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Rising to the Occasion

Treatment options for men’s reproductive health have grown immensely as those with erectile dysfunction seek to improve their sex lives and their overall well-being

By NewsChina Updated Apr.1

A man walks in front of a Beijing pharmacy advertising erectile dysfunction drugs

In 2000, Viagra, the world’s first effective drug to treat erectile dysfunction (ED), hit the Chinese market, causing a stir nationwide at a time when public discussions about sex were largely taboo.  

Over the past 20 years, similar drugs made in China and abroad have been released to help men with ED. However, as social attitudes toward sex become more open, anxieties over sexual performance have increased.  

Marketing Performance 
Sales of Viagra registered US$1 billion in the US alone in 1999, a year after Pfizer debuted the drug, whose success was in part credited to its successful advertisement and marketing campaigns.  

In May 2018, Hebei Changshan Biochemical Pharmaceutical Company, which manufactures a generic version of Viagra, announced that China was home to 140 million ED patients and a 10 billion-yuan (US$1.6b) market.  

On December 29, 2020, however, the Hebei Provincial Securities Regulatory Commission fined the company 600,000 yuan (US$92,760) for “releasing incorrect data likely to mislead investors.”  

Age proves to be the most important factor in ED cases.  

According to a survey conducted by a research group in Massachusetts, US, from 1987 to 2004, 52 percent of men aged between 40 and 70 suffered from ED in the US. In 2017, Li Hongjun, a professor of urology surgery at Peking Union Medical College Hospital in Beijing surveyed 5,000 men and found that 40.56 percent over 40 had ED.  

Official statistics show that there are 300 million men over 40 in China. According to Li’s survey results, that means roughly 120 million of them have ED (excluding those under 40). 

The prevalence of ED, however, does not equate to market size. Li told the reporter that there are different degrees of ED. Those with mild cases do not need treatment because they are neither impotent nor sexually dysfunctional. ED symptoms are not always the result of medical conditions, and elderly and younger people with lower libidos are not likely to seek medical treatment for ED.  

Li said that basing a 10 billion yuan (US$1.6b) market on the assumption that 140 million people in China suffer from ED confuses several ideas. “Pfizer was the first company to be misled. When Viagra entered the Chinese market, the company thought that China had roughly 200 million ED patients. It eventually discovered that not many people went to pharmacies to buy ED drugs,” he said.  

For many, ED is brought on by psychological or social factors. For example, roughly 10 percent of ED patients cite partners with inhibited sexual desire (sexual apathy), a narrowing of the vagina (colpostenosis), or painful intercourse (dyspareunia). Fatigue and loveless marriages also play a role.  

“Ask ED patients three questions: Do you think you’re impotent? Do you like sex? Does your partner cooperate?” Li said.  

Li said it is common for people in other countries above 50 to see a doctor for ED. In China, however, the majority of patients are aged between 20 and 40, many of whom are not married. 

“Young people who have failed to perform once or twice usually end up with anxiety and diminished self-confidence, which is exacerbated by online and TV ads,” he said. “Drug manufacturers and advertising tend to exaggerate ED, leading many younger people to believe they’re impotent.”  

Hard Sell 
Before the 1980s, ED was mostly considered a psychological issue. In March 1998, the US Food and Drug Administration (FDA) approved Viagra for the market. In 2003, the FDA approved similar drugs such as Cialis from Eli Lilly and Company, and Levitra, developed by GlaxoSmithKline and Bayer.  

Viagra and Levitra generally last between 30 minutes and four hours. Cialis can last up to 36 hours and is not affected by diet or alcohol.  

Li Hongjun told the reporter that Viagra is more well-known and sells better in pharmacies and online. At hospitals, however, doctors prefer to prescribe Cialis.  

In the 1990s, more options became available to doctors for managing ED, such as injections into the base of the penis and inflatable penile implants. While advanced treatments continue to develop, medications remain the most popular choice.  

Chen Huixing, a doctor of andrology (men’s reproductive health) at Shanghai Central Hospital, told NewsChina that drug treatments are prescribed more than surgery. Inflatable penile implants, he added, are a last resort. “They are instantly effective. But some patients are likely to develop complications,” he said.  

In addition, penile prosthesis must be replaced every 15 to 20 years with surgery costing 100,000-200,000 yuan (US$15,460-30,920). Less than 1,000 such operations are conducted in China annually.  

Mind over Matter 
Chen said that in recent years, a growing number of urology surgeons believe that ED is more physical than psychological. Common causes of sexual dysfunction include age, chronic diseases such as diabetes, use of prescription drugs such as antidepressants, and prostate issues.  

In the 1970 edition of Campbell-Walsh Urology, a world-recognized reference book for andrology, there was only one page about impotence. By 1998, there were 118 pages about ED. 

In the early 1990s, andrology in China mainly focused on ED and infertility. In 1995, the China Medical Association made andrology a separate branch of urology.  

“The development of andrology in China hinges on two things. First, test-tube babies helped resolve infertility issues for men. Second, drugs such as Viagra addressed ED. Popular conceptions toward sex and the status of men’s health issues have changed,” Li said. “Treatment of ED has eventually turned from operations advertised on flyers and secret home remedies into a real science.”  

Chen Huixing told the reporter that lacking effective medical treatment, doctors could only counsel their patients. “People with ED eventually stopped seeking treatment at hospitals,” he said. “Now there are more andrologists.”  

Many are becoming increasingly aware of the role that overall health plays in sexual health. Generally speaking, ED patients usually suffer from other problems such as endothelial dysfunction, which is when large blood vessels fail to dilate. This can lead to chronic ailments such as cardiovascular and cerebrovascular diseases, as well as metabolic disorders.  

Li Hongjun said that ED drugs are classed as phosphoriesterase 5 inhibitors, which affect blood flow and how cells communicate in the body. As a result, ED drugs are also effective for diseases including high blood pressure, arteriosclerosis (hardening of the arteries), high cholesterol, and diabetes.  

“ED drugs could kill two birds with one stone for those suffering from ED and these chronic diseases, which are common in ED patients,” Li said.  

“Elderly people should change their minds and pay more attention to ED issues,” he said. “The treatment will not only add days to their lives but also life to their days.” 

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