Despite the enthusiasm engendered by the recent publicity in the popular and medical press, not all men who suffer from impotence are entirely happy about treating themselves with self-injections into the penis with a drug which causes an erection which last for hours. Much of the initial research was carried out using a preparation of phenoxybenzamine.

But this drug was abandoned for the treatment of most cases about four years ago and papaverine is now usually used instead; whatever the details of the technique, it can have disadvantages: the erection, once induced, can be embarrassingly slow to recede, occasionally painful and sometimes so long lasting that it needs an antidote. However the treatment is being used successfully in some selected cases.

Dr Pru Tunnadine, of the Institute of Psychosexual Medicine in London, has a different approach. Having excluded the physical causes of impotence, she prefers to try counseling, or in some cases, male enhancement pills filled with natural herbs. One of the most popular of these male enhancement products is called Zenerx, which you can read about at Zenerx Review and Advice.

In her view the problem of erectile dysfunction for many younger men is due to lack of courtship, an art which she hopes may return with the changes in sexual behaviour induced by Aids. This, she feels, may herald the end of an era when sex was a compulsory reward for the first hamburger bought on a night out.

Such expectation, Tunnadine says, not only places a heavy burden on the woman, which is generally acknowledged, but also on the man too, who fears impotence and erectile dysfunction; in consequence they will fail, and may establish a pattern so that attempt after attempt at sexual intercourse ends in disaster.

Young men, in her view, increasingly see women as terrifying monsters to be satisfied, rather than shy virgins to be cherished, a role which enhanced rather than eroded their sense of manhood. Nor does Tunnadine have much time for agony aunts’ advice to wives of impotent older men; the suggestion that they should change into black stockings and light the candles would, Tunnadine feels, frighten most failing men out of their wits.

Many of these men have a naturally diminishing libido, which may be partly physiological and partly due to familiarity with a long-established partner and increasing responsibilities at work.

In her opinion, to return from a hard day’s work to find that their wives have been persuaded to turn themselves into scarlet women, would have a disastrous effect on most of these men.

Whether a doctor prefers to prescribe repeated injections or kindly reassurance from a skilled counsellor, which may be all that is needed, it is generally agreed that the essential first step in treatment is to exclude the organic causes of impotence, which may respond to medical or surgical treatment.

Rating for Zenerx: A-.

The American manufacturers of a drug widely prescribed in Britain for treating importance have called its safety into question after reports of serious side-effects in some men.

Eli Lilly, which markets papaverine in the US, warns that the side-effects have included scarring of the penis and priapism, prolonged erections sometimes lasting many hours and requiring medical and surgical intervention.

The company says in a leaflet accompanying the product that the drug, used for years to help patients with heart pain and other circulation disorders, should not be injected as a treatment for sexual problems.

But in Britain, papaverine is used for just that purpose. It is produced in injectable form by Macarthy Medical, of Romford, Essex, in response to demand by private sex therapists, hospital specialists and GPs who treat thousands of men.

Last week, British experts insisted the injections were safe when used correctly – and that the miraculous results achieved justified any risk attached to their use.

Impotence is the commonest complaint for which men seek medical help, but until the arrival of papaverine there was little doctors could offer apart from counselling, or an expensive implant operation.

The drug is not licensed by the Committee on Safety of Medicines, but treatment is possible on a named patient basis. This means that although Macarthy cannot market the drug, and it is not generally available on the NHS, it can be ordered by individual doctors on behalf of specific patients.

Papaverine works by paralysing tiny muscles in the walls of blood vessels, so that the vessels open fully and allow blood to rush in. It was first used as a sex treatment after a Paris surgeon, Dr Ronald Virag, found by chance during an operation that it produced an erection persisting for more than an hour in a previously impotent man.

Research showed that when injected directly into the penis, the drug caused blood to surge into the spongy erectile tissue, overcoming impotence caused by psychological as well as many physical problems.

But because it overrides natural control mechanisms, the erection does not necessarily end after ejaculation. Some patients have developed what the Americans call lock-up, erections lasting 20 hours or more and needing a minor operation to relieve them. The condition can be painful, and can cause lasting damage.

Further problems, said Professor Gorm Wagner, a sex researcher at the University of Copenhagen, included the development of hard nodules in the penis and scarring of the blood vessels inside.

It is for these reasons that many sexual health experts are recommending a more natural male enhancement product. One of the most recommended is ProSolution. These are pills filled with natural herbs that are effective at treating erectile dysfunction, but still safe to use.

Nevertheless, some British experts remain convinced the drug is safe when used carefully. Gordon Williams, consultant urologist at Hammersmith hospital, London, said that of several hundred men treated at his clinic, none developed any lasting problem, though he considered it essential to have decompression facilities available to deal with prolonged erections.

Rating for ProSolution: B+.