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See All Coupons. More Stories. While no deaths have been reported, the AP found records of emergency room visits attributed to all-natural sex pills in Georgia, Chicago, Philadelphia, San Diego and elsewhere. An elderly man in a retirement community north of Los Angeles took an in-the-mail sample and landed in the hospital for four days.

A Michigan man sued the maker of Spontane-ES, blaming it for the stroke he suffered 20 minutes after taking a freebie that was advertised as "extremely safe. Mark B. Mycyk, a Chicago emergency room doctor who directs Northwestern University's clinical toxicology research program, said he is seeing increasing numbers of patients who unwittingly took prescription-strength doses of the alternatives, a trend he attributes to ease of purchase on the Internet and the desperation of vulnerable men.

He said he wouldn't be surprised if there'd been undetected deaths from bad herbal pills. Some herbal labels warn off users with heart or blood-pressure problems if they have taken their medicine within six hours; some doctors say 24 hours or more would be safer. The AP often couldn't determine from records whether incidents reported to tracking systems of the federal Food and Drug Administration and state poison control centers involved mixing herbal alternatives with nitrates.

Some men in their 30s who went to emergency rooms after taking herbal sex pills were presumably otherwise healthy, but they showed the transitory side effects of the active ingredients in regulated impotency pharmaceuticals, such as difficulty seeing clearly or severe headaches, records show. While public health officials don't know the extent of the problem, they agree that incidents are vastly underreported, with national tracking systems capturing perhaps as little as 1 percent of them.

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Victims may be embarrassed, and doctors rarely ask about supplements. Some legitimate herbal mixtures claim to work gradually over weeks; it's the herbals marketed for immediate trysts that often are the problem. Tight budgets, weak regulations and other priorities limit the FDA's ability to police the products, often promoted via blasts of e-mail spam and fly-by-night Web sites. Linda Silvers, who leads an FDA team that targets fraudulent health products sold online.

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In many cases, the ingredients used to alter herbal pills come from Asia, particularly China, where the sexual enhancers are cooked up in labs at the beginning of a winding supply chain. The FDA has placed pills by two manufacturers in China and one from Malaysia on an import watch list. Many health insurance plans provide limited coverage for prescription sex pills, especially for those with health-related difficulties.

Few over-the-counter treatments are covered, and herbals aren't likely to be among them, in part because they're classified as foods not pharmaceuticals, said Mohit M. Ghose, spokesman for America's Health Insurance Plans, which represents major health insurers.