Prescription for Perfect Sex?

In spite of some rocky moments, John and Jane continued dating and made it to the one-year mark. It was time to celebrate. Only how? Sure, meeting up for a fancy dinner was a good start. They had something else planned for afterward, though, that they hoped would make the occasion especially memorable: Orgasma, the ultimate pleasure pill.

Jane and John had stumbled across Orgasma while surfing the Internet. According to the manufacturers Web site, this pill brought on orgasms galore for both men and women.

“That can’t work,” John scoffed.

Jane agreed. “Still,” she pointed out, “how can we say for sure unless we give it a try?”

On a whim, they ordered a bottle. After their anniversary dinner, they each popped a pill, hopped into bed, then waited to see what would happen. Fifteen minutes passed. Then a half hour. “I don’t feel anything,” John said. “So much for that.”

Jane, however, swore she could feel something—a slight tingling perhaps. John, upon hearing this, suddenly felt a little tingly, too, which was as much of an excuse that they needed to hop in the saddle and ride their way toward some pretty anniversary-worthy finales. Still, was the pill responsible, or was it just the placebo effect? Did any of those pills, potions, or patches John and Jane had heard about online or otherwise possess aphrodisiacal powers?

AS LONG AS we’ve been having sex, people have been experimenting with elixirs that supposedly make sex better. Had John and Jane been living in ancient Persia, they might have rubbed boiled alligator testes on their feet. Egyptians took a more direct approach and smeared crocodile hearts right on the penis. Today, pills are all the rage, although there are also patches, ointments, and plenty of other panaceas being sold online or in TV infomercials that promise to catapult your sex life to new levels. Only do any of them work?

Scientists have scrutinized many of the quick fixes currently on the market, and have found a few that actually do deliver on their claims (as well as many that don’t). In this chapter, you’ll learn how to separate the good from the bad so you can stock your medicine cabinet with the right stuff, and get a look at what might be coming down the pike.

Penis Pumps, Testicle Implants, and Injections,
Oh My! A History of Sexual Healing

Sexual performance panaceas didn’t morph overnight from crocodile hearts into pills. Along the way, scientists have tried other ideas, some more palatable than others. In 1889, seventy-two-year-old French endocrinologist Charles Édouard Brown-Séquard announced he’d fully regained his youthful virility by injecting crushed testicles from guinea pigs and dogs into his body. Soon enough, doctors struck upon an even better idea: Why inject just the extract of testicles when you could use the whole thing? Physicians began implanting entire testicles from goats and monkeys inside men’s scrotums, which easily expanded to make room for their new guest. In 1918, things went from weird to really macabre when Leo Stanley, resident physician at San Quentin prison in California, began transplanting human testicles from executed prisoners into other inmates. In most cases, men who received such treatments claimed they felt more virile, but reliable erections rarely resulted from these experiments. The race was still on to build a better hard-on. In 1982, the first leg of this relay was won thanks to a tire shop owner.

Geddings Osbon, who struggled with impotence, was determined to find a way to make love to his wife. And so, tinkering around in his tire shop one day, he built a contraption that did the trick. Osbon’s vacuum pump fit over the penis and literally Hoovered more blood into the area. To keep the blood from flowing back out, Osbon placed an elastic ring around the base of his penis. This contraption, no matter how excruciating it sounds, certainly worked better than testicle implants. It went on to win FDA approval and is still prescribed to this day. For the ladies, there’s even an FDA-approved clitoral pump. Still, while devices often fixed the problem, it made having sex about as suave as unclogging a drainpipe. There had to be a better way.

In 1983, Professor Giles Brindley stepped on stage at a urology conference in Las Vegas. His specialty? Erectile dysfunction, a field in which he had recently made notable progress. Rather than put his audience to sleep with a PowerPoint presentation, though, the British physiologist had more memorable evidence. Brindley announced that just prior to his presentation, he’d injected himself with a drug called papaverine, which helped get more blood flowing due south. To prove it, he pulled down his pants and displayed exhibit A: his erection.

The audience sat stunned. A few women in the front row squealed as Brindley hopped off stage to allow them a closer inspection. Erectile dysfunction, his presentation made abundantly clear, could be treated with medication. Papaverine injections were one possibility, but perhaps there were even easier methods on the horizon. Like pills.

In 1998, the U.S. Food and Drug Administration approved Viagra for the treatment of male erectile dysfunction. In its first year on the market, Pfizer sold $788 million worth of Viagra prescriptions. Even men who couldn’t afford Viagra were getting handouts, thanks to Alan Greenberg, head of investment firm Bear Stearns, who reportedly donated $1 million to New York City’s Hospital for Special Surgery to give it away to men in need. The invention of Viagra changed not only the lives of millions of men, but the very way scientists view sexual problems and come to solutions. If there’s a pill to help guys get it up, then maybe there’s also a pill to rev our libidos, reach orgasm more easily, and improve every facet of sex as we know it. The next step, of course, would be to invent a little pink pill for women so all those blue ones don’t go to waste. Easy, right?

Women’s Viagra: What’s the Holdup?

More than a decade has passed since the arrival of Viagra, and scientists in search of a women’s version are still scratching their heads. In trials by Pfizer, the effects of Viagra on Female Sexual Arousal Disorder remained inconclusive. The problem, say some scientists, may be that while blood flow plays a role in women’s arousal, a far bigger hold-up is that women lack desire—the drive to strip down and hop into bed in the first place. Without desire, arousal is a moot point. It’s like fixing the cart when the horse isn’t inspired to pull the load. What women need, then, is something that would give the horse more get up and go, which led scientists to start tinkering with testosterone.

Testosterone serves as the jet fuel for both men’s and women’s libidos. Boost testosterone, and it stands to reason that women’s sex drives will rise as well. This treatment seemed especially promising for women who have undergone menopause, since this can cause a significant drop in testosterone levels. From June 2002 to October 2003, Procter & Gamble tested a testosterone patch called Intrinsa on 549 women who had undergone menopause. Women on Intrinsa reported a 73 percent increase in satisfying sexual activity, compared to 19 percent for placebo users. And yet, Intrinsa was not recommended for approval by the FDA Advisory Committee, who cited the need for additional long-term safety studies. Since then, Procter & Gamble has conducted several larger studies on Intrinsa. That said, testosterone may not be the answer for everyone, since most pre-menopausal women don’t have low testosterone levels. As we discussed a bit in chapter 6, these women’s libido problems may lie within the brain.

During sex, most guys are thinking about one thing: sex. Women’s minds, however, tend to wander—to the undone laundry, to the size of their thighs, to an earlier snide comment from a coworker, the possibilities are endless. Women can become too distracted to relish the sensations sex is designed to deliver, which could potentially be solved with a drug that helps them stay focused. To that end, some doctors have started prescribing low doses of Ritalin to increase women’s ability to concentrate in bed, although the FDA hasn’t approved the drug for this purpose. Other medications that affect women’s brain chemistry are also in the works. Scientists were surprised when a drug named flibanserin, originally tested as an antidepressant, was found to trigger a surge in women’s sex drives, most likely due to its effect on neurotransmitters in the brain such as serotonin. Currently, the drug’s maker, Boehringer Ingelheim, is conducting clinical trials evaluating the drug’s libido-enhancing effects on 5,000 women. Still, in spite of a few contenders, if years of false starts and failed experiments prove anything, it’s this: Women are complicated, and it might take more than a magic pill to solve any sexual problems they may have.

3 Viagra Facts You Didn’t Know

It may cure jet lag. A team of Argentinean researchers led by Patricia Agostino administered Viagra to hamsters, then induced jet lag by turning the lights on and off at odd hours. Hamsters on Viagra recovered 50 percent faster, as was evidenced by their performance on exercise wheels. According to the study, Viagra affects enzymes in the body that regulate circadian rhythms. It only helped, though, when the hamster experiments simulated eastbound flights. Viagra is not approved by the FDA for the treatment of jet lag, so Pfizer does not recommend the drug for this condition.

Some may see the world through blue-tinted goggles. A small percentage of Viagra takers experience temporary changes in color vision where they see objects with a blue tinge or have trouble distinguishing blue and green objects. For this reason, Donato Borillo, Commander of Flight Medicine at Wright-Patterson Air Force Base, wrote a report in the Federal Air Surgeon’s Medical Bulletin recommending that pilots wait a minimum of six hours from taking Viagra to hopping in a cockpit, since color vision is often crucial for flights, particularly at night.

It may reduce male fertility. One 2008 study in the journal Fertility and Sterility found that mice given Viagra produce 40 percent fewer embryos than other mice. According to study authors David Glenn and Sheena Lewis at the University of Belfast, this may occur because Viagra damages the acrosome, a caplike structure on the sperm head containing enzymes that help sperm break down the egg’s outer layer. When the acrosome is damaged, these enzymes are released too early, rendering sperm infertile. That said, Pfizer points out that this research was not performed on human subjects, which suggests that more tests should be conducted before drawing any conclusions.

Crushed Beatles, Toad Sweat,
and Other Quack Cures

What rhymes with Viagra, comes in a blue bottle, and supposedly sends women’s sex drives into orbit? Niagara—an energy drink whose name was later changed to Nexcite after Pfizer sued the manufacturer for trademark infringement in 2001. Still, even without the catchy name, everyone was buzzing for a while about whether the beverage’s patented formula of so-called “love herbs from Sweden”—damiana, ginseng, guarana, maté, and schizandra among others—could deliver on its sex-craze-inducing claims. A full 1,400 bottles were shipped to the Playboy mansion. At one point, Julia Roberts and Adam Sandler discussed making a movie about it. And yet does the drink live up to the hype, or is it just clever marketing wrapped in cute packaging?

Some libido-enhancing products might look legit, but be warned, the FDA’s rules governing herbal and dietary supplements treat them as foods rather than drugs, which means that their safety and effectiveness aren’t held to the same high standards as prescription and over-the-counter medications. As a result, many of these so-called panaceas can pose serious health risks, and yet they are easy to buy online or even in your local health food store without your being aware of the consequences. In 2004, Albert Sabucedo at the International Forensic Research Institute published a report in JAMA stating he’d bought bottles of the sexual enhancement herbal supplement Actra-Rx, also known as Yilishen, at a local alternative health food store. After analyzing its ingredients, he found that Actra-Rx contained prescription-strength levels of sildenafil—the active ingredient in Viagra. In the United States, Viagra is only available by prescription from a physician, and there’s a good reason for this. The use of Viagra along with organic nitrates (often prescribed for chest pain) may cause a sudden, unsafe drop in blood pressure. Actra-Rx, however, had snuck through the cracks as an herbal supplement until Sabucedo’s team sounded the alarm. The FDA promptly issued a warning that people shouldn’t buy the supplement.

Next, let’s take a closer look at the most legendary aphrodisiac of them all: Spanish fly. This powder is made from crushed beetles containing cantharidin, a compound that causes inflammation in the urethra after urination and produces an itchy sensation in the genitals that you’ll feel compelled to scratch. Its status as a sexual stimulant is legendary. In ancient Rome, it was slipped into drinks to inspire indiscretions that could be later cashed in as blackmail. In 1772, the Marquis de Sade got an orgy going with the help of Spanish fly-laced candy. But this love drug has serious side effects. It can lead to painful urination, bloody discharge, and permanent damage to the kidneys and genitals. The FDA has banned the use of Spanish fly in the United States, although few have heard about its dangers and can easily buy it online. Most likely, the only reason more people aren’t suffering is that most Spanish fly is fake (i.e., pills of cayenne pepper).

As yet another cautionary tale, consider the “Love Stone,” a lump of ointment made of toad secretions containing a hallucinogen called bufotenine. Also called Piedra, Jamaica Stone, Black Stone, and Chinese Rock, this “street aphrodisiac” was sold in New York smoke shops. While it’s usually rubbed on the genitals, in the mid-1990s, five men decided to eat it instead. Four died of heart failure. And that’s just the tip of the iceberg. Another popular aphrodisiac, horny goat weed—so named because a Chinese goat herder observed that his flocks of goats got frisky after eating the plant—has been found to have adverse effects on pregnant women if they eat it. Yohimbe, stripped from the bark of a West African tree, can cause a dangerous rise in blood pressure if taken in the wrong quantities.

Even in cases where sexual enhancement products aren’t life threatening, most are still ineffective. The FDA maintains that no aphrodisiac works. And yet, not all scientists were willing to write off every quick fix without taking a closer look. And what they found may surprise you.

Roots, Weeds, and Other Worthy Contenders

Ginseng is Chinese for “man root,” and describes the root’s pale, humanoid appearance—like a turnip with arms and legs. In spite of its troll-like looks, ginseng has a lot going for it, according to some scientists. For one, it enhances the activity of neurotransmitters in the brain and increases blood flow to the pelvic region, making it helpful for all sorts of bedroom-related problems. In one double-blind, placebo-controlled study published in the Journal of Urology, Korean researchers administered 900 milligrams of red ginseng three times daily to patients with erectile dysfunction for sixteen weeks. Over that time period, men’s progress was monitored in the lab via penile duplex ultrasonography, which uses sound waves to provide detailed images of veins and arteries. Men also answered a questionnaire called the International Index of Erectile Function, which tabulated how often they were able to achieve erection and sexual intercourse at home. By the end of the experiment, men on ginseng had improved significantly on all parameters—frequency of erection, penetration, libido, and sexual satisfaction, showing more improvement than those who took a placebo.

Another product that shows promise for women is Zestra, an ointment rubbed on the genitals containing dozens of herbs, each with its own arousal-enhancing effects. Borage and evening primrose oils are high in gamma-linolinic acid, which helps increase blood flow and nerve conductivity. Coleus forskohlii extract acts as a stimulant. Angelica root extract contains the chemical osthole, which may boost hormone production. In 2007, 256 women struggling with issues of libido, arousal, or orgasm participated in a double-blind, placebo-controlled study in which they used Zestra and kept running tabs on their love life via a questionnaire called the Female Sexual Function Index (FSFI). The FSFI calibrates nineteen different variables, including the frequency and the strength of sexual desire, the ease of reaching orgasm, and how satisfied women felt when they reached their peaks. For women on Zestra, their FSFI scores shot up significantly compared to those on placebo, which suggests that this unassuming salve with a rubber stopper has more going for it than clever marketing and a cute name.

Still other contenders may merely require some tinkering before they do the trick. Take horny goat weed. This herb contains icariin, a compound that acts like a PDE-5 inhibitor, a chemical found in the body that dilates blood vessels throughout the body, including the penis. Viagra’s active ingredient, sildenafil, is also a PDE-5 inhibitor, although it’s eighty times as effective as the icariin in horny goat weed, according to research by Italian researcher Mario Dell’Agli. When Dell’Agli extracted icarriin from the plant and produced a modified version, he hit upon a new formula that could inhibit PDE-5 as well as sildenafil, he says. So far, Dell’Agli’s new concoction hasn’t been tested on live subjects, so the effects on humans are unknown and more tests should be done before any conclusions are drawn. Still, Dell’Agli plans to keep tinkering and testing, hoping to hit upon a winning formula.

Another aphrodisiac where the jury’s still out on its effectiveness is Tribulus terrestris, a star-shaped fruit that first gained notoriety in the United States after Bulgarian athletes touted it as their secret weapon to winning the Olympics. The active ingredient is most likely protodioscin, a chemical that’s related to DHEA, a “prohormone” found in our bodies that serves as the precursor to testosterone, estrogen, and other substances that keep our sexual motors running. In studies on rats, Tribulus produced more mounting activity, although the impact of Tribulus on men’s mounting activities remain inconclusive. In one Bulgarian study involving twenty-one men published in the Journal of Ethnopharmacology, men’s testosterone levels remained the same whether they were taking Tribulus or not.

Aphrodisiacs in Your Home

But what about those aphrodisiacs rumored to be lying in the recesses of your fridge or your local restaurant? Chocolate. Oysters. Do any of these things work? If you were to simply look at a breakdown of the chemicals contained in chocolate, it might look promising. Chocolate contains phenylethylamine, which is also released in the brain when people fall in love-no wonder a box of Godiva is the gift of choice on Valentine’s Day. Still, scientists, never ones to put much stock in mushy holidays, decided to put this confection to the test under laboratory conditions. In one study, they measured the levels of phenylethylamine in women who had eaten chocolate and those who hadn’t. No difference was found between the two groups, leading researchers to conclude that the phenylethylamine in chocolate is metabolized in the stomach long before it can reach the brain and induce its amorous effects. In another study published in The Journal of Sexual Medicine, Italian researchers compared scores on the Female Sexual Function Index among 163 women, some of whom reported regularly eating one serving of chocolate a day, others more than three servings, and still others who didn’t indulge much at all. Women in all three groups scored similarly. Chocolate may provide a sugar rush, but it isn’t the gift that keeps on giving, so don’t count on getting lucky if you treat your sweetheart to a box.

But what about oysters? At the very least, they look sexually suggestive, which may explain why Casanova reportedly downed dozens to prepare for his legendary lovemaking marathons. The logic cited by proponents of this aphrodisiac is that oysters are high in zinc, and deficiencies of this mineral can cause impotence. Pop a zinc supplement, and studies show that higher libido, testosterone levels, and more frequent sex will ensue. That said, the levels of zinc in a pill far outstrip the amount found in several dozen oysters. So, unless you eat oysters all day, every day, we doubt you’ll feel much of a difference in bed—and that’s assuming you’ve got a zinc deficiency, which is fairly uncommon today. Many aphrodisiacs, including oysters, in fact, might have worked back in the day when certain nutrients essential to sexual functioning were scarce. Rhinoceros horn, for example, is rich in calcium and phosphorus, which are essential to healthy energy levels. If some ancient people’s levels were low to begin with, it’s certainly plausible that a dose of Rhino horn could bring someone’s libido back.

In one study titled “Coffee, Tea, and Me” published in the journal Pharmacology, Biochemistry and Behaviour, Fay Guarraci at Southwestern University administered a tiny jolt of caffeine to over a hundred female rats, then set them loose to mate with males. After mating once, the caffeinated rats quickly returned for another romp. Guarraci theorizes that caffeine stimulates neurotransmitters in the hypothalamus, which plays a leading role in sexual arousal. That said, these libido-enhancing effects would probably only occur in humans who don’t drink coffee regularly.

How to Tell Which
Aphrodisiacs Work

Don’t believe everything you hear about herbal supplements. Herbal supplements aren’t regulated by the FDA in the same way prescription and over-the-counter drugs are, and could therefore pose serious health risks. If a product’s claim seems too good to be true (for example, add two inches to your erection!), it probably is. Make sure to check the FDA Web site for reliable information and updates about various substances.

Opt for safer alternatives. There is some evidence that certain products can improve sexual function, such as ginseng and the topical ointment Zestra. Even coffee and vitamin C supplements may have a positive effect, although you should always do your research and check with your doctor to make sure the risks don’t outweigh the benefits.

Plain old vitamin C may also juice up your sex life when not battling colds and the flu on your body’s behalf. In one study published in Biological Psychiatry, men and women who took 3,000 milligrams of sustained-release vitamin C supplements had penile/vaginal intercourse significantly more often than those popping a placebo. That’s because vitamin C increases catecholaminergic activity, which boosts the levels of certain sexually arousing chemicals such as epinephrine, nor-epinephrine, and dopamine coursing through your body. Keep in mind, 3,000 milligrams of vitamin C is a pretty high dose. It’s not dangerous, and reported adverse side effects (stomach upset, diarrhea) were no higher in those taking the supplement than in the placebo group, but Brody conditions that people with Iron Overload Disease or problems with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, a common human enzyme deficiency, should consult their physician before taking such a high dose of vitamin C. And don’t expect fruit alone to fast-track your sex life, given that the average orange contains only 70 milligrams of vitamin C. That means you’d be eating nearly fifty oranges a day to get your dose.

Pills may solve some sexual problems, but they’ll never be the answer to everything. After all, aside from the occasional bug, our bodies are designed to deliver their own natural highs in bed—which is why in our next chapter, we’ll turn to the very moment during sex that feels much like a drug itself. Orgasm.