Possibly the greatest contradiction in men’s health is that it became much easier to talk about when it was also simultaneously much more discreet and easy to hide.
When medication for erectile dysfunction became easy to hide, it became a personal decision whether or not to take it, and because of that as well as the availability of cheap sildenafil and the work of spokesmen such as the late, great Pele, men’s health has become something people talk about and get treatments for in greater numbers than ever before.
The next step towards this is a new formulation of sildenafil that is distributed as an oral dissolving film that allows it to be taken even more discreetly than the little blue pill and a glass of water.
Oral dissolving films or orodispersible films are wafer-thin polymers that dissolve easily on the tongue without the awkward fizzing of existing disposable tablets and without the issues involved with swallowing.
It is not currently available in the UK, but a recent trademark application suggests that the company behind it, Viatris, is looking to sell it in the UK soon, with the Canadian launch in September 2024 suggesting that it would retail at a similar cost to other sildenafil pills.
Whilst a box or a single pill is already fairly discreet as a medicine because it needs water to take it does often require a man to go to a bathroom or a sink to quickly take it, and the comparatively smaller pouch and film might make the difference for some men.
The importance of discretion also cannot be overstated, and a very strong argument can be made that the very reason men’s health evolved the way it did is because erectile dysfunction medication went from extremely conspicuous to pocket-sized.
The Problem Of Preparation
Before the release of Viagra in the late 1990s, erectile dysfunction treatments were either unwieldy, unreliable or both.
Setting aside quackery such as John R Brinkley’s goat gland surgeries, there were two major issues with erectile dysfunction treatments.
The first was that the term ED was not used until the 1990s, and the commonly used impotence implied a kind of personal or social failing on the part of the person diagnosed rather than a condition that can be generally very easily treated.
This was not just a cultural assumption, either. Following Mr Brinkley’s inadvertent work in progressing the idea that a lot of ED cases are physiological in nature, from the 1940s until the 1980s, medical consensus was that up to 95 per cent of ED cases were psychological in nature.
This turned out not to be the case; even if there are psychological aspects to many cases of ED, and treatments can not only involve sildenafil, tadalafil or another PDE5 inhibitor but also some form of talking therapy related to sex, the primary cause is often physiological.
By the late 1970s, this was beginning to change with the development of more advanced surgical implants and vacuum erection devices (VEDs or penis pumps) which did work remarkably effectively for some people.
The issue was that they were far from discreet treatments; surgical implants were initially used to treat war injuries as early as 1936, although the malleable, inflatable implants used today were first developed in the 1970s.
Regardless, they are a surgical procedure, meaning that it is a drastic option for many dealing with erectile dysfunction, although it can be helpful for ED cases caused by traumatic injury, as well as being important for people undergoing gender affirmation surgery.
VEDs, on the other hand, are effective but they are also relatively large pumps designed to be worn over the penis and create an airtight seal, requiring up to seven minutes of manual pumping to induce an erection, and requiring careful removal of a construction ring within half an hour to avoid further damage.
The first pharmaceutical solution came in 1982 with the discovery by Ronald Virag that papaverine could induce an erection if injected directly into the base of the penis.
This discovery became very well-known a year later thanks to the infamous Brindley Lecture when Sir Giles Brindley rather infamously dropped his trousers during a conference of the Urodynamics Society in Las Vegas.
Whilst Sir Giles’ revelation was very much a surprise to the audience, several of which rather understandably screamed, it was an effect that took a rather long time to prepare and became fairly impractical for many people as a treatment for erectile dysfunction.
It involved an intracavernous injection, where the base of the penis is injected with a muscle relaxant, in this case papaverine. It had to be administered this way because papaverine can only enter the bloodstream via injection and would simply be dissolved in the stomach.
Whilst it was a slightly more discreet solution than a penis pump and less drastic than surgery, it still involved having sterilised needles to hand, preparing a solution of papaverine ahead of time and injecting oneself (or trusting a significant other to inject you) in the penis.
It is still used as a test for ED, and can sometimes be prescribed as a medical treatment for the condition owing to its effectiveness and speed. It works almost immediately, in contrast to medicines such as tadalafil or sildenafil which take up to an hour to take effect.
However, it was difficult for many men to choose between what would have been in some countries an expensive and fairly uncomfortable treatment and living with ED, particularly since it would explicitly signpost to potential partners that they were living with a condition that was at the time still seen as a badge of shame.
Even with modern automatic injectors, this was still a concern, and for ED to have a treatment as widely accessible as the condition is, it needed an easy, safe, discreet treatment route.
This came about, rather famously, by accident, as an oral angina medication turned out to be effective at inducing erections.
This drug, sildenafil citrate, was repurposed for treating ED, Pele and Bob Dole marketed it and the rest is history, with a wafer-thin future potentially on its way.
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