Viagra revolution!!!

How the emergence of Viagra, the world’s first oral treatment for impotence revolutionized therapy for a sensitive problem and contributed to a growing pharmaceutically based culture where “instant cures” are as far away as your medicine cabinet..

The Discovery

Most great discoveries seem to have one thing in common: They start out innocently enough – and quite accidentally. At least that’s what the “legend” says. Researchers working on a solution to relieve angina pain with a drug call sildenifil citrate realized that it just wasn’t working. They packed up their statistics and called off the clinical trials. Chalk this one up to trial and error, they thought. Then one astute scientist noticed a side effect reported by a significant number of men: a more satisfying performance in bed.

The researchers scratched their heads and returned to the project. Certainly sildenifil citrate didn’t work on the original angina problem, but what if … no, the possibility couldn’t even be considered. But then again … maybe it could.

Sildenifil citrate, tests would bear out, did indeed seem to be that “magic pill”…. that Holy Grail for men with impotence. The unexpected – and from Pfizer’s viewpoint extremely lucrative – benefit from this drug was that it allowed men with impotence problems to perform successfully and satisfyingly in the bedroom again. Sildenifil citrate, which works by trapping the blood in the penis, it appeared, even positively affected men whose erectile dysfunction stemmed from psychological problems. The statistics were overwhelming. This medication worked for up to 72 percent of the men who tried it, regardless of the origins of their problems. It just didn’t matter, the researchers discovered, whether the cause was psychological or based on an underlying medical problem, like diabetes or cardiovascular disease.

After several years of clinical trials aimed specifically at treating impotence, Pfizer had a winner. The U.S. Food and Drug Administration approved sildenifil citrate – brand name Viagra – for the U.S. Market, March 27, 1998.

Viagra Sildenafil represents the first successful non-surgical, non-surgical treatment for impotence ever. It, indeed, represented a revolution in the treatment of male sexuality and changed forever the way men – and by necessity – their partners viewed sex.

Not much more than 40 years ago, medical school training taught would-be doctors that the cause of impotence – and yes, it was called impotence then – was all psychologically based. In other words, a man’s failure to sustain a satisfying erection was all in his head.

In fact, the 1966 edition of General Urology, a textbook used in medical schools, gave this explanation for impotence: “Various degrees of impotence in men are common, but it is rare to find definite organic cause for the complaints …The cause of almost all of these difficulties is psychogenic.”

In fact, men’s impotence wasn’t really his fault at all… it was his wife’s.

“With few exceptions,” the text continued, “the causes of sexual difficulties in the male are psychic, i.e., based on guilt, anxiety, jealousy, or frigidity on the part of the wife. Many of these men are obviously tense and nervous… Unless the patient’s difficulties are of short duration, he should be referred to a psychiatrist.”[1]

A 180-Degree Turn

Wow! What a complete turnaround in thinking in a little more than a generation. Today, with the appearance of Viagra and other prescription drugs that followed, virtually all impotence problems can be successfully treated [2]. At least, the symptoms can be successfully treated. And it certainly has given millions of men back their sense of masculinity. But, has Viagra and other drugs to treat impotence raised more questions than it answers?

Many experts think that is exactly the case. Today, more than ever, American culture proclaims a “quick fix” is absolutely necessary. And that is exactly what Viagra and similar medications give them. Viagra gives new meaning to the proverbial doctor’s phrase, “Take two and call me in the morning.”

Critics claim, though, that while Viagra may be making Supermen out of Underdogs, it is only reinforcing a culture that already relies too heavily on medications that can quickly solve any medical problem around. Can’t perform in bed? Take this pill; you’ll have the most powerful erections of your life. Never mind that your wife didn’t have a problem with your bedroom performance before this. Never mind that there just might be serious, unspoken problems, in your marriage that need to be dealt with. And, yes … don’t worry about the potential side effects which have included blindness and possibly death.
The pharmaceutical industry, intentionally or not, has finally reduced lovemaking to sexual performance. In fact, Meika Loe, author of The Rise of Viagra: How the Little Blue Pill Changed Sex in America, argues that with the appearance of Viagra, the medical community has effectively “McDonaldized” lovemaking. Pfizer did to sex, what McDonald’s did to food. Society now wants it fast, hot and
supersized. [3]

It is just one more step toward being able to “fix” any problem – including aging – with drugs. Pfizer – either intentionally or unwittingly – has turned the most intimate act between a man and woman into a performance-based sport, somewhat akin to hitting a homerun in baseball, or making a touchdown in football.

Some men view Viagra as a “magic cure,” explains Arleen Goldman, author of Secrets of Sexual Ecstasy. This makes them less likely to work on other, potentially more intricate solutions, to the problem. It also makes them less likely to deal with any underlying emotional problems in the bedroom. [4]

Viagra is only one example, albeit the most publicized, of how Americans are craving a quick fix to their problems – and their perceived problems. For more than a generation now, the American culture has reinforced the idea that life can be better … if only you take more medications. In the early 1950s, it was the advent of penicillin, the wonder antibiotic that every child received (in the form of a shot) when taken to the doctor for any reason. The flower child of the 1960s and 1970s experimented with a myriad of designer drugs – most notably LSD – and tried to “drop out of society”. Although the older generation condemned this blatant drug abuse, they were busy visiting doctors who doled out Valium and other sedatives to housewives who failed to cope with their lot in lives. Is it any wonder that the “cure” for poor performance in bed was a prescription pill, whose sales are fueled by the recent ability of the pharmaceutical industry to advertise directly to the consumer through television commercials and print ads?

The Public’s General Perception of Viagra

“For the millions of men who want to make love and can’t, we are about to make your night.” Those were the words of Hugh Downs, broadcast journalist, announcing the FDA landmark approval of Viagra.[5]

Since that night, millions of men visited their doctors to get a prescription for this little blue pill. The response of men to the first non-surgical, non-injectable treatment for impotence made Viagra the most successful drug release in history. Talk about a market for a product!

However, the approval of Viagra did more than revolutionize the way medicine treated a condition once thought nearly untreatable. It revolutionized how a nation, indeed, the world, viewed the problem of impotence (albeit now referred to as erectile dysfunction). No longer was it only spoken of behind closed doors. Viagra swung the doors wide open. Former presidential candidate, Sen. Bob Dole spoke about his own erectile dysfunction in nationwide advertisements, NASCAR driver Mark Martin raced around in front of hundreds of thousands of race fans every week with Viagra painted on his car,

Men who had nearly forgotten what satisfying sex felt like were once again enjoying the bedroom experience. The entire nation greeted the pill with an awed reverence. Science had broken through the last barrier, it seemed. Not since the FDA approved the birth control pill in 1960 did America feel so liberated sexually. Women called their family physicians to make appointments for their husbands. Men created excuses to see their doctors so they could mention their desire for a prescription.

If sales of the little blue pill, as it has been dubbed, are any indication, the initial perception by the public was overwhelmingly favorable. Pfizer’s sales in the United States for 1998 for Viagra topped $656 million. Considering that Viagra wasn’t approved until the end of March, those figures are pretty impressive. Soon after approval was received in this country, many western European countries also approved use of the medication, including France, Switzerland, France, the United Kingdom and Germany. Other nations worldwide that approved the sale of the drug included Brazil, Israel, and Australia.

Viagra: Changing the Lives of Men and the Women Who Love Them

Men, who may not have approached a doctor prior to this about their impotence, now were knocking at the office door in record numbers. And that, it seems, is a good thing, at least in some cases. One gentleman, a management consultant in California who was among the initial 1,500 men who took part in the original clinical trials for Viagra, praises the pill for transforming his marriage and in particular his love life. He scoffs at the notion that lovemaking, fueled by Viagra, is less romantic and more performance oriented. He lived with erectile dysfunction following surgery for prostate cancer more than a decade prior to his participation in the clinical trials. “What definitely isn’t romantic,” he says, “is not being able to experience sexual intimacy ever, which is where I’d be if this [prostate surgery] had happened to me 20 years ago.”

“One of the biggest myths,” he explained, “is that men are taking these medications only to have sex with younger women. I love and desire my wife … And I certainly wasn’t ready to stop having sex in my 50s.”[6]

And, indeed, for many married couples nationwide Viagra became the lifeline that saved a marriage. Sex, for many, became more intimate, just as the gentleman in the clinical trial said. Couples, in many instances, became more communicative. These were the ones who were able to “turn foreplay into a home run,” according to the co-directors of the Network for Excellence in Woman’s Sexual Health, Drs. Laura and Jennifer Berman.[7]

These doctors, while recognizing the down side of Viagra, also are able to view its full potential as one tool in a series of events to help married couples in the bedroom. “What is crucial,” the doctors, who happen to be sisters, write, “is that we address the psychological and educational aspects about how to effectively incorporate the regained erectile potential into a broader and relational context.”

In other words, Viagra is a great start, but it’s not the end-all of sexual therapy. Sex, they caution, is not performance oriented, but satisfaction oriented. “Men who are being sent home with Viagra,” they explain, “are given instructions on how and when to take it …” And that, they contend, is only a partial prescription for sexual fulfillment. These men are not being told “what to do once it works.”[8]

But for every success story, there exists a story of a failed marriage or infidelity. Soon reports were appearing in newspapers and news magazines of “Viagra divorces.” Men, with their new-found sexual powers and a brazen self confidence, were dumping their wives for younger, sexier and presumably more sexually active women.

Consider these cases, gleaned from newspaper articles across the nation following the introduction of Viagra to the American public:

A 70-year-old New York man started cheating on his wife, age 61, only two days into taking his new Viagra prescription, according to USA Today.

A wife sued her husband after he spiked her drink with Viagra in an attempt to improve their sex life.

The underlying problem, many sex therapists say, is that in many cases, women may have problems adjusting to their husband’s new found sexual prowess. “One of the things that people have forgotten about Viagra,” explains Julia Cole, a sex therapist with the relationship counseling service, Relate, “is that it can’t change the attitude of the man or the pattern of lovemaking the couple have previously had.” That means while the man, armed with his Viagra prescription, is now suddenly ready to spend the entire evening in bed, it may come as an unexpected change for a wife accustomed to a marriage practically void of lovemaking.[9]

Viagra to the Rescue: Will You Still Love Me When I’m … 84?

“Is it not strange that desire should so many years outlive performance?”
–Shakespeare, Henry IV, Act 2, Scene 4

Perhaps it was strange to the great bard, Shakespeare, that desire should outlive performance. But today thanks to Viagra and other sexual enhancement prescription drugs, that no longer needs to be the case. Desire and performance can now be maintained at the same level.

Many experts thought it would be boon to the older married population, something akin to discovering the fountain of youth. And at first it appeared that Viagra just might be that. But it didn’t take long for negative reports to start flooding the news. Here again, Viagra presented complications into relationships that many times were comfortable with the status quo. One partner suddenly discovers a new-found power and the other is not quite sure how to handle it.[10]

And the consequences with older couples can be even more dramatic. With many younger married couples, it is assumed that only the man has the impotence problem. However, with elderly couples, it very well could be that both the husband and the wife experience some type of sexual dysfunction. For many post-menopausal women a reduced sexual drive and inhibited performance in the form of dryness and pain are part of the aging process.

Enter a husband, fresh from the doctor’s office, with a bottle of Viagra in hand. Popping one into his mouth, this husband believing, he is saving their marriage, is ready for sex within an hour or so. However, his wife’s physical problems are not solved. She is not so receptive. Even her libido may be under active and has really no physical urge for sex. The pair may have been relatively happy this way, adjusting to a new-found life without sex and compensating in other areas of their relationship. Suddenly sex is foisted upon her. Tensions form.

There were reports of older couples breaking up because the 84-year-old man was acting like a 25-year-old kid again, and his 80-year-old wife was acting … well, like an 80-year-old woman.

For a drug that supposedly was to put the spark back in a couple’s love life, it sure caused quite a few marriages to extinguish.

And now, a word from a certified expert on sex …

The internet abounds with message boards dedicated to men drooling over their new-found ability to make love, longer and harder. They brag in both polite and downright graphic terms about how they are able to satisfy not only their partners, but themselves. These men – average American males who had for whatever reason been unable to assert their masculinity – are now announcing to the world (granted under screen names that are not likely to reveal their real identity) their great love for Viagra. Their girlfriends, wives, lovers, they say, are also extremely satisfied with the results.[11]

Gary Schubach, Ed.D., A.C.S., an internationally known sex educator, lecturer, writer and group facilitator, decided the only way to truly understand the changes men experienced with Viagra was to take it himself. So he trudged off to his physician, who realized, by the way, Schubach’s occupation of sexologist, and received a prescription for Viagra.

Now, Schubach’s wife, Shama, also happens to be his partner in sex therapy. She has more than 10 years of experience as a hynotherapist and chemical dependency counselor in addition to her sex counseling experience. Schubach did not tell Shama he had received the prescription. He wanted her unbiased reaction. Would there be a difference in his performance with the medication?

Schubach used the medication upon Shama’s arrival home from an extended business trip. He explains, in the couple’s on line article, “The Easy Erection: Penile Panacea?”, that Shama had come home Friday night, they had made love. The counselor popped the little blue pill Saturday morning. The stage was set for a “before and after” test.

“Over the course of the day,” Schubach writes, “we made love several times, taking breaks to eat and deal with life.” Among his comments, he notes: “I was pleased to find that the effect of the drug felt very natural.”

He continued: “Not having to be concerned about losing an erection took a lot of pressure off of me. It allowed me to do a number of things during intercourse …that I could not have done without Viagra.”

The end result from Schubach’s point of view: An increased sense of pleasure and intimacy.

And Shama’s evaluation after being told of the “test”? “In retrospect, I think that because his erection was so strong, I felt it actually took some of the pressure off of me to help maintain a certain level of arousal between us.”

However successful this initial trial run of Viagra was, Part II of their test was less than memorable, Shama explains. The following day Sunday, was a long and hectic day, which included the hosting of a dinner party. Schubach took another 50 mg of Viagra. The results this time were different.

“Even though … [I was] stimulated and my desire was there, my erectile response was minimal.” Schubach said that this only confirmed his suspicion that men find great success in the product the first time they use it, but may encounter difficulties if they are tired or if there are more problems present in the relationship than just impotence.[12]

Viagra for Women?

The wild success of Viagra prompted pharmaceutical companies worldwide to search for an easy “cure” for women’s sexual problems … a Viagra for women as it were.

Women in search of a solution to their problems though are waiting. Some, inspired by their partners’ success, used Viagra to test what sexual effect, if any, it had on them. And since Viagra works by inducing blood flow to the genital area and trapping it, some females found it improved their arousal and increased lubrication.

In fact, Shama, whose husband Gary Schubach used Viagra to test its effect, experimented with it herself. “When Gary and I made love this time [while I was using Viagra], I noticed a marked increase in sensitivity in my genitals which did heighten my pleasure.”13

However, these isolated incidents have not been translated into any effective medication. The problem is that Female Sexual Dysfunction (FSD) is not a disease … and therefore not easily treated with a magic bullet. FSD is a label physicians and other health professionals use to describe a syndrome – or a set of symptoms – which includes loss of libido or desire, decreased sexual arousal, lack of orgasm, pain during sex and lubrications problems.

Forty three percent of women ages 18 to 59 suffer from some type of FSD. At least, that’s the results of a 1999 national survey published in the Journal of the American Medical Association. FSD occurs most frequently in premenopausal women ages 18 to 50.14

As with male erectile dysfunction, medical experts initially believed that FSD origins lie purely within the realm of psychological conditions. However, professional opinion is now shifting on this. They now believe some sexual issues stem from physical or organic origins.[15]

“Pharmaceutical products that could treat FSD could be a significant medical advance.” These are the words of Leland Wilson, president and CEO of Vivus, Inc., a California based company specializing in products to “improve the quality of life for men and women with a focus on sexual dysfunction.” His company is testing a topical medicated cream called Alista. This cream is aimed at helping women overcome problems with arousal. Alista’s active ingredient is alprostadil, a synthetic version of a naturally occurring vasodilating agent of the body.[16]

Industry giant Proctor & Gamble is examining the role testosterone plays in the female during the sex. It hopes to market a testosterone patch. Low levels of this hormone, typically associated with men, plays a role in a lowered sexual desire in women. Some gynecologists are already prescribing this male hormone for their patients who suffer from decreased desire.

Pfizer, buoyed by its profitable development and marketing of Viagra, spent nearly a decade looking for a Viagra equivalent for women. Finally in February 2004, the company abandoned the project. The pharmaceutical researchers discovered what every woman probably could have told them from the start: Women do not have the same relationship between sexual arousal and desire that men do.

In men, arousal almost always leads to desire. Viagra works on men because it improves his ability to have an erection and in turn affects his sexual function. But in women arousal and desire are not as intricately intertwined.

“Men consistently get erections in the presence of naked women and want to have sex. With women, things depend on a myriad of factors,” explains Dr. Mitra Boolel,, a leading member of Pfizer’s sex research team. So, instead of focusing on Viagra, Dr. Boolel and his team are changing their focus from a Viagra-like medication that would affect blood flow to the crucial sexual organ of women, the brain. 17

Viagra in American culture … where does it all lead?

In less than ten years, Viagra has become a household word. You would be hard pressed to find a person who hasn’t heard about the drug or what it does. It’s been the subject of jokes, ridicule and praise. In fact, it’s been so commonplace, that up until June 2005 Medicaid paid for Viagra prescriptions.

You can thank the power of direct-to-consumer advertising of prescription drugs for a large dose of that recognition. And if trends are any indication, you’re bound to see a lot more of it for medications that are now being classified as “smart” drugs. These are drugs that affect your “quality of life” more than your physical well-being. Basically, it can be described as drug use by otherwise healthy individuals whose sole desire for the medication is to manipulate mood, memory or perhaps concentration. It’s already a phenomenon on many college campuses, with students asking the campus doctors for a prescription for Ritalin so they can stay up late and study.18

Scientists are learning more about the brain everyday and it’s not unreasonable to assume that the past success of direct-to-consumer advertising will join forces with the nation’s desire to perform better – not just in bed – but on the job and in school as well.

There exists a trend – the pros and cons of which are being argued in scientific circles – of branding such normal mood swings .. depression, sadness, anxiety and the like .. as medical disorders. Combine this trend with the track rate of the direct-to-consumer advertising of drugs and you’ve just created a market that otherwise has not existed in the past.

If you tell someone often enough and long enough that his occasional sadness is a serious condition that needs medicating, he’s bound to believe you. His next step is to go to his doctor and tell him about his symptoms. He’ll even mention he saw an ad on television for a medication that might help him. What do you think, doc?

And the doctor, through no fault of his own, is busy and believes that if the patient believes the symptoms are serious enough to see a doctor, then perhaps the medication just might work for him. The patient walks out of the doctor’s office with a prescription for a drug he really doesn’t need and the doctor goes on to his next patient.

If taken to extremes, people won’t have to tolerate any type of mood swings or any lack of concentration or any other variation in their personalities. Watch television long enough and you’re bound to hear an advertisement for a condition similar to yours.

After all, up until this point, hasn’t our society told us that we shouldn’t want for anything. Everything we want is at our fingertips. If we don’t have enough money for it, don’t worry, we’ll charge it. Our heart isn’t functioning well? Don’t bother with that pesky exercise and trying to eat properly. Why that takes just way too long. Here’s a pill that can help bring down your cholesterol. After all it isn’t your fault anyway that your cholesterol level is sky high? You inherited that from Aunt Pauline.

And, oh, by the way, are you having a difficult time pleasing your partner and you in bed? Here’s another pill to take care of that. Welcome to Viagra country!