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Doing the Viagra tango


Commentary

Doing the Viagra tango Sex pill as symbol and substance

Leonore tiefer

A

four-page full-colour advertisement for Viagra tablets has appeared in the latest issues of the American Psychologist, the flagship scientific journal of the American Psychological Association (APA). The ad shows a healthy, welldressed couple dancing and smiling into each otherʼs eyes. They seem to be in a public location, maybe a hotel or train station, since they are dancing in front of a curved marble staircase with several blurry figures holding suitcases. The couple are happily absorbed with each other, and the words read, ʻSuccess is one simple step away.… Introducing new Viagra, the simple new step to improve erectile function.ʼ There has never before, to my knowledge, been an ad for a drug, an ad in colour, or a four-page supplement for anything in the American Psychologist. The APA is doing the Viagra tango.

Viagra was approved by the US Food and Drug Administration for prescription to men with ʻerectile dysfunctionʼ on 27 March 1998. In the short time since then, it has become a player and symbol in many ongoing sociocultural and socioeconomic debates, including but not limited to ones focused on sexuality. For example, a front-page article in the 2 August 1998 New York Times began, ʻSeizing upon the celebrity of the male impotency pill Viagra, family planning groups are pressing lawmakers in Congress and the states on a long-ignored demand that employers cover the costs of contraception as a health benefit.ʼ What does Viagra have to do with contraception? Gender politics! If insurance will pay for menʼs sexuality, so the argument goes, it should pay for womenʼs sexuality. Viagraʼs sudden symbolic value as god-sent gift for men may allow American women finally to achieve their long-frustrated demand that health insurance cover the cost of contraceptives.

Viagra, though officially marketed as a treatment for a medical condition, erectile dysfunction, has been seized on by the hyperactive, hypersexual media industry much like that other perfect story, the American presidentʼs sex-life. The media do the Viagra tango in news and features, highbrow and lowbrow. As metaphor, Viagra is coming to signify positive, energetic, strong, and solving of all difficulties, as in ʻViagra-politicianʼ (contrasted with ʻProzac-politicianʼ) and ʻViagrafied old ageʼ. The word-clever are having a field day.

There are many stories to tell about doing the Viagra tango, but let me limit myself to four. The first is about how Viagra the pill, but more importantly, Viagra the symbol, may affect the sexual conduct and experience of women and men in many parts of the world. The second is about how the arrival of Viagra has already changed the practice of scientific sex research and policy in substantial ways. The third is about how Viagra, as shown by the story on contraceptive insurance, will play a role in contemporary political disputes involving gender, sexuality, health care and ageing. And the fourth is about how the celebrity and sexiness of Viagra can enable progressives to get peopleʼs attention for important, but often dry, political and economic discussions. People, it seems, will read anything about Viagra; so read on.

Sexual conduct and experience

There is scant data so far to let us know what impact Viagra has on the sexual lives of individuals. In terms of anecdotes, we are swamped in media and industry-sponsored research hallelujahs, but they are highly selective and untrustworthy. Several months before Viagra was released, I asked a group of sex therapist colleagues to suggest its likely impact. Their fairly predictable speculations focused on who would benefit (ʻolder men in good relationshipsʼ, ʻanxious widowers returning to datingʼ), and who would not (ʻcouples with long-standing erotic avoidance and lack of affectionate touchingʼ, ʻmen whose lack of erection expresses unconscious hostilityʼ, ʻmen whose experience with Viagra will only decrease their own self-esteemʼ). One sex therapist suggested that this last group would suffer the terrors of ʻthe padded-bra syndromeʼ, with fear of disrobing (either admitting use of the drug or having sex without it) maintaining the very insecurity the bra/pill was supposed to eliminate.

Will Viagra, the sexual security blanket, further postpone the emotional maturity allegedly lacking in the baby-boomer generation (or is it old-fashioned to think that some narcissistic wounds are important to maturation)? Will Viagra be most popular in patriarchal cultures where womenʼs sexual bargaining is reduced, men are entitled to use family resources for their sexual pleasure, and potency is the major measure of masculinity? News stories about black markets for Viagra in Kuwait, Egypt, Vietnam, Japan and China support such global speculations.

Some have argued that, like the contraceptive pill, Viagra will simply eliminate a major anxiety associated with heterosexual intercourse, and will free couples to engage in spontaneous, worry-free lovemaking. But will the sexual script of Viagra lovemaking actually be flexible and worry-free, or will Viagra-sex be all about worshipping the penis, since no one spending upwards of $10 to have an erection will ignore it? Will men feel relaxed or worry about fraudulence? In the worst-case scenario, Viagra could cause both men and women to feel resentful and less erotic – women, because the drug eliminates their sense of desirability and sexual efficacy; men, because the pill is just further proof that they are less potent and less masculine than they used to be.

Journalists have applauded Viagra (together with the Clinton–Lewinsky sex scandal) for normalizing discussions of sexuality and sexual problems, but I am not so sure. The extent of public discussion seems limited to the same old repertoire of jokes and bragging, and while the language may be more technical (ʻoral sexʼ and ʻerectionʼ instead of ʻdoing the nastyʼ), it seems that ancient jokes about ʻdirty old menʼ and ʻis that a gun in your pocket or are you glad to see me?ʼ are just being re-circulated. The one exception seems to be that men being treated for prostate cancer, such as former senator and presidential candidate Bob Dole, can publicly admit that they need and use Viagra.

Sex research and policy

Sexuality has been a marginal academic topic throughout the twentieth century, and the USA still lacks any departments of sexuality studies in colleges and universities. Sex researchers are often one of a kind in their institutions. Sex research is chronically underfunded, and sexuality scholars find their publications and congresses ridiculed by colleagues and the media. Following the conservative political shift in the 1980s, sex research became even more unpopular and unfundable since it was associated with ʻpermissive valuesʼ.In this climate, the recent interest of the pharmaceutical industry in funding sex research has understandably been thrilling to many sexologists. It represents security for a research programme (space, graduate students, technical assistance) and reduces nagging from oneʼs university administration (since American academics, especially those in medical schools, are expected nowadays to contribute generously to their departmental budgets).

However, the involvement of the pharmaceutical industry has created substantial conflicts of interest for sex researchers. Under the influence of inter-company competitiveness, collegial relations are severely threatened. ʻProprietary secrecyʼ has suddenly gagged scientists from speaking about industry-ʻownedʼ data because of nondisclosure agreements they have signed in order to obtain funding. I know of one researcher studying the effects of Viagra on women who completed data collection in February 1997 but, as of August 1998, is not yet permitted to discuss the data publicly. The danger of such nondisclosure agreements goes beyond the frustration of researchers to possible harm to the public, since despite Viagra being tested only on men, many doctors are writing prescriptions for women, and the media are irresponsibly speculating about effects on women and publishing unsubstantiated anecdotes.

But Viagraʼs challenges to sex research go beyond ethical conflicts. Pharmaceutical industry funding endorses an essentialist, biomedical model of sexuality that ignores relationality, the social construction of sex, and most sociocultural factors. While no one prevents researchers from pursuing broader sex research or even broader sex research on erection treatments, industry money is only available to those following industry protocols, and that means comparing dysfunction treatments using limited outcome definitions. Mandatory questionnaires ask whether taking the pill affected the hardness of the erection, the frequency of intercourse, and the satisfactoriness of intercourse. Such quantitative research assumes that all men mean the same thing by ʻerectionʼ, ʻintercourseʼ, and even ʻsatisfactionʼ, though much sexological research has shown that terms in questionnaires are interpreted quite diversely. Furthermore, industry-sponsored research wonʼt examine how use of Viagra affects couple power dynamics or the subtle effects on sexual techniques and communication.

In addition to gender politics in contraceptivesʼ insurance coverage, let me indicate a few other current political stories which have seen new life because of Viagra.1. Government pharmaceutical regulation. As of summer 1998, a few dozen well-publicized deaths have been attributed to use of Viagra. The manufacturer claimed coincidence given the drugʼs vast popularity, but consumer health organizations seized the opportunity to publicize their demands for increased government regulation of drug testing, for expanded warnings to consumers about drug sideeffects, and for elimination of computer on-line drug dispensing.2. Insurance coverage for pharmaceuticals. Quite aside from the issue of contraceptives for women, there has been enormous debate over whether and to what extent Viagra itself should be paid for by health insurance. This controversy has offered oceans of publicity to players in health insurance disputes. When Kaiser Permanente, the USAʼs largest health maintenance organization (9.1 million subscribers) announced its refusal to cover Viagra because of cost worries (the pill is wholesaling at about $7 per 100 mg pill), consumer advocates and progressive politicians argued that insurers were like ʻcamels sticking their noses under the tentʼ to see if the public would go along with drug exclusions based on cost.

Additionally, the language used in disputes over Viagra coverage has been examined for its policy implications. For example, when insurance companies rejected Viagra because it is used not only for ʻmedical necessityʼ but also for ʻlifestyle enhancementʼ, disability-rights groups publicized the threat such language poses to their situation, such as the elimination of insurance-reimbursement for wheelchairs. 3. Government regulation of ʻdangerʼ. Viagra has made it possible to discuss publicly what a terrible thing the threat of impotence is. So, for example, in the fight over regulation of cigarette smoking, advocates for raising the legal age for cigarette purchase have recently added ʻthreat of impotencyʼ to the dangers of smoking from which young people must be protected. 4. Right-wing sexual agenda. No topic related to sexuality could possibly escape some connection with homosexuality or other biblical sexual transgressions in the current US atmosphere. An Alabama state representative named Sims recently called a press conference to announce his plan to introduce legislation ʻbanning doctors from prescribing the impotence drug for anyone known to have a sexually transmitted diseaseʼ. This coded threat allowed Representative Sims to remind voters that he is opposed to anything that might increase the predatory capacities of HIV-positive homo-sexuals (or unfaithful heterosexuals).

Viagraʼs sexiness and celebrity can be used to hold the publicʼs attention for education about global economics. The public is interested, for example, in the cost of the miracle drug, and might learn how inflated drug costs are connected to huge advertising and marketing budgets. A French marketing and communications organization was recently hired ʻto accelerate market acceptance of [Viagra] and sustain marketability … [through] advertising and promotion, contact sales, publishing, medical education, public relations, interactive multimediaʼ, and so on. Such a story illuminates the interlocking worlds of science, government and commerce.

Newspaper business pages are full of stories showing how Viagra-influenced ʻmarket dynamicsʼ have triggered shifts throughout the entire ʻerectile dysfunction industryʼ. The manufacturer of Muse, an older erection treatment drug administered intra-urethrally instead of orally, changed its international sales strategy because Viagraʼs popularity suddenly brought primary-care physicians into the forefront of sexual medicine. Like the contraceptive pill, Viagra will have intended effects, and many unintended effects. Because of commercial media, the Internet and the reach of global capital, Viagra has suddenly appeared to participate in the construction of gender, sexuality, ageing and medicine, just to name a few. Everyone can use this latest fantasy symbol to their own ends. Everyone will dance.

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