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).