It's difficult to argue orgasms with a man who has an upright plastic penis perched on his desk. New York University School of Medicine Urologist Jed C. Kaminetsky is talking about diffuse (or, if you will, "diff-use") effects of a new drug, and he is talking on the record but quite off-label. Almost since Viagra's approval last year, word has been spreading about a possible female use of the stuff, and Kaminetsky has prescribed the erectile drug to more than twenty women to good climactic effect over the last year. In short, Viagra boosts blood flow not only to a man's penis but also to a woman's clitoris. Even more important targets, Kaminetsky believes, may be the bundles of nerve-rich tissues that lie beneath the clitoris and alongside the inner labia and the mons pubis. "We have a long history of using drugs off-label," he says of doctors in general. In this instance, he is talking about a long-playing buzz his female patients feel lucky to have found, one that may take the FDA (too many) years to confirm. Kaminetsky and a few of his cohorts have gotten creative with other male sex medications as well. He takes pride in having concocted an off-label vaginal suppository made from Muse, one of the more popular pre-Viagra erectile-dysfunction drugs. For women looking for more memorable orgasms, a pellet of Muse mixed with insert jelly like compounds is applied prior to intercourse to the anterior wall of the vagina- otherwise known as the G-spot. "Personally, I think Viagra worked better and is a little less cumbersome," Kaminetsky says. "But the suppository is really comfortable, and there is a company doing tests on this right now."

PICK ME UP, SLOW ME DOWN

Not every man needs Viagra, of course. Especially those afflicted with the condition known as premature ejaculation (PE). In an odd twist, those who come too soon too often may benefit from not coming down. Consider: Now that the "new" antidepressants Prozac, Zoloft and Anafranil have been prescribed to millions of patients throughout the 1990's, some of the lesser-known uses of these drugs have been discovered. One of these uses is decidedly off-label; it evolved because one of the frequent side effects of these drugs is low libido. Why not harness this loss of drive, the thinking goes, to tame the overeager?

Outside his private practice, as an assistant clinical professor of Urology, Kaminetsky sees evidence of off-label medicine far beyond his specialty. "It's a clear case of using a drug to "capture" side effects of the drug-in this case (to control) premature ejaculation. And some of my happiest patients are those who have used this, (PE is) embarrassing, upsetting, and patients are at their wit's end." A word of caution is in order, though. Anyone who uses Prozac, Zoloft or Anafranil for PE should be prescribed a lower-than-normal and possibly periodic, (not continual) dose. And if someone knows he's not having sex for a while, he'd be well advised to lay off the drug temporarily.