Better than talking?

by Kate Steadman

Consider these staggering statistics: Nine tablets of Viagra are dispensed every second worldwide. Pfizer sold $850 million worth of the "little blue pill" in the first half of this year, with 16 million prescriptions written since 1998 — not including the many men obtaining the drug illegally.

More than a pharmaceutical to treat erectile dysfunction (ED), Viagra is a phenomenon. That's because the ill it cures is serious, at least to those in its grip. Men who suffer from ED experience significant problems in their relationships, self-esteem and quality of life. Viagra provides relief by increasing "blood flow to the penis, so that when a man is sexually excited, he can get and keep an erection," according to www.viagra.com. Few people seem to worry about the perils of Viagra — namely, when it is easily available illegally, taken for reasons other than ED and combined with other drugs. But I am. Our culture has established a normative sexual identity for men: that of the penetrator. If a man loses his ability to achieve or sustain an erection, and thus his ability to penetrate, he forfeits his masculinity. And while this role creates unreasonable expectations and can foster poor selfimage, the misuse of Viagra only serves to reinforce it. A recent study in Social Science and Medicine involved New Zealand men who had taken Viagra and women whose partners had. Many participants expressed concern that they (or their partner) were becoming psychologically dependent on Viagra. One woman confessed, "He's addicted to it ... we won't have sex unless he's had the pill.... There were problems in our marriage because of erectile dysfunction beforehand ... but the problems became much bigger when he started using Viagra." Some couples think their problems will disappear with Viagra. A young man clearly illustrated its misuse in a recent New York Times article by David Kirby. "My ex-girlfriend used to be very creative and experimental in bed, and I never considered Viagra, but my new partner wanted a more traditional, missionary-position approach, and I found it less exciting and a little harder to perform." For some couples, Viagra is replacing communication.

The New Zealand study also illustrates a frustrating situation many older women are experiencing: a mismatch between their partners' newfound virility and their own. One woman noted: "Up until Viagra . . . nature took care of it and men's ability went down equally with women getting older, losing the same desire that they had when they were young women ... I think Viagra has made a lot of people feel inadequate ... everybody's on the defense about how often they have sex and so on, in the older agegroup."

Another participant, an older man, admitted his renewed abilities make him want to experiment: "[I] was keen to explore its parameters...," alluding that he was cheating on his wife, with whom sex was "ho-hum." Many women also admitted to feeling pressure not to waste the pill, often resulting in a disappointing encounter incited by a pharmaceutical rather than sexual attraction.

The consequences of recreational Viagra use prove scarier. The New York Times article examined the use of Viagra along with dangerous drugs like cocaine, crystal meth and ecstasy among young men. Many drugs greatly increase the libido, but the physical effects make it difficult to achieve and sustain an erection. As a result, men are turning to Viagra to help them have sex while using these other drugs. Studies have not examined the combination of Viagra with illegal substances. But because one of the main pathways affected by Viagra is circulation, one can imagine the potentially disastrous effects on the heart.

I can't say that I have direct experience with Viagra, or with cocaine, crystal meth or ecstasy. But like most people my age, I know people who use illegal drugs and abuse prescription drugs for purposes that are both recreational (what happens if I snort this?) and educational (I can't stay awake to study without this). I know people who smoke valium on top of their marijuana. And I probably know men who abuse Viagra —or have the potential to. I dated someone who had difficulty getting an erection. His problem was emotional rather than physical: he was new to sex and nervous. I suspect that if he had reacted by getting hold of Viagra, it could have led to a lifelong dependency, which I truly believe would have damaged his sexual experiences. Another friend was sexually incapacitated for two years after some teenage performance anxiety destroyed his confidence. He found his fix in communication and openness with a long-term girlfriend, and hasn't had a problem since. "I often thought of using Viagra," he recently told me, but "I'm glad now that 1 didn't. In the long run, I would have been much worse off because I'd never have been forced to face and fix the root of my dysfunction."

I also fear an increase of acquaintance rape in connection with Viagra abuse. The combination of a man going to a party, drinking a lot and/or taking drugs, popping a Viagra as "insurance" and being primed for an erection for up to four hours seems like an equation for sexual assault. I've been lucky, as a college student, to attend many rape education workshops where I have learned strategies for avoiding acquaintance rape: always go to parties with at least one friend, keep your drink with you at all times, never go upstairs alone with an intoxicated — or barely known —man, and latch onto women who seem to be alone and /or intoxicated.

If our partners are considering taking Viagra, we must be sure it's for the right reason: to disable ED caused by physical problems. It should never be an easy fix for our relationship problems or a party drug. We should consider pharmaceutical alternatives such as Cialis, which can alleviate the pressure to have sex when not aroused, as it acts quickly and can be taken when a sexual encounter is initiated. And we should advocate for other women, particularly those who are at risk.

Kate Steadman, a NWHN intern in the summer 0/2004, is a senior at the University of California at Santa Cruz majoring in sociology. She plans to attend medical or osteopathic school to work in pediatrics or family practice.