Briefing: The Viagra revolution

The little blue pill that ushered in ‘the second sexual revolution’ just celebrated its 10th anniversary. How has Viagra changed the world of sex?

How popular is Viagra?

Pfizer’s “erectile dysfunction” drug is one of the most widely used prescription medicines in the world. Since its approval by the Food and Drug Administration a decade ago, some 35 million men in more than 120 countries have taken nearly 2 billion Viagra pills; an average of six Viagra pills are taken every second. Known in the industry as “Pfizer’s riser,” the $10 pill generates annual revenue of $1 billion, while two competitors that followed it to market, Eli Lilly’s Cialis and Bayer Pharmaceuticals’ Levitra, are also big sellers. All told, 4 million Americans take erectile dysfunction pills every year. “These drugs have been the gateway to allow patients to have open communication with doctors—and their partners—about sexuality,” said Dr. Terrie Ginsberg of the New Jersey Institute for Successful Aging. “They helped explode the myth that people over 50 are not sexual.”

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What does Viagra do, exactly?

It gets the blood flowing. Erections are the result of increased blood flow into the spongy tissues of the penis. Tens of millions of men have difficulty sustaining an erection, a problem that can worsen with age and such health problems as diabetes and “hardening of the arteries,” or atherosclerosis. Viagra and the other impotency drugs set off a chemical reaction in the bloodstream that produces nitric oxide, a neurotransmitter that opens up blood vessels—which is vital to erections and other physical responses. Back in the 1980s, Pfizer scientists were actually looking at the main ingredient in Viagra, sildenafil citrate, as a treatment for high blood pressure and angina. But after test subjects started exhibiting rather prominent side effects, researchers’ attention shifted. The results, say medical experts and sociologists alike, were nothing short of revolutionary.

Revolutionary in what way?

Other than the birth control pill, there has never been a product that had such a sudden, dramatic impact on human sexuality. Before Viagra, male dysfunction was largely treated as a psychological problem, not a physical one. The available medical treatments, including vacuum pumps, surgical implants, and penis injections, were cumbersome and sometimes painful. Viagra not only rejuvenated sex for millions of men and their partners, it also moved an unmentionable topic into the mainstream, making it suitable for TV commercials starring the likes of former presidential candidate Bob Dole. The drug has also generated an endless amount of material for late-night comedians, as well as billions of e-mail messages for mail-order Viagra (just check your spam inbox). “It was the second sexual revolution,” said fertility expert Dr. Michael Werner. But like every revolution, this one has its detractors.

What do the critics say?

That many men take Viagra for the “wrong reason,” with troubling results. While officially prescribed for sexual dysfunction, men of all ages pop the readily available pill to enhance sexual performance or get over the jitters. But some critics say that separating out the physical functions of sex from the emotional component hurts both men and women. “We live in a time and culture in which we look for the quick fix,” said Dr. Abraham Morgentaler, author of The Viagra Myth: The Surprising Impact on Love and Relationships. Morgentaler maintains that sexual problems in a relationship often reflect other issues—which can fester if the sexual problem is “solved.” Viagra can especially cause problems for older couples.

Why is that?

Our sex drives naturally slow down as we age. When Viagra came on the scene, men in their 60s, 70s, and older who saw the pill as a fountain of youth suddenly began acting like 30-year-olds, asking their wives for sex several times a week, or beginning affairs with younger women. “Some of my friends complain that while their libido is undergoing a natural decline, their husbands’ interest in sex has rebounded due to Viagra,” said Rosalind Brannigan, 58, of Arlington, Va. “It creates a disparity of intentions and expectations.” In fact, Viagra has become a factor in many divorces; one Manhattan divorce lawyer says it comes up in at least 5 percent of his cases, often because of a “Viagra-fueled” affair by the husband.

So has Viagra done more harm than good?

That would be a difficult case to make to millions of satisfied customers, such as Alfred and Cheryl Pariser of Rancho Mirage, Calif. After prostate surgery several years ago, Alfred lost his ability to sustain an erection. Now in his mid-60s and taking Viagra, Alfred says he has sex “as often as my wife wants.” Chimes in Cheryl: “Thank you, God, for Viagra.” Despite its popularity, though, Viagra is still subject to many misconceptions.

What sorts of misconceptions?

First, Viagra is not an aphrodisiac. In other words, it cannot cause an erection in the absence of actual sexual desire and stimulation. Also, Viagra is not a cure for erectile dysfunction but rather a treatment for a symptom; eliminating a symptom is not the same thing as treating the underlying cause, whether physical or psychological. And while there have been countless jokes about one of Viagra’s potential side effects—an erection that can last four hours or more—doctors say that is no laughing matter. While such long-lasting erections are rare, they can be painful and can cause permanent damage to blood vessels and tissue. Fortunately, in most cases, a simple ice pack will make the swelling go down.

Young men and Viagra

Playboy’s Hugh Hefner once referred to Viagra as the world’s “best legal recreational drug,” and it’s clear that many users think of Viagra that way. This has given rise to a phenomenon that has alarmed health officials and law-enforcement authorities alike. Starting a few years ago, reports began surfacing that gay and straight clubgoers in New York, Boston, and other cities were using Viagra in combination with alcohol and so-called club drugs such as Ecstasy—a drug combo that became known as “Sextasy.” Ecstasy may make people feel sexy, but it also curtails a man’s ability to have an erection. Viagra takes care of that problem—but as a result it allows men with loosened inhibitions to have ill-advised or unsafe sex. Under pressure from public-health advocates, Pfizer has added a label on Viagra warning that it “does not protect against sexually transmitted diseases, including HIV.” But critics still complain that Pfizer’s advertisements subtly push recreational, as opposed to clinical, use of Viagra. In one ad that ran before the Super Bowl last year, a man in his 40s smiles at the camera to the tag line: “Be this Sunday’s MVP.”