Viagra and its unintended consequences
Viagra has now been on the market for many years, but there haven’t been many studies of its impact on society. We know that it only works in a certain percentage of cases of erectile dysfunction, around 75% to be exact. The other 25% of cases are generally those where there are psychosocial or emotional issues within the sexual relationship. Since Viagra is not an aphrodisiac, but can only promote erection where there is pre-existing sexual arousal, it clearly won’t work for couples where there are more fundamental relationship issues which need to be resolved. In short, the question is: what are the emotional and social side effects of Viagra?
Well, some of these effects were certainly unexpected when Viagra (V) was first launched onto the market as the wonder drug to deal with erectile dysfunction. For example, who would have thought that it would have become a drug to be traded in pubs and nightclubs as a means of counteracting the effect of cocaine and other illegal drugs which render a man randy but impotent? To some degree, therefore, one of the unexpected effects of V availability has been the promotion of the greatest sexual license amongst younger, hard-living socializers who are out for a quick sexual thrill. There is no evidence that it has become a drug of choice amongst the swingers and other sexually liberated groups, but it wouldn’t surprise me in the least to learn that it was facilitating the sexual encounters that are so widespread behind the lace curtains of suburbia.
What is more interesting, perhaps, is the fact that women seem to be taking Viagra as well. One must be careful in adopting anecdotal accounts of sexual behavior in society as evidence of anything, particularly when they are reported in the tabloid press, which delights in a hypocritical attitude of moralizing sexual prohibition on the one hand and repressed, Victorian-style titillation and innuendo on the other.
Nonetheless, if women are using this compound, what are they using it for? There isn’t any evidence whatsoever that V improves sexual enjoyment or sexual function in women, although studies have been conducted to establish whether this might be the case. (Any market opportunity which could potentially increase the sales of a drug designed to deal with a psychosocial condition like sexual dysfunction is clearly a desirable thing from the point of view of the drug companies.) (Read about side effects here, if you are worried about taking this drug.)
The answer seems to be that there is an association between V and sexual behavior: that is to say, it somehow gives people permission to be uninhibited. In men, it can promote an erection which may last well beyond one ejaculation: in other words, men are turned into sex machines, possessing an erect penis which may go on after the first encounter to a second, or third, or more … and so, because V impacts on a man’s ability to engage in coitus, but doesn’t facilitate intimacy or emotional connection between couples, and doesn’t “work” for women, it has the potential to highlight the real and fundamental differences between men and women in their attitude to sex.
Indeed, it has highlighted the fact that men are not necessarily the best source of women’s orgasms, and that women may actually be better lovers than men when you take into account orgasmic capacity, and the length of time for which they can continue to enjoy sex. In other words: men are not, in the main, very good lovers, and their model of sexual satisfaction is not necessarily shared by women.
Over 30 million men have been prescribed Viagra for impotence, while many more have obtained it illicitly on either the internet or elsewhere for recreational use. What are the social consequences of sex depending on an erection which has been induced by a chemical compound’s action on the body? Many authors have commented on the implicit transformation of an erotic, intimate act into a mechanical one.
Middle-aged male users, who ought naturally to be slowing down sexually (adapting as middle-aged men do to a slower pace of sexual arousal and intercourse, not to mention a softer erection and less reliable erectile capacity, even if they don’t have overt erectile dysfunction), are effectively transformed into men with the sexual capacity of rampant teenagers, able to get an erection on demand. Apart from the fact that this obviously interferes with the natural progress of a man’s sexual growth and the evolution of his sexuality, it transforms him into a lover who has an erection which needs to be used.
No matter that he may already have ejaculated, he’ll want to use his erection again and perhaps again … which may be exhausting, particularly if the middle-aged woman who is on the receiving end of his attention is unwilling to co-operate further. And apart from this, there are obvious physical side-effects such as blue vision, a flushed face, and possibly palpitations.
It’s almost as though V is encouraging a couple to believe penetrative sex is the only acceptable way to have sex. Apart from the fact that this is evidently untrue, since human sexuality is immensely complex and there are many ways to achieve satisfaction and fulfillment, let alone intimacy, it may also be forcing women to admit that penetrative sex is not all it’s always been cracked up to be. Faced with ever-increasing demands from a man with a rampant hard penis, some women are choosing, it seems, to finally come clean that penetrative sex has not been the thrill for them that their men may have believed.
While a hard erection which doesn’t go down after ejaculation may work wonders for a man’s self-esteem, it might not be quite so exciting for a woman. Indeed, some studies suggest that up to half the men who have been prescribed Viagra receive no benefit, a fact which has been explained by low testosterone, but another possibility is the lack of involvement of women in the prescribing process: many women are turned off by the decision of their man to take a pill to get an erection for intercourse. This seems to strike at the root of some women’s self-esteem, because they believe that they should be the object of the man’s sexual desire and the source of his arousal. The fact that he needs a pill to get turned on to have sex may suggest to a woman that she is not attractive.
The lack of mutual understanding of a couple who are in this situation is profound: first of all, the decision by the man not to consult his partner, but to spring an erection on her after obtaining a prescription for V is a mistake. It demonstrates that his attitude to sex is fundamentally different from hers. This is neither right nor wrong, and is not intended to make any judgment about men’s relationship skills; men make decisions like these because they wish to please their partner, and they usually think she’ll be absolutely delighted with it.
This is a classic example of how a man may try to please a woman and meet her needs while misreading the situation totally. His actions certainly come from the best of intentions but clash dramatically with what she wants. What she wants of course, is to know that she’s attractive, that she was turning him on, and that she still has enough seductive appeal to arouse him without the use of stimulants. The best way to avoid this is to ensure that your partner is involved in every stage of the assessment and treatment program for erectile dysfunction.
It’s somewhat cynical to suggest that erectile dysfunction has become medicalized by doctors who are under the influence of the pharmaceutical companies, but there is a grain of truth in that statement somewhere. Men may go to their doctors asking for a prescription so that they can regain an erection without addressing the underlying relationship issues. Doctors who prescribe Viagra in this situation have defended their actions by saying that you simply have to look at the relief on the face of a man and his partner to understand that sometimes the prescription for an erection is enough. Well, it’s an interesting point of view. But the problem is that in almost every case where ED is genuinely caused by an underlying physical or organic problem, urgent medical attention for that problem is needed. In almost every other case, psychological treatment is much the better option because it enhances the strength of the relationship.
One consequence of prescribing Viagra so freely is that it impacts on the status quo which has evolved within a relationship for some very good reason. The level of sex within a relationship is arrived at by subtle processes of communication, not all of them direct and obvious. If a man becomes obviously ready, willing and able to have sex – and wants it – after a sex-free period, then the woman is not necessarily going to be ready or willing to join him. Clearly the psychological balance of the relationship can be upset dramatically in such situations.
And interestingly enough, it seems that many people don’t actually mind the absence of sex within their relationship. In 1996, a study was conducted by Keele University among 4000 men and women with an average age of 50 years. About 34% of the men in the study had intermittent or permanent problems with erection, and about half of their female partners found penetrative sex to be painful. When they were asked if they wanted assistance to re-establish an active sex life, less than half of the men and half of the women said they did. You see where the ready availability of Viagra takes us: into the medicalization of what appears to be a common situation in long-term relationships (low levels of sexual activity) — and the medical profession (or rather the pharmaceutical industry) takes the view that these people don’t know what’s good for them!
Cynical or not, it’s been suggested that the insurance-based, cash-driven US health system has propelled sales of Viagra, simply because urologists needed to persuade men who did not have erections that they had a medical problem rather than a relationship problem. This means they can prescribe Viagra and keep the flow of new patients arriving at their door. (However, the obesity epidemic has certainly helped in this regard, since levels of heart disease and diabetes are now so high – and none of those conditions help a man to get or keep an erection.)
And the average age of men who are having difficulty with erection problems seems to be gradually declining. Certainly the number of diabetics is increasing, and taken together these two facts are not slowing down demand for Viagra as a treatment for erectile dysfunction in the marketplace. And even though it was originally promoted as a way of helping elderly men achieve erection in the face of chronic underlying illness, it’s a fact that it works better in men who are healthy, where it promotes the ability to have repeated, very hard, long-lasting erections.
When Viagra was being developed scientists knew that sexual arousal sends impulses from the brain down to the penis where they promote the production of cyclic guanosine monophosphate (cyclic GMP). This is a compound which relaxes muscles in the penis and so allows blood to flow in, thereby creating an erection. cGMP is normally broken down by an enzyme called PDE5, the action of which is inhibited by Viagra.
Presidential candidate Bob Dole became the first public face of Pfizer’s marketing campaigns. He appeared in ads to recommended that American males should get regular checks prostate cancer — and by implication deal with the possible effects on their erectile capacity. But when Pfizer began using a 37-year-old Texas Rangers baseball star as their front man they immediately started to send a different message: that even healthy young sporting heroes could see a change by taking this wonder drug. And that’s true, because the drug will work on almost any healthy man beyond the age of puberty (relationship issues aside). It does indeed also work for those who have any one of the rather limited range physical conditions which induce impotence.
The worst effect of all of the hype and marketing around the compound is the fact it has shifted the perception of sex from being a couple-centered activity to one that is penis-centered (which to be honest is how most men probably see it, deep down, anyway).
John Bancroft has been at the forefront of those who have been talking about the risks of applying a penis-centered model of sexuality to women. He also refers to the risks of medicalizing sexual dysfunction by implying that there is a particular, normal pattern of sexual activity that couples “should” be engaged in.
But both sex and sexuality are highly individualistic, and it’s up to every couple to explore fully the range, depth and type of sexual interactions which they wish to enjoy. There most certainly isn’t a “one size fits all” approach to sex that people find acceptable: indeed, couples enjoy activities such as mutual masturbation, sensual touching and caressing, non-ejaculatory orgasms in men, energy transfer between men and women after the Tantric tradition, and so on. Penetrative sex is not the only or indeed the “normal” form of sexual activity between men and women.
And, having said all of that, women probably don’t understand how much a man’s sense of male sexuality and masculinity depends on his ability to achieve regular erections. Being potent is an absolutely fundamental part of a man’s self-image, and as soon as he loses his erection, he loses some vital part of his masculinity, a part whose absence diminishes him more than most women can imagine. Women don’t understand this, not least because nobody is telling them: instead they are being pressurized into accepting penetrative sex, perhaps of a rather mechanistic kind, as being not only normal, but also the answer to all their relationship problems.
But a man who can’t communicate with his partner about the issues that are either causing his loss of erection or are caused by his loss of erection, and who gets a prescription for Viagra, before presenting his rampant erection to her is only going to make matters worse, not better.
And what’s been cynically referred to as the sexual dysfunction industry seems to be happily identifying more and more women as deficient or perverse in that they have been given their own clutch of medicalized sexual dysfunctions: hypoactive sexual desire disorder, arousal disorder, orgasmic disorder, and pain disorder. It doesn’t seem to occur to anybody in the medicalized “sexual dysfunction industry” that perhaps what these women need is a little bit more communication, intimacy and affection. And so it turns out that, for example, Annie Potts, a psychologist in gender studies in New Zealand, has discovered that female partners of Viagra users complain that doctors prescribe Viagra to men but fail to question the couple about their relationship, their attitude to sex, or their communication skills, which means that Viagra may actually end up promoting relationship difficulties.
In the natural order of things, older men experience a lower sex drive, a gentler, perhaps even less aggressive form of sex, one which lasts longer and is more intimate — and which older men report as being more satisfying. In other words, it’s possible for a man, as he grows older, to experience erectile changes as an opportunity to enjoy a natural form of sexual evolution which offers the chance of increased sensuality and intimacy with his partner (not to mention the opportunity for more sexual experimentation).
As I mentioned before, doctors who support the use of Viagra say that complaints such as those listed above are not only unhelpful but possibly destructive. And, certainly, there are many doctors who can testify to the fact that V has brought renewed happiness and sexuality to millions of couples, which in turn may mean there has been a huge saving in treating depression and other emotional problems linked to sexual dysfunction. Even so, many of these doctors would admit that the widespread prescribing of V to men not accompanied by their partners may have been ill-advised, although it’s hard to see how a doctor could refuse to prescribe Viagra to a man who is experiencing erectile dysfunction when he’s not accompanied by his partner. One doctor who was involved in the original trials of the drug memorably said that he didn’t think that prescribing Viagra was medicalizing sexual function any more than wearing glasses was medicalizing shortsightedness. There are, after all, disadvantages to almost any decision of this sort.
What’s needed is a study of the proportion of men who have generally found Viagra to be beneficial. It’s also important that men to whom it is prescribed are given sufficient information to enable them to use it effectively. For example, some men need to take it eight or nine times before it becomes fully effective. Others find that it may deaden sensation slightly, an effect which has been likened to wearing an invisible extra condom. Another issue that needs attention is whether or not V is psychologically addictive. One thing for which it can hardly be blamed is a rise in sexually transmitted diseases amongst elderly people, where a revitalized sexual appetite appears to have led to a lack of safe sex in some quarters.
Paula Hall, a Relate psychotherapist has identified “dependency” as a factor in some relationship breakdowns, with the woman angry or distressed that her male partner or husband needs a chemical stimulus to be able to have sex with her. “I don’t know that it is ever a primary cause; it is more likely to be the last straw,” she says. “But I worry about so many people becoming habitual users. We simply don’t know what the long-term effects might be.” Pfizer denies the possibility of dependency, but admits it is not possible to predict the long-term impact.
It’s also important to emphasize that if women’s dislike of penetrative sex has suddenly been exposed by men who were previously sexually undemanding now requiring an outlet for their revitalized erections, the solution to this problem is in finding a way for men and women to enjoy a mutually satisfactory way of making love; it’s not right to victimize women by coming up with contrived conditions such as hypoactive sexual desire disorder to explain their supposed lack of interest in sex (nor, one might add, is it acceptable for women to blame men for their “unreasonable” sexual demands). As Thomas Szasz, emeritus professor of psychiatry in New York, has observed, the drive to medicalize sex diminishes and debases what it is to be human. Besides which, there are good reasons for thinking that, at least in some cases, men who have difficulty achieving erection (or indeed who have a low sexual drive) may have some issues which would better be dealt with by means of psychotherapy or shadow work.
Shadow work, which involves exploring one’s hidden or unacknowledged aspects, can be a valuable tool for addressing sexual issues by fostering self-acceptance and healing past traumas related to sexuality. It can help individuals understand and integrate their “shadow,” which encompasses the parts of themselves they may have disowned or repressed, often due to societal or personal judgments.
Here’s how shadow work can be applied to sexual issues:
Shadow work can help individuals uncover and acknowledge feelings, desires, or experiences related to sexuality that they may have suppressed due to shame, guilt, or fear.
Understanding Patterns:
By exploring the shadow, individuals can identify recurring patterns in their sexual behavior or relationships that may stem from unresolved issues or trauma.
Reclaiming Forbidden Desires:
Shadow work can help individuals confront and potentially embrace aspects of their sexuality that they may have previously deemed unacceptable or taboo, leading to greater self-acceptance and integration.
Healing Trauma:
Shadow work can be particularly helpful in addressing past traumas related to sexual abuse, assault, or other experiences that have negatively impacted a person’s sexual self-perception.
Improving Relationships:
By understanding their own shadows, individuals can also gain insights into how their shadows affect their relationships with others, leading to more fulfilling and authentic connections. It’s important to approach shadow work with self-compassion and to seek support from a qualified therapist or counselor, especially if dealing with past trauma or mental health conditions, webmd.com says.
This video will teach you how to safely engage in shadow work.