Black stone – a natural remedy for premature ejaculation and performance enhancement,or maybe not?

Introduction

Erectile dysfunction affects around 10–15% of men ¹ and although there are some approved pharmacological therapies in this area, many men are turning to alternative treatments or the internet for help.

Premature ejaculation (PE) is said to be the most common sexual complaint in men with a reporting rate of 30% in most studies.^1,2 Although biological and psychological factors are important in the aetiology of PE, therapeutic options and psychosexual counselling are limited. In the UK, the only licensed pharmacological agent is dapoxetine although other agents have been tried but have to be given off-label.

Topical over-the-counter sprays and creams employing local anaesthetics have been used but it is probable that few subjects with PE are able to discuss the various options available in pharmacy settings because of embarrassment. ³ Recently, there has been a proliferation of ‘spam’ emails offering agents to help with multiple sexual problems in an anonymous manner.

We describe the case of a man who used a non-prescribed remedy (Black stone) to improve sexual performance with unfortunate consequences.

Case report

A 37-year-old man of Indian origin presented to a genitourinary medicine walk-in clinic 48 h after using the performance enhancer ‘Black stone’ for the first time. This was given to him by a friend who often used the stone to prevent PE and make sex last longer. The stone had no packaging or official instructions and had reputedly come from Jamaica.

He had been told to rub the stone with the tip of his wettened finger and then rub the head of the penis with the finger. He was told to expect a tingling sensation but when this did not happen he repeated the instructions 5–6 times, within 20 min, to be sure he had enough on. After around 30 min the tip of his penis began to burn and continued to be excruciatingly painful throughout the night. The following day the pain was starting to subside, but he developed a discharge from under the foreskin which was why he presented.

This was his first visit to a sexual health clinic. He had no history of STIs or HIV and had last had sex three months ago with a casual female partner using a condom. He was usually fit and well with no significant medical history and no regular medication.

On examination, he was uncircumcised with a swollen erythematous glans and with what looked like a chemical burn covering most of the area (Figure 1). He also had a copious sub-preputial discharge. Examination was otherwise normal with normal testes and no swollen lymph nodes. OPEN IN VIEWER

Investigations including a full screen for sexually transmitted infections and culture of the discharge were taken. Urine testing for glucose was negative. He was advised to retract the foreskin and bathe with salt and water twice daily and was given erythromycin 500 mg bd orally for seven days.

One week later he returned to clinic having washed as advised and had completed the course of antibiotics. All test results were negative. Clinical examination was now normal with no sign of penile erythema.

Discussion

There are many websites which offer to sell Black stone and boast about its advantages of being a natural product. Different sources say it originates in China or Jamaica and has alternative names such as Jamaican stone, sex stone or love stone. It can be made from concentrated tree sap, or root formula or herbs according to a Black stone website.

After an extensive search of the available scientific literature as well as other online resources we could find very little evidence as to how Black stone is meant to work or its adverse effects. In 2008, the New York City Health Department issued a warning about its use stating that a man had died after ingesting the stone which is illegal in the USA and also warned that it can be harmful when applied to the skin. ⁴ We could find no evidence that it is illegal in the UK.

There are many forums and blogs which have anecdotal reports of the use of Black stone. ⁵ These are mostly either in favour saying that the user had a positive benefit or complaining that the stone did nothing at all. There are a few complaints about a burning sensation if left on too long or swelling if used too often but nothing that sounded as severe as in our patient.

Many unregulated substances are now being sold online or on the black market that claim to improve sexual performance but do not have labelling identifying active ingredients. Potentially serious side effects are usually not mentioned. There are studies which have found traces of analogues of prescribed drugs such as sildenafil in supplements marketed as ‘herbal’ or ‘natural’ with none of the warnings that would come with prescribed medication. ⁶ The use of such remedies is likely to grow and it follows that we could see the adverse consequences of these substances more often in the future.