Steve completed the questionnaire he waited for Dr. Rynnes evaluation. Within 24 hours Steve had a response to his questionnaire in his Inbox that read:

STEP 3 The Consultation:

Response Dr. Rynne

————email 1————
Hello "Steve".
March 10th 2011.

Thank you for completing your medical questionnaire and for committing to this online medical service. It made for interesting reading.

The really good thing about your situation is that you see it very clearly for what it is — classical performance anxiety erectile dysfunction. You are not in any way in denial as so often is the case. Being straight up, as you clearly are, makes complete recovery so much more likely.

I would just make these points as they occur to me – not in any particular order:

1. You have a lot of background stress for which you take the occasional Xanax. This is very understandable but you might consider dealing with your work-related issues in more practical ways. If its people, talk to them, have it out with them. If its sales pressures talk to the boss and ask that he back off a bit. You know, do any and all practical things that need doing. Stop putting these off and just hoping for the best. That is not going to work. You have a right to some peace and quite like all of us have.
2. Outside of work consider meditation or self-hypnosis or yoga or the music you love while walking or exercising. Take a siesta and have quiet moments. Phase out the Xanax because there is no future in whitewashing stress that needs to be confronted and dealt with now.
3. Your porn watching or whatever is not a problem and serves to demonstrate that you difficulties with erections are not physiological.
4. Taking the occasional Cialis is not a problem and will not do you any harm long or short term. If you wish though, you can do exercises that will bring about a situation where you will not need them any longer.
5. You will have read by short e-book on ED in younger men. Maybe your wife might read it too. Talk to her lots and make sure that her sexual needs are met and that she understands that your ED is your ED and has nothing to with anything that she is doing or not doing. Try taking intercourse off the menu a few times and just pleasure each other. Tell her you’re going on strike, have a laugh and ask her to do all the work. Its only sex. You will be fine. Feel free to revert if you have any questions. Thanks again.

————email 1————

————email 2————

Response Steve:

Hello Dr. Rynne
March 10th 2011.