Internet Websites Selling Herbal Treatments for Erectile Dysfunction

Erectile dysfunction (ED) is a common and distressing condition affecting an increasing number of men. It is estimated that almost 30 million men in the US and two to three million men in the UK suffer from erectile dysfunction.

According to the American Urological Association clinical guidelines, erectile dysfunction is defined as 'the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse'. The growing incidence of erectile dysfunction is related primarily to a growing ageing population worldwide, a rise in the prevalence of risk factors (such as diabetes and cardiovascular disease) and an increase in treatment for prostate cancer. Prostate cancer is now the most commonly diagnosed cancer among Western men and, erectile dysfunction is a common side effect of treatment. Despite this, it is estimated that close to 90% of erectile dysfunction sufferers are still reluctant to visit their family doctors because of embarrassment. Furthermore, the National Health and Social Life Survey (NHSLS) concluded that although 31% of American men aged 18-59 y suffered sexual dysfunction, only 10% of the men (or 3% of the men surveyed) sought medical advice while the postsildenafil survey for the Pfizer Global Study of Sexual Attitudes and Behaviours found that only 19% of men reporting sexual problems actively sought medical advice in the past year.

The internet is now one of the most readily accessible and comprehensive methods for accessing medical information and treatments by the public. Studies have shown that more than half the population of North America has access to the internet and up to 62% of users were seeking health or medical information. Many websites address health and medical issues in conjunction with the sale of products that may alleviate health problems and diseases, including prescription and non-prescription drugs and health supplements. In the US, from 1990 to 1997, there was a 380% increase in the use of herbal remedies and in 2001 over half the population of America were regularly taking herbal supplements.

Herbal treatments are health supplements that are chemically rich in plant or plant parts containing single or multiple ingredients in the form of tablets, capsules, creams or tinctures. Since Viagra (sildenafil) was first introduced as an effective tablet treatment for erectile dysfunction by Pfizer in 1998, there has been a rise in the sale of herbal substitutes of Viagra on the internet. Viagra is now well established as a brand name, which the public associate with effective and safe relief from erectile failure. Websites therefore use the Viagra brand to promote their products and may even advertise herbal treatments for erectile dysfunction as 'Herbal Viagra'. Such websites frequently describe their products as being efficacious, safe and containing only natural products with no side effects. The internet therefore provides an easy and confidential method obtaining non-prescription herbal treatments for erectile dysfunction, which will be perceived as being both safe and effective.

However, the safety of herbal treatments purchased from the internet is unclear. In addition, the quality and reliability of medical information provided by websites providing herbal treatments for erectile dysfunction is unknown. A survey of internet sites selling herbal supplements for ED was therefore conducted in order to investigate their safety and reliability against set criteria.

Most sites (88%) made claims about the effectiveness of their products in treating erectile dysfunction but almost a third (30%) failed to clearly state the ingredients making up the treatments. This has concerning implications since it has previously been reported that treatments marketed as entirely natural dietary supplements have subsequently been found to contain significant levels of active pharmaceutical compounds. For example, in April 2003, in the United States, the Food and Drug Administration (FDA) discovered that tablets marketed as all-natural herbal products to enhance sexual experience for men and women (Vinarol) contained a type-5 phosphodiesterase (PDE5) inhibitor (sildenafil). Likewise in Canada, the Chinese herbal preparation 'Hua Fo' was also found to contain a compound similar to sildenafil. Patients taking these preparations would unwittingly be putting themselves at risk from the potentially dangerous adverse effects of a prescription-only PDE5 inhibitor (such as life-threatening hypotension if taken concurrently with nitrates). For this reason, Vinarol and 'Hua Fo' were subsequently recalled. However, it is unknown how many other treatments for erectile dysfunction marketed as 'Herbal' supplements actually contain active and potentially dangerous compounds.

Less than a quarter (24%) of the sites reviewed in this study encouraged patients to seek medical advice. Erectile dysfunction is known to be associated with generalised disease in the vascular endothelium and the onset of erectile dysfunction may be the first presentation of treatable but potentially life-threatening cardiovascular disease. By self-treating erectile dysfunction with herbal products purchased from the internet, occult erectile dysfunction-associated cardiovascular disease would go undiagnosed and untreated, which could result in irreversible complications and even death.

In conclusion, acquiring medical information regarding erectile dysfunction and purchasing treatments such as 'Herbal Viagra' from the internet is convenient and easy; however, the safety and reliability of such websites and treatments is poor. Occult erectile dysfunction-associated cardiovascular disease will go undiagnosed and untreated among patients using this approach and patients taking herbal treatments without knowing their composition and effects are at risk from potentially harmful adverse effects. Until more stringent regulations are implemented, patients should be cautious when acquiring information and 'Herbal' treatment for erectile dysfunction from the internet.

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