Monday, October 4, 2010

Snafi: Erectile Dysfunction, Dubious Advertising, and the Importance of Getting it Down

It seems that a specific commercial for a Saudi marketed erectile dysfunction medication, Snafi (Tadalafil), has caused complaints of impropriety by Saudi viewers. Moreover, this seems to fascinate the Western right wing press, uniquely. The Daily Mail is the best written, most detailed of them, and the title captures well the attitude towards Saudi in such media: No sex please, we're Saudis! Anti-impotence pill advert draws complaints after it is shown on state TV. Part way through the article is a "Read more..." linked article, just to bring home the stereotypes: French immigration minister forced to cancel wedding to 24-year-old Arab girl following Facebook threats. Actually, his anti-immigration policies are what have people disturbed.

I'm not sure how offended the Saudi populace (as opposed to the self-selected complainants) were about the idea of conjugal sex being implied, or the idea that it is a "chore" (or is that a mistranslation for "duty"?), or if the timing of the airing of the commercial was part of the issue.

Erectile dysfunction, the inability to obtain and maintain a firm enough erection to have sexual relations, is a serious problem, usually for older men with vascular damage due to diabetes, hypertension, or arteriosclerosis, but sometimes for younger men with similar medical problems. Viagra, the first of these types of medications, was initially developed to help these men have a normal sex life.

The medications are taken about 2 hours prior to the expected time of intercourse and enable the man, when appropriately sexually aroused, to obtain an erection, and have satisfactory sexual activity. The biggest caveat against them is cardiac complications, specifically cardiac arrest, which is a risk of the medication, and of sexual activity for the cardiac impaired (the risk is higher if the sex is with a lover, not a wife--there are medical reasons, but divine retribution also comes to mind).

Up until viewing this ad for Snafi, my biggest concern about these medications was the expansion of the target audience from men with medical problems preventing normal erectile function, to men wanting to enhance their performance, and specifically young healthy men, including university aged undergraduates and graduates. An undergraduate told me that Viagra is considered a party type drug, after I commented on an ad I had seen. Given that the drug itself increases cardiac risk, that is especially disturbing.

Part of my concern was the misuse of Viagra, Cialis, Snafi type medications for performance anxiety leading to temporary erectile dysfunction. This issue was raised by a patient, a graduate student who consulted me initially for anxiety, but rapidly specified that his concern was performance anxiety, that had resulted in impotence with his current girlfriend, despite ~15 years of normal sexual relations with more than one woman partner (serial monogamy). He had persuaded a GP to prescribe one of these erectile dysfunction medications that worked for him physically, but he was unhappy with needing it.

In fact, the problem was more that this particular woman, who was more intelligent, assertive, and socially prominent than his previous partners, intimidated him. It didn't help that she wanted to talk about his impotence a lot, nor that she had "shared" this information with her psychotherapist father, who sent him a sympathetic email about it, which included a joke card with a picture of an erect desert cactus. While he was most concerned about her having made this public, and to another man, I was most concerned about the father's professional ethics (the family ethics of his addressing this with his daughter's boyfriend are questionable too).

Performance anxiety leading to erectile dysfunction is better treated with psychotherapy (cognitive-behavioural, exploratory, supportive) than with medication (unless other issues require a psychotropic medication). If a man is able to get a morning erection, the cause is most likely psychological. Relationship issues are best addressed through psychotherapy (individual, couple), and are a very common cause. The requirement to perform on demand, for example when trying for a pregnancy, especially on an infertility treatment schedule, can also lead to impotence for psychological reasons. The anxiety about an episode of erectile dysfunction, the feelings of shame, or inadequacy, and unhelpful reactions from the sexual partner make the initial problem worse, and sometimes self-perpetuating.

Other common causes of erectile dysfunction in healthy men, like fatigue (including jet lag), alcohol (may temporarily increase libido, decreases inhibitions, decreases performance), stress, depression (decreases libido), medication side effects (including some anti-depressants), are best remedied by treating the underlying cause.

One online site advertises Snafi as a "sex pill toy".

After viewing the Snafi commercial, I am more concerned about the marketing of the "36 hours of stiffness". This is a feature of Snafi's impressive marketing website as well. However, it is not a claim made in the pharmaceutical product information sheet that is standard for all medications, and addressed to pharmacists and medical practitioners. In fact, based on the information there on pharmacokinetics and pharmacodynamics, it is hard to imagine how the medication lasts long enough in the body in high enough concentrations after taking a dose to ensure 36 hours of stiffness (mean half life 17.5 hrs; ie half of it is out of the body by 17.5 hours after taking it). The efficacy of a dose, meaning the ability for it to enhance an erection in a man who is sexually aroused or stimulated, lasts up to 24 hours; but no mention is made of the length of time of the erection itself.

More importantly, whatever fantasies are "aroused" by the idea of a 36 hour erection, an erection lasting more than 4 hours, called priapism (after the well-endowed Greek god of fertility Priapos), is considered a medico-surgical emergency.

Priapism: Getting it down or losing it

A persistent erection is not only painful, it can lead to ischemia, or insufficient fresh blood supply to the penis, with permanent damage to blood vessels, and permanent loss of erectile function. Worst cases can lead to gangrene, or the need to amputate the penis.

For that reason, a man with an erection lasting more than 4 hours should go immediately to a hospital emergency room for medical/ surgical treatment (medication/ withdrawing blood from the penis by various techniques).

Here is what the pharmaceutical information for Snafi says about priapism:
Priapism was not reported in clinical trials with Snafi. However, priapism has been reported with another PDE5 inhibitor, If priapism is not treated immediately, penile tissue damage and permanent loss of potency may result.
Snafi should be used with caution in patients who have conditions that might predispose them to priapism (such as sickle cell anaemia, multiple myeloma, or leukaemia), or in patients with anatomical deformation of the penis (such as angulation, cavernosal fibrosis or Peyronie's disease).
So yes, conjugal chore, duty, pleasure, bliss, whatever, but "in a timely fashion".

Your comments, thoughts, impressions?

*In the time it took to compose this post, the background television noise went from the occasional erectile dysfunction medication ad in the course of a film to an infomercial for one that is now available for women too! (clitorism is the equivalent of priapism).


jaraad said...

The video is so funny :)
But yes it is not proper for Muslim viewers or Arab culture. Not because of the item they are trying to promote but because of the context or the dialogue between the actors. To imply having sex even between married couple in public is what, I think, caused some people to feel offended.
Even in US couple of years ago there was a commercial for a drug similar to Viagra that American viewers felt not proper. If I remember well I think the male actor in that commercial grows big red ears like Satan.
By the way, such drugs are known for long time in the Arab world but in their natural herb forms not as chemical drugs. And no one complaint about it.

Chiara said...

Jaraad--Thank you for your comment and elaboration on the "offense". I wonder if the public display of the wife initiating sex was an issue too. In some ways that is a very feminist ad, and a reminder that in Islam a wife has the same right to sexual pleasure as a man--unlike in Christianity where procreation is the focus, and pleasure a non-topic, or in Catholicism where even marital sex is supposed to be with the intent or possibility of procreation (no birth control).

Advertising these drugs does make people squirm in a number of countries. I don't remember the Satanic husband, but it makes me think of the satyr of mythology, half man half goat, all sex all the time.

I found it interesting who in the West bothered to report this Saudi issue, particularly after a Saudi friend said it was an old ad, and he remembers it from 2 years ago.

Interesting about the traditional herbal remedies for erectile dysfunction. A quick search for ones used in MENA shows cardamom, anise, liquorice, ginger, and acacia. The latter is specifically mentioned in a medieval Persian textbook as an Arab remedy for erectile dysfunction of cardiac origin, and mentioned again in a recent academic journal article.

Thanks again for your comment and insight!

I hope others will join in (even if they are wincing :D)!

Wendy said...

I am always amazed when people squirm at ads in cultures where having large families is so important! LOL!!!

Majed said...

Naturally Saudis and Arabs in general are obsessed with sex, it is the only thing that occurs to them when they see a woman and in case of many or cute .... , people think that sex is a big taboo and arabs do not talk about it a lot, but that is wrong, sex the is the axle around which life revolves and is the major topic of group sittings.
most Saudi men dont like to use Viagra with their wives except in certain cases, because it is costly,aslo wives might get used to their performance with it and become demanding , and then who is crazy enough to use Viagra for his wife she is always there,besides they have explored every sqaure mm of her,as you have said Viagra is considered a recreational and party-time drug that is true, have you ever heard of someone going for recreation to his office. that is why they do not use it for wives but instead with someone they pick up at some shopping mall or for someone they bring around through Mr.Nokia or Mr.Erecson etc who are excellent pimps of our time and are safe and will never give you up to anyone,the pill is wonderful with someone they pick up at sea-side or someone they pay money to treat themselves to some fresh meat this is where it gives them maximum benefit in returns for money paid.
Paradoxically, one might find Viagra more often in women `s purses than in men `s pockets and it is not strange to see women purchasing it at pharmacies for husbands, boyfriends or lovers and I am not talking about she Viagra. and hooray for more working class women and hooray for more furnished apartments and hooray for easier rules to hiring rooms at hotels.
I wonder, where this people were all this years, this types of adds have been around for ages now, specially on MBC TV and others and on MBC FM radio on daily bases which is followed by everyone who rides a car and the national TV channels are the least followed of all channels again and always Hypocracy. inundated i wonder (how many) or it is just to say we are civilized,this is where drivers give horns to each of even fully covered women walking on the streets how true inundated could be.

Susanne said...

Chiara, I grew up in a Christian household, church, school and we never were taught what you said about sex in my circles. In fact we often speak of Song of Solomon and verses in Proverbs as examples of how pleasurable married sex should be. I have often been amazed at the view you promoted that I've read on other blogs concerning these teachings. They are always from people with Catholic backgrounds. With the sheer number of Protestants, I'm sure there are some similar, but I wanted to point out that not ALL Christians believe as you have stated that we do.

That said, I always giggled at the Viagara commercials that warned of the four-hour erection problem so this THIRTY SIX hour possibility has to be some of that famous Middle Eastern hyperbole! That or it's wishful thinking, Inshallah! ;-)

Cute ad!

oby said...

I couldn't understand the dialogue but what made me uncomfortable about it is the idea of a "quickie" with the kids in the next room able to hear if there were anything to hear. I felt it was a bit least wait until the kids go out and play or are asleep.

Chiara said...

Wendy--LOL :)

Majed--Thanks for your commment, which gives a different image of how these drugs are used. I do think women should be able to work, it has little relation with any sexual extracurricular activities. Your comment about these being old ads, along with that of my Saudi friend, suggests perhaps that part of the offense was them now being on a government run channel. That would also suggest who might have been offended more than others. Thanks again for your comment.

Susanne--thanks for sharing that perspective. I usually split off Catholicism and Protestantism where relevant in comments about Christianity as I did above. In my experience, Christianity including Catholicism speak of love, joy, and pleasure in marriage, but not as explicity of sexual gratification as Islam does. The Songs of Solomon are among the most beautiful of all poetry. They are also an anomaly within the Bible because of their explicitly erotic nature. This is often explained in exegesis as not being 2 lovers but the believer and the teachings of the religion, eg not entering a woman but entering the temple of God, etc.
True, only fundamentalist Protestants come close to Catholics in teaching sex for procreation, and the sperm hitting the egg theory of ensoulment, and personhood. The adherents of both groups do as they please in private. :D

You are kinder about the 36 hours, than I am. I'm thinking deceptive advertising, and too smart to write it in a medical pamphlet!

Oby--I think you may share the sense of indiscretion of the complainants. I think there is an issue for Westerners of acting styles, too. However, assuming you've seen your share of Bollywood films, you are probably used to that style of acting. :D
The translation is in the linked article. After the standard greetings of each other, the husband says: "How are the kids?". The wife replies: "They’ve finished all their chores, and you, Abu Faisel, don't forget your chore."

Thanks again to all for your comments.

I wonder what you and others think about the ethics in advertising on this one?

Majed said...

Chiara, I have nothing against women working, but, here I think they will take some time before men and women cool down after they get used to the concept of gender mixing.

As I read a lot, I have since very early found that my ship always drifted windward, so I vowed and made up my mind not to adopt or believe all that is written or said or seen without further looking into it ,and just to read to know more about how people think, and that, the data accumulated someday will add up to make something. I have never thought of the way Arab women think and frankly talk about sexual and conjugal matters from the angle you have just thrown light onto, when you said that it is (a reminder that in Islam a wife has the same right to sexual pleasure as a man). I have always thought of them like Insatiable......

Just as I said data accumulated, at right times add up to make something, and that reminded me of few cases of women who used to come to a Sheikh ( a powerful,scholar, elderly,knowledgable,wise) person with whom I was very close , in a famous Yemeni Tribe called Hamadan that follows the Zaidi Shia School of thought, in the land of Hamadan in the vicinity of Sanaa where I spent few months teaching their children ,it is very Old tribe about 2000 years of known history with very famous scholars, poets ,warriors and historians of grave importance in Arabic history, women used to come and complain against their husbands falling behind on fulfilling their conjugal (sexual) duties. some was as absurd as saying things about times he used do it per day and is no more able to do it, and that it is not ok with her and that she wants Kulhaa (divorce from woman side) otherwise she was not to blame if she did anything wrong, and another newly-wed saying that she did not like him without clothes and that she did not know he would be like that before marriage and want Kullaa I used to blush, shrink with shame and think very bad of them and deep in my heart I wondered what are these bi...... ??!!!

The sheikh used to tell me they are just practising their rights, and that if she supresses herself out of shy or because what people might say about her it is her loss.

oby said...

I had missed the translation link. thanks.

Well, it certainly knocks the myth of the quiet submissive wife out of the park. Now that I know what it says I feel even more uncomfortable with the kids right there. Perhaps her sense of voraciousness is also what some people found upsetting. It is the eternal dichotomy of the "whore in bed and madonna out of bed" thing. Perhaps those two things overlapped a little too close for comfort for some. It might be OK in private for a woman to desire her husband so much and be assertive but to put it out there for millions to see and "own" the behavior might be a bit unsettling for many. As for me the aggression didn't bother me...more power to him and her!! Rather, it was the sense that the aggression on the part of the woman(or it could be a man) was so strong as to overcome common sense when the children are present.

Susanne said...

Majed, do you think those women just wanted divorces so badly that they made up reasons why they no longer wanted to be married to these men? If someone really loved another, she would not care so much about these silly things (e.g. she didn't like him without clothes? Haaaa!). I think these women just didn't like their husbands for whatever reasons and wanted any excuse to divorce.


"In my experience, Christianity including Catholicism speak of love, joy, and pleasure in marriage, but not as explicity of sexual gratification as Islam does."

THAT is probably true. Nor do we analyze and record the bathroom habits of our prophets so we can poop, pee and clean exactly as they did. Some things really don't need graphic holy book explanations, IMO.

"The Songs of Solomon are among the most beautiful of all poetry. They are also an anomaly within the Bible because of their explicitly erotic nature. This is often explained in exegesis as not being 2 lovers but the believer and the teachings of the religion, eg not entering a woman but entering the temple of God, etc."

Yes, I've heard it can be both literal (love between a man and woman) and also spiritual (Christ and the Church; God and Israel). A Muslim friend tells me that Christians are mystics since we often find spiritual dimensions to our texts. I'd never considered that before, but it's how she sees it from an outsider's point of view. Then again, she has Sufi tendencies ... :) I think I read that Jewish men weren't allowed to read Songs of Solomon until they were about 18 due to its erotic nature. I remember Samer being surprised by it and said "Christian children read this?" :-D

Oby, you are sweet because your concern seems to be for the children. :) I am really curious what those who protested didn't like about it. Did they think the same as you? Maybe their problem was the aggressive woman. Women aren't supposed to want sex, are they? This reminds me of a discussion on another blog about women being made for men's sexual pleasures. It's a Muslim feminism blog and they are discussing those houris and the thought of women's reason for living being sexual fulfillment for the men.

Majed said...

Yes, it is possible they just wated divorce,but if a man can divorce his wife, based on, that after marriage he discovered, she was not a virgin, then she too should has the right to divorce him, if she did not like something in him after marriage, besides,I think not loving him is a reason enough to ask for divorce.

Another thing, I was being polite, when I just said, she did not like him without clothes, and did not elaborate.

Sussan you are a modern and educated lady, in your case it would be very silly, to teach you and give you guidelines on how to do basic things humanly, like pooping,peeing,sleeping,eating,socializing,fighting,loving,caring,cleaning,drink water and even how to treat and be kind to animals, but believe me, a countless lot of people need to be taught how to be human and need guidelines and a role model to follow, and who are better human than the prophets of God to follow.


A very interesting topic. But before commenting on Sanafi, we must understand the difference between Sanafi and Viagra. Usually, people confuse Sanafi with Viagra. This is not the case.

Viagra enhances performance for between 4-5 hours whereas Sanafi remains active for anywhere between 24-36 hours. Viagra, gives just one time enhancement whereas Sanafi needs a stimulant to work. That stimulant can be the thought process even.

If the language in the ad is offensive, then it should be immediately changed. This is a sensitive issue in all societies. Saying that Arabs are more into sex does not make the copy of an ad right. And sex is common in every society.

The average age for a girl to experience the physical relationships is 13 years. And that is because of a few valid reasons. For now, that is a different discussion.

The advertisements of Sanafi have always been very subtle and have relied more on visual communication than bawdy copy. If kept within the boundaries of decency, there is no harm in airing such advertisements. It is more important to channelize the issues than to deny them and let them blow out of proportions.

Majed, your observations are cogent and lucid.

erectile dysfunction in young men said...

I don't think there is any thing wrong with these kind of advertisement..

Anonymous said...

The way i see it, there is nothing wrong with the video. I have seen more worst scenario than this. But let us accept the fact that saudi men are "sex addicts"...Why? Because it is very costly to have a wife! That is why saudi men are fond of having sex with another man!I am an asian and i worked in saudi before. I remember riding in a taxi with a saudi driver. while on the way, the driver just grab my hand against his penis! This didn't happened just once, but a lot of times. They dont respect you even if you are older than them. This also happened to my colleagues. Not all, but i guess most saudi men are pervs

Anonymous said...

i worked in a Saudi hospital before and i remember this soldier offering money to me in exchange of sex! He wanted to have sex with another man!!!!They always pray to Allah but their actions are not acceptable!So, with all these i think the video is ok compared to the real world of saudi

Anonymous said...

There was again a time when my colleagues went to the market. They rode a taxi with a saudi driver. My friends told me that the driver offered a free ride in exchange for sex! My friends,all professionals,refused the offer but it didnt stopped there. The Driver parked the taxi somewhere and started masturbating inside the car!The video is nothing compared to what this driver did!

Majed said...


For me it is hard to refute you peoples experiences,but I am sure everyone else will think you all are exaggerating, But I differ with you on why some Arabs are attracted to men, it could not only be due to marriage being costly, it must be something else too, as some of them who have married very young and have gorgeous wives yet can not stop themselves craving men and boys, which I personally think is very disgusting I dont even follow the Arab way in saluting and greeting men with kisses on the cheeks,I only go for shaking hands and on occasion I hug.

But as some Asian men specially those from the Philippines are so delicate and soft that by mistake some gorillas might take them for females.


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