It has been six months since Pfizer pharmaceuticals unleashed its wonder drug to combat erectile dysfunction on an unsuspecting – albeit receptive – public. Since then, the news has been awash in stories of the sales records being set (4.3 million prescriptions in its first week), the gushings of satisfied users, the lamentations of besieged doctors, the black markets for the pill that are thriving overseas (it’s reportedly selling for $100 a pop in Kuwait), and the ongoing battle over whether insurers will cover the drug. (Some will. Some won’t. Some will pay for only four or six or eight pills per month.) Even reports of several dozen potentially Viagra-related deaths – many occurring during or just after sex – have done little to dampen demand. Thus far, only la femme Monica has generated more buzz this year.
At the heart of all this sound and fury lies a fundamental truth: Men are obsessed with their penises. They fret about size, frequency of use, and most certainly – how do I put this delicately? – whether all systems are go. Now, erectile dysfunction is a very real problem. (The term “impotent” is thankfully going the way of the equally enlightened “barren.”) Diabetes, prostate cancer, injury – any number of unfortunate events can deprive a man of his ability to perform sexually. And for a gender so wrapped up in its genitalia, the impact on one’s psyche can be devastating. The collective pain of men concerning this issue is so sorely felt – as is the jubilation over Pfizer’s pharmacological miracle – that Alan Greenberg, chairman of Bear Stearns, recently donated $1 million to finance Viagra prescriptions for needy brethren.
The furor over Viagra, however, goes way beyond the quest to correct a physical ailment. Doctors report that many Viagra supplicants don’t technically suffer from erectile dysfunction, but hope to “enhance” their sexual experiences, to increase the number of times they can have intercourse, to, as more than one senior gentleman has crowed, “feel like [they’re] 18-years-old again.”
Make no mistake: Women like sex too. Whether you credit (or blame) feminism, birth control, or the decline of American morals, the typical female view of sex in this country is a far cry from the Victorian attitude of “shut your eyes and think of England.” But to screw or not to screw is often a complicated question for women, tangled up with a variety of related, even contradictory, issues – guilt, independence, intimacy, pregnancy, health, love, commitment. For men, the equation tends to be much simpler: More is better. At the risk of stereotyping, the male gender too often views sex as the end-all be-all of human existence and the ultimate gauge of one’s status as A Man. (As such, it’s hardly shocking that even the most conservative survey findings show that one in four married men admit to having cheated on their wives.) As one TV comedian put it: The difference in the way men and women think about sex is like the difference between shooting a bullet and throwing it.
Panic-stricken by the tsunami of demand for Viagra, many insurance companies plan to cover the drug only for serious sufferers of erectile dysfunction. But trying to sort recreational Viagrans from the truly Viagra needy may prove an exercise in futility. The current definition of and statistics on ED are vague – and somewhat misleading. Because of the sensitive nature of the condition, accurate figures on its prevalence are hard to come by. In pre-Viagra America, only an estimated 18 million men were receiving treatment for the disorder. According to the best estimates of the National Institutes of Health, however, somewhere between 10 and 20 million American men actually suffer from erectile dysfunction, defined as “the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.” Toss in men plagued by “partial erectile dysfuntion,” and the number creeps closer to 30 million – nearly one-quarter of all men in this country. With these kind of figures being bandied about, who could blame the public for fearing that ED has, as one business publication put it, become “a national epidemic”?
Upon closer examination, however, the numbers prove specious at best. First off, which is it: 10 million or 20 million ED sufferers? We’re talking about a potential difference here equal to the total populations of New York and Chicago combined. Also, the phrase “sufficient for satisfactory sexual performance” injects considerable wiggle room into the equation. Does this mean unable to have sex at all? Unable to have sex as hot as the sex you enjoyed as a teenager? [talk to Dr. Goldstein] In the landmark Massachusetts Male Aging Study, 52 percent of men ages 40 to 70 were characterized as experiencing erectile dysfunction. But only 10 percent actually could not achieve erection. The other 42 percent had problems sufficient to interfere with normal sex. [normal?] And what about the additional 10 million men suffering “partial” ED? Can they have a “satisfactory” experience only once a week? Once a month? One middle-aged victim of partial ED told Newsweek that he started taking Viagra because, although he could achieve erections, he felt that they “should have been stronger and much longer-lasting.” Thus, it appears our national ED “epidemic” is a product not only of men’s medical malfunctions, but also of their high expectations.
But here’s the real kicker: According to NIH, the majority of men suffering from “erectile dysfunction” are age 65 or older. (Here we must tread carefully to avoid accusations of agism.) Certainly, there is no upper age limit on sex. With the average lifespan now hovering around 76, it’s nice to think that we’ll all be shagging away well into our golden years. But as people grow older, they slow down physically. Certain things simply do not work as well as they did in years gone by: eyes, ears, knees, kidneys, lungs. (Already I must face the fact that my metabolism no longer permits me to eat gallons of ice cream with impunity.) In recent years, healthier lifestyles and medical advances have slowed this physical disintegration, while cosmetic surgery, Propecia, Rogaine, and Retin-A help mask the outward signs of aging. Nonetheless, you can get face lifts until your tear ducts stop working and your cheeks are stretched as taut as a trampoline; it does not change the fact that your skin is aging. The same is true of the human reproductive system, and on a certain level we recognize this. How often do you hear the millions of women over 65 who can no longer have children characterized as suffering from “fertility dysfunction”? Never. The female reproductive system has a limited shelf life. Sometime around age 50 – or 55 or 60 – women run headlong into “the change.” Our estrogen level shoots through the floor, we suffer hot flashes and some truly spectacular mood swings, and we lose the capacity to bear children. There is nothing dysfunctional about the process. It is not a disease to be treated. It is the reality of growing older. And in the spirit of fair play, the same holds true for men. By lumping the sexual difficulties of 70-year-old men together with those of 35-year-olds, our youth-worshipping culture is merely trying to deny a fundamental reality: Parts wear out – especially moving parts.
There is a certain dispassionate logic at work in nature, and if we wanted to be particularly harsh about the millions of seniors facing “erectile dysfunction,” we could argue that nature did not intend for men to continue sowing their seed well into old age. From a purely Darwinian perspective, nature’s idea of the ideal father is most likely not a 75-year-old who, odds are, won’t be around to see his newborn son enter junior high. The fact that some men can sire children in their old age does not mean that all men were intended to do so.
Applying Darwinian logic to human beings, however, seems simplistic. Overcoming the limitations with which nature has attempted to saddle us is what drives our species. (Besides, if there’s one thing modern man has tried to do – much to the distress of the Catholic Church – it is separate sex from procreation.) In fact, Viagra is simply the latest step in the medicalization of nature in this country: our growing tendency to treat any less-than-desirable characteristic as a medical disorder to be eradicated. It’s not just that we don’t want to grow old; it’s that we are increasingly intolerant of any abnormalities, inconsistencies, or even annoying personality traits in our citizenry. Twenty years ago, elementary school children were expected to be a bit hyperactive (at least in the eyes of adults). Today, fidgety kids are labeled ADD and dosed with Ritalin until they can sit still in math class. Ten years ago, moodiness was understood to be a part of adolescence. Today, we have Prozac for teens (as well as for every actor, writer, stock broker, teacher, and housewife who thinks his or her temperament should be more even-keeled.) Forget genetic engineering, the drug companies are already working to create the “perfect” human specimen. Yes, as with Viagra, some people would be lost without such medications. But we seem to be rapidly blurring the line separating “disorders” from physical imperfections, personality quirks, and garden variety aging.
Abstract philosophical concerns aside, getting millions of older men revved up to reenter the wonderful world of intercourse presents some decidedly practical dangers. On the most basic level, there is the question of physical strain. Just as the 75-year-old penis isn’t what it used to be, neither is the 75-year-old heart. Popping a pill to rejuvenate the former does nothing to shore up the latter. And while doctors can lecture about the hazards of mixing meds (the combination of Viagra with some nitrate-based medications has proved fatal) and of overexerting oneself (a person’s heart rate and adrenaline level jump dramatically during sex), more than a few men will allow the prospect of “getting some” to override their common sense.
Then there are the less tangible side effects of Viagra fever. As noted earlier, men place too much importance on their sexual equipment. (Perhaps 30 seconds after Viagra hit the stores, jokes started flying about how – had women been in charge of R&D at Pfizer – the company would have developed a pill to make men more sensitive, better listeners, less afraid of commitment, more conscientious about putting the toilet seat down, and so on.) When the demanding little organ starts slowing down due to age, many men are forced to focus on other aspects of sex: intimacy, romance, foreplay. Couples gradually adjust to a physical life not centered around intercourse and discover other ways to express affection. What will the return of the raging phallus mean for these men’s lovers? Some women will be thrilled; others may find themselves confronted by a 70-year-old Romeo who can’t understand why his 70-year-old Juliet doesn’t want to go at it again tonight. (Still other women might be thrilled if they could just stop worrying that Hubby was about to suffer a coital coronary.)
In the worst case scenario, our rejuvenated Romeos, their revivified manhood not properly appreciated at home, will go in search of newer-model Juliets. Already the allegations are flying. This May, a 63-year-old Long Island woman sued her 70-year-old common law husband for $2 million, claiming that, upon obtaining a Viagra prescription, the man had promptly started running around with another woman. Likewise, a 67-year-old Florida man recently shared with The New York Times the role Viagra played in his decision to leave his wife of 46 years and move in with a woman half his age. It was his renewed sexual prowess, the man explained, that “gave him the confidence to see other women.”
One gets the uneasy feeling that such stories will not prove isolated incidents. For decades, a not insubstantial number of older men – especially successful older men – have considered a hot young babe to be the ultimate reward for their years of hard work. Thus, the new, younger girlfriend or trophy wife has become a depressingly cliched symbol of the male mid-life crisis. (As one sanguine 73-year-old remarked to The New York Times: “What [Viagra users] need is not a pill but an 18-year-old girl.”) What if the nation’s “epidemic” of erectile dysfunction is all that has thus far prevented hordes of senior and middle-aged men from trying to charm impressionable young law clerks and interns out of their pantyhose? Just six months into the Viagra revolution, who knows how many rejuvenated Don Juans have begun eyeing their honey-limbed administrative assistants? Granted, we’re not likely to see randy seniors flooding the divorce courts in coming months – or confront a geriatric version of the 1960s’ free-love movement. Still, Viagra’s potential contribution to the breakdown of the American family should keep the social conservatives up at night.
At least one Viagra defender has argued that claiming the drug will encourage older men to cheat is tantamount to claiming that giving teenagers condoms will encourage them to have sex. There are, however, a couple of basic flaws in this argument: 1.) Providing teenage Lotharios access to condoms, while perhaps giving them a sense of readiness, does not instill in them a heightened sense of virility. Teenage boys can “be a man” with or without a condom. The message of Viagra is that it can give older men back the lost manhood of their youth. Considering the aforementioned link between a man’s self-worth and his sexual equipment, this is a dangerous promise to be peddling. 2. Teenage boys are already obsessed with sex 24 hours a day, seven days a week. Their hormones are raging. They get excited when the wind blows. The same is generally not true for more mature gentlemen – at least, not to the same degree. Clinically speaking, a 60-year-old man’s hormones are not raging. While sex is still a glorious thing, older men are occasionally able to focus on other matters. Viagra helps move that focus back down below the belt.
Which brings us to perhaps the most disturbing potential impact of Viagra: Even allowing that existing demand for the drug was substantial, once a product hits the marketplace, the buzz it generates – aided by the marketing efforts of its manufacturer – creates even more demand. In this country, we use sex to up the demand for blue jeans, beer, shampoo, cars, and breakfast cereal. It won’t take any advertising genius for Pfizer to sell sex itself to the American public.
And as the hysteria over Viagra grows, it reinforces the notion that, if a man isn’t the sex machine he was in days gone by, he has clearly lost his joie de vivre. Thus, our society – with a little help from Madison Avenue – continues to manufacture need, raising the bar for what is “normal” ever higher.