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Just for Sex?

They don't make people better lovers, instantly mend broken relationships or enlarge penises.

Still, many doctors and drug companies say they don't believe the drugs are being overused and, in any case, see little danger in them.

About 75 percent of the erectile drugs are now prescribed by general practitioners rather than urologists or cardiologists. Dr. Louis Kuritzky, a clinical assistant professor at the University of Florida's department of community health and family medicine, says he generally gives a prescription when asked. "There's no way to prove they have it any more than a woman having menstrual cramps or headaches. We trust them unless there's reason to believe otherwise."

Even if the cause is psychologically rooted, Kuritzky says, many people can't afford the money or the time that therapy would require.

The pills, he adds, can offer a temporary quick fix to restore confidence, which may be all that's needed.

"When you have garbage that is rotting, the best thing to do is to take it out," he says. "But if you can't, sometimes it's best to spray perfume on it. Sex therapy is a luxury for only the economically elite."

Pfizer, which sold $1.9 billion worth of Viagra last year and says 23 million men worldwide have tried it, maintains that it is not promoting the drug for male enhancement purposes. Spokesman Daniel Watts says the company believes that if a man is troubled enough by erection problems, then he should consult a doctor about a possible underlying condition.

Carole Copeland, a spokeswoman for Eli Lilly, which makes Cialis, says the company "strongly discourages" use by those seeking enhancement only. "It's just not safe. People who don't have a condition that necessitates it shouldn't use any drugs," noting that erectile dysfunction drugs can be deadly if taken with nitrates.

Dr. Sanjay Kaul, a cardiologist at Cedars-Sinai hospital in Los Angeles, questions whether some of the purported need for the drugs has been drummed up by the drugmakers' advertising and reports that 30 million men in the United States may suffer from erectile dysfunction.

There's little doubt that the age of erectile drug users is getting lower. Express Scripts, which, with 50 million members, is one of the nation's largest managers of employee prescription-drug benefit plans, said the fastest-growing segment of users who applied for reimbursement of Viagra prescriptions was men ages 18 to 55 from 1998 to 2002.

The number of men younger than 45 using the drug tripled during that time, although it is still small compared with the majority of users, who are older than 50. Pfizer says the average age of men taking the drug is now about 53, lower than it was previously, although exact comparisons aren't available. As of earlier this year, about 8 percent of prescription Viagra users were age 34 to 40, about 26 percent were in their 40s, 36 percent in their 50s and 22 percent in their 60s, Pfizer's data shows.

Mark A.R. Kleiman, a public-policy professor at the University of California at Los Angeles and director of its drug-analysis program, goes so far as to contend that the drugs meet the criteria for distribution as "controlled substances" in the United States, handled in the way drugs such Oxycontin are.

"Using a prescription drug for a purpose not prescribed is in essence drug abuse," Kleiman says. "It's not that men have it (erectile dysfunction) or don't have it, it's that men vary in sexual performance," he says. "A lot of people want to be higher on the curve. Being a 50-year-old who no longer performs like a 20-year-old is not a disease."

Sam Fields

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