NEWSFLASH

WHEN MEN CAN'T GET IT UP

Live Webcast in Hong Kong, June 6, 2002 (STAR) By Joseph O. Cortes - Believe it or not, but the brain is the biggest sexual organ in the human body. Romantics may think that the act of lovemaking is an intimate exchange between partners fueled by the heart. However, without the brain’s active participation, sexual congress will not take place.

In a press briefing and live webcast by an expert forum on erectile dysfunction held in Hong Kong recently, Abbott Laboratories associate medical director Dr. Darryl Sleep says an erection is a neurovascular event.

"All sexual action originates from the brain," Sleep says.

He explains that the brain transmits nerve impulses along the spinal cord to the penis. These nerve impulses, coursed by the neurotransmitter dopamine, cause the erectile tissue in the penis to relax, enabling blood to flow in and cause an erection.

But this is not the case in 150 million men worldwide. Erectile dysfunction is the biggest problem affecting these men’s relationship with their partners.

Erectile dysfunction (ED) is defined as the consistent or recurrent inability of a man to attain or maintain an erection sufficient for sexual performance. It may sound distressing, but it is still a far cry from impotence, wherein the male partner can derive no sexual function from the penis.

Dr. Timothy S.C. Teoh, consultant urologist and head of the Men’s Health Clinic of Precious Blood Hospital in Hong Kong, says that of the 150 million believed afflicted by ED worldwide, 90 million are in Asia.

Teoh adds that the figure for Asia is expected to rise by 130 percent, or roughly 207 million men with ED, by 2025.

The number of men with ED continues to rise because the problem is rarely diagnosed.

Prof. Ates Kadioglu, professor of radiology at Istanbul University, says patients do not complain about ED and doctors do not ask about the problem.

"There is a lack of awareness about ED and its treatment," says Kadioglu.

He cites a study that says 70 percent of men are embarrassed to tell their doctors about their problem, 20 percent believe ED is a normal part of aging, while five percent think the problem is unimportant and totally ignore it. Likewise, 68 percent of men have never spoken about their sexual problems with their doctors.

There is a need to determine ED as early as possible because it can serve as an indicator of other health problems a patient may have.

Dr. Christian Stief of the department of urology, MHH Medical School in Hannover, Germany, says that ED is often associated with cardiovascular disorders.

"Men with ED are more likely to suffer from cardiovascular disorders," Stief says. "ED is strongly correlated with cardiovascular disorders, like coronary artery disease (CAD), angina and myocardial infarction (MI), and men being treated for heart disease are several times more likely to experience ED."

He adds that many men with ED often have undiagnosed CAD. He said studies indicate that more than 40 percent of men seeking treatment for ED had significant narrowing of coronary arteries, despite their lack of symptoms, and that 71 percent had high risk of developing CAD.

There are a number of treatment options for erectile dysfunction. Past therapies consisted of physical devices, injectable drugs or transurethral therapy, psychosexual and, lately, oral therapies.

Physical devices include penile implants, where a semi-rigid or inflatable synthetic rod is surgically inserted into the penis to cause a mechanical erection, and vacuum pumps, which constrict blood within the penis causing it to temporarily swell and expand.

Injectable drugs involved the injection of a medication or the insertion of a pellet into the urethra to stimulate an erection.

Psychosexual therapy is often prescribed if problems in the relationship between the patient and his partner are felt to be the primary cause of ED.

Oral therapies have been available only in the past years and have the advantage of being simple, non-invasive, non-painful and highly successful, with side effects that are more acceptable to the patient.

The first available oral therapy, sildenafil, more popularly known as Viagra, works locally within the penis by blocking the action of certain enzymes that inhibit the erectile response.

Abbott Laboratories introduced during the Hong Kong briefing a new oral therapy that activates receptors in the brain, rather than affect blood flow into the penis.

Apomorphine hydrochloride acts by activating the dopamine receptors in the brain that are involved in the erectile process, enhancing the way men normally initiate and maintain an erection. A dose of two milligrams or three milligrams provide the optimal balance of efficacy and tolerability.

The drug is now available in Europe, South Korea and New Zealand and was launched in Hong Kong and Macau last May.

Since apomorphine hydrochloride works on the central nervous system, it can be tolerated by men with cardiovascular disorders.

"Men with ED are more likely to have cardiovascular conditions," says Prof. Jeremy Heaton of Queens University, Kingston, Ontario, who did a study of the drug. "Unlike other oral treatments that work directly on the circulatory system, its unique mode of action provides a well-tolerated option for men who may take medications for cardiovascular disorder or who may unexpectedly require nitrates for a heart attack."

Studies have shown that sildenafil, when taken in combination with nitrates, commonly prescribed for CAD, can cause serious prolonged restrictions in blood flow in critically narrowed coronary arteries and result in a potentially life-threatening drug interaction.

Apomorphine hydrochloride is administered sublingually, or under the tongue, allowing for fast onset of action. It takes effect in less than 20 minutes. The erection it causes lasts until discharge. The drug may be taken as much as three times a day, or once every eight hours.

"Apomorphine hydrochloride offers several benefits for patients and is an important addition to their choices in ED treatment," says Dr. Apichat Kongkanand of Thailand. "It works fast, it’s well tolerated, and it works by enhancing the body’s normal response to sexual stimulation."

In clinical trials, the most commonly reported adverse events were nausea, dizziness and headaches, which were generally mild and transient in nature and decreased with continued use.

Since it does not work directly on the circulatory system, it can be used safely by men with coronary vascular disease and controlled hypertension. No specific safety concerns were identified in the elderly or in patients with hypertension, diabetes, coronary artery disease or benign prostatic hyperplasia. In clinical studies, there were no major illnesses due to apomorphine hydrochloride – no myocardial infarctions, no cerebral vascular accidents and no cases of priapism.

There is also no fear that drug would be abused. In clinical trials, patients reported no subjective increase in sexual desire following its administration.

"It is not an aphrodisiac," Sleep emphasizes. "It does not increase libido."

Apomorphine hydrochloride has been extensively studied in clinical trials involving more than 5,000 patients, with more than 12,000 doses administered. The medication was studied in men with varying severity of ED and included patients with organic, psychogenic or mixed etiology ED. Its effectiveness was measured by its ability to produce an erection firm enough for intercourse, with assessments conducted by both patient and partner on a per-attempt basis, a unique approach in clinical trials of the drug.