Dr. Keith Roach
DEAR DR. ROACH: I recently read an article about the over-the-counter erectile dysfunction cream called Eroxon. Do you have any thoughts on it? — J.T.
ANSWER: The company that makes MED3000 (Eroxon) also made a different compound called MED2005, a nitroglycerine-containing cream. Two trials have been completed, but only one was published. In the published trial, the results showed that the results for the active drug were only marginally better than a placebo, with about 37% of placebo recipients being satisfied with their experience versus 48% in those who received the active drug.
This means that about one man out of nine who used the active drug found it more helpful than a placebo. It also means that most people who were satisfied with the results were having a placebo response, but still, it worked. It was safe to use and worked quickly, within 10 minutes.
The company then decided to market the placebo compound itself as Eroxon, which does not contain nitroglycerine or any compound that is expected to have a pharmacologic effect, although the company suggests that the “evaporative effect” of the cream may stimulate nerve endings, without any data to support this.
When I looked online to see how much it cost, I was surprised to see that a 1.75-ounce tube costs $99 — and it was temporarily out of stock.
I know that many men are willing to do almost anything to treat erectile dysfunction. I am also supportive of the placebo response when it is used ethically. However, I have a hard time recommending paying $100 for a compound that was designed and tested as a placebo, even if 37% of men will find some benefit from it.
DEAR DR. ROACH: I read your recent column about liver cysts. After learning that these are mostly benign, I’m wondering if the same is true for gallbladder polyps. I had one found during an ultrasound for a separate reason. I’m 55-year-old female. They also found a kidney cyst on my right side during the same ultrasound. — C.E.
ANSWER: You are quite right that most polyps found incidentally on an ultrasound are benign. In a large study of over 35,000 people with gallbladder polyps that were incidentally found, only 19 were subsequently diagnosed with gallbladder cancer, so you can be 99.95% reassured.
However, there are a few people who should undergo further evaluation. A large polyp (greater than 1 centimeter) is a higher risk, and it is usually treated through a cholecystectomy. People with primary sclerosing cholangitis are at a high risk for gallbladder cancer. People over 60 and whose ancestors came from India are also at a higher risk. In people without risk factors, follow-up ultrasounds are usually recommended to be sure that the polyp isn’t growing.
The recommendations for an evaluation of asymptomatic kidney cysts also depend on the appearance of the cyst, but for the majority of simple kidney cysts, follow-ups aren’t necessary. Non-simple cysts should undergo evaluation by a CT scan, with management based on the results. Most of the time, these don’t require further testing.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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