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"Viagratization" of America



What is this "Viagratization" of America? What does it bode for the future?

Certainly, when ViagraTM came onto the market two years ago last March, it was touted as a miracle treatment for male impotence. Initial studies demonstrated that while only about 10 percent of male erectile dysfunction is psychologically based, Viagra even resolved psychogenic erectile dysfunction in men over 80 percent of the time.

But what does all of this mean for the couple and the female partner?

Dear Abby columns and the like have abounded with accounts of distraught women who lost their husbands to their newfound virility as they sought newer (and often younger) partners. Other women complained that they were perfectly happy not having sex with their husbands and were upset that the nature of their relationship had suddenly shifted to focus on intercourse again. The media attention and associated hype has reflected a range of reactions to this new "wonder drug."

But what was going on in these couples before Viagra? Was there marital bliss, or did a complacency grow out of the impotence? Did the male partner's impotence result in him staying in an otherwise unsatisfactory relationship because of his fears that no one else would want him? Many men with erectile dysfunction report that they have tremendous fears about starting new relationships. In many cases, a familiar, albeit unsatisfactory relationship may feel safer than a new, potentially positive one. When these men regained erectile potential, they sought escape from the relationship instead of trying to work on the problems that made it undesirable.

The point at which a couple's sexual life is terminated as a result of impotence, much like the termination of a sexual act, is very often determined by the male partner's interest and motivation. When he reached orgasm, sex was often over. When he could no longer maintain an erection adequate for intercourse, sex often stopped. Now with Viagra sex is possible again for some of these men, but there is often no longer a couples context in which to experience it. Maybe the intimacy in the relationship has broken down to a point where it is impossible.

Maybe the female partner was relieved that sex was no longer an issue because sex had become work due to her own lack of response that came with menopause. Maybe she never knew she couldn't respond until they started having intercourse again and she noticed vaginal dryness, pain or lack of sensation or response that wasn't present in her earlier years.

Many couples who were faced with impotence sought sexual and/or couples therapy early on. For these couples, the focus of the treatment was to mourn the loss of the sexual relationship as they knew it and then to move on to broaden their perceptions of sexuality beyond intercourse, for example a couples training program I developed called VENIS: Very Erotic Non-Insertive Sex.

Couples had to learn to "turn foreplay into a home run." The interesting thing is that for many these couples, sex became more intimate and more communicative. Through the process of adapting to the impotence, the couple learned knew ways to sexually communicate and sexually pleasure one another. Because most women find it difficult to reach orgasm through intercourse alone, their sexual response was actually improving because of the increased sensuality, intimacy, not to mention clitoral stimulation.

Now many of these couples are revisiting therapy with the rise of Viagra. How do they readjust their sexual lives to include an erection and intercourse again? The man, who has adjusted to not focusing on erections now becomes erection-focused again. He revisits that old anxiety around achieving and maintaining a rigid penis.

When he takes Viagra and gets an erection, he wants to have intercourse immediately because he clearly connects to a time when he had to take advantage of it there and then or else loose the opportunity. Although he has regained the potential to have an erection, he has not regained his confidence in his ability to maintain one or regain one should he loose it in the process of pleasuring his partner.

How does this play out in the couples sexual lives? Take Susan and Harry. He has started taking Viagra after 12 years of erectile dysfunction and can now have erections. He tends to take it before dinner (as per the empty stomach requirements). About an hour later, after a light romantic dinner, they start to stimulate one another and Harry gets an erection. The stimulation of Susan then stops because Harry doesn't want to loose his erection. Susan could have used a little more foreplay, and while enjoying it, she has not received enough foreplay to reach orgasm by the time Harry does.

Afterward Harry, basking in the afterglow of this positive sexual experience, lovingly kisses Susan, tells her how much he enjoyed it and goes to sleep. What will happen to the foreplay when a fast acting Viagra or Viagra substitute is available. We already are hearing about a sublingual version that has an effect after 15 minutes ("New Sub-Lingual Delivery System for Viagra Devised by a Compounding Pharmacist") So now Harry and Susan may not even have dinner together first, but go right to it and within 15 minutes will be having intercourse.

Viagra definitely provides tremendous opportunities that have never been present before for both men as well as women. Yet with this range of new possibilities, many couples will be faced with the problem of how to emotionally re-connect to one another. As with any major change, the man's new erectile potential can create anxiety, conflict, and turmoil in the couple along with the potential for intimacy, sexual enhancement and reconciliation.

What is crucial is that we address the psychological and educational aspects about how to effectively incorporate the regained erectile potential into a broader sexual and relational context.

Men who are being sent home with Viagra are given instructions on how and when to take it. Not what to do once it works. The hope for this era of Viagra and drugs like it is that along with prescriptions, when indicated, men and women will also receive guidance and education about how to incorporate intercourse back into a sexual relationship, remembering that intercourse is not the only means to the end; remembering that when an erection is lost, if the drug is working, it can be regained; remembering that women often need a lot of direct clitoral stimulation in order to reach orgasm which may require non-intercourse sexual activity; and remembering to communicate with each other about their sexual needs as well as fears.

Most of all, help must be made available to the significant number of couples who, for whatever reason, are having difficulty adjusting to this positive change. No matter what the drug, our brain is our main sexual organ and the brain is connected to our psyche which exists in the context of our relationships with intimate partners.

No drug will ever be able to replace or compensate for that intimacy. The challenge will be to remain attentive to this crucial part of sexual identity as even more medications and medical interventions become available over the course of this new millennium.