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Viagra: The Little Blue Pill with
Big Repercussions
Zoe L Barnett
Nancy A Pachana
Overview
Psychological Research on Viagra Reveals
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Normal ageing viewed as dysfunctional
Lack of discussion with key users
Lack of consultation with partners
Limited research on the
- social
- psychological and
- emotional impact
Erectile Dysfunction (ED)
Erectile Dysfunction (ED)
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In 2003 six million men had used Viagra (Sildenafil Citrate)
Remarkable effects of Viagra
Significant improvements millions of men’s sex lives
Previously not possible with other treatments
322 million men worldwide (ED) by 2025 (Fisher et al., 2005)
90% remain untreated (ED)
The impact is enormous
Inflated Expectations
• Very high public expectation
• Viagra marketing taps into wishful
fantasies
• Providing certainty and a quick fix
• Research indicates men believe in
100% success (Tomlinson & Wright, 2004)
Inflated Expectations
Cont/…
• Research indicates drop out rate of 40-80%
(Fisher et al., 2005)
• Failure to return to prior sexual norm
• Limited assimilation of Viagra into lovemaking
• Lack the ‘psychological, relational and
emotional’ skills (McCarthy & Fucito, 2005)
• Unmet expectations compound relationship
issues (Potts, Gavey, Grace & Vares, 2003)
Viagra Dialogue?
Viagra Dialogue?
• “opening the door to frank discussion” (Melchiode & Slaon,
1999)
• Media attention ensured Viagra and ED became household
names
• Physicians are uncomfortable discussing sexuality
• Wait for patients to bring up sexual matters (Boisaubin &
McCullough, 2004)
• Only 30-50% consult a physician for ED (Fisher et al., 2005)
• Assessment without partners present (Kleinplatz, 2004)
• Lack of joint decision or negotiation (Potts et al., 2003)
Psychosocial Issues
Psychosocial Issues
Viagra is a socially embedded phenomenon
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Huge public interest in Viagra
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Men with and without ED share Viagra stories
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Complex interplay self image, belief systems, interpersonal
relationships (Potts et al., 2003)
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Partners are largely peripheral ( McCarthy & Fucito, 2005)
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Unwanted changes to sexual relationships, tension, communication
Wide ranging impact
- infidelity
- risk taking behaviour
Psychophysiological Issues
From Psychological (20th c) to Vascular (21st c)
• Up to 90% Physicians focus diagnostically on organic causes
(Fisher et al., 2005).
• Viagra advertising to physicians claims “regardless of the
etiology” (Pfizer promotion targeting NZ physicians, 1998)
• Disregard psychological causes
- work, relationship, sexual performance, preference and
depression (Boisaubin & McCullough, 2004).
Psychophysiological Issues
Cont/…
• 17% of ED is psychogenic in origin (Pallas et al., 2000).
• 12 out of 37 participants experienced a new sexual symptom
(Pallas et al., 2000).
• Important clinicians recognize the psychogenic influences
• Little research how ED influences the lives and well being of
patients.
• Focus on sexual function over and above men’s feelings
(Tomlinson & Wright 2004)
Viagra and Older Women
Viagra and Older Women
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Proliferation of efficacy literature re men's physiological response (
Boisaubin & McCullough, 2004)
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Common for research to vicariously assess partners response ( Tomlinson
& Wright, 2004)
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Assumption that women automatically benefit from Viagra ( Potts et al., 2003)
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Women report unwanted advances, unwanted stress and vaginal injury
( Katz & Marshall, 2003)
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Lack of serious consideration of women’s perspectives ( Bancroft, Loftus &
Long, 2004)
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Sexual dysfunction not always related to dissatisfaction (Bancroft, Loftus &
Long, 2004)
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Many women report a sense of obligation and guilt (Loe, 2004)
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Confusion re: sexual health and risks (Loe, 2004)
Viagra and Ageism
Viagra and Ageism
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Group poorly represented in the research on Viagra
Research tends to calculate research results and apply to older men (
Calasanti & King, 2005)
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Sexuality does not equate with ageing
Restoration of youthful sexual vitality
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Viagra as a fountain of youth
Terms including “ageing well” – “growing old without ageing” (Katz &
Marshall, 2003)
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Erections through the lifespan equate to successful living ( Katz & Marshall,
Potts et al., 2003)
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Some research older people have described Viagra as interfering with
the ageing process (Potts et al., 2003)
Conclusions
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Many individuals report disappointment with Viagra’s results
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Refill rate for Viagra prescriptions < 50 %
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Many older users report erection did not solve their relationship
problems
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Couples are forced to deal with more profound troubles in the
relationship
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Consultation is an opportunity to discuss distorted cognitions
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Some physicians lack the counselling skills to address these
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Disturbing lack of inclusion and dialogue with partners
Conclusions Cont/…
• Older women rarely considered in the Viagra dialogue
• Normal ageing pathologised as dysfunction
• Feminist and social discourse but limited clinical research
• Increased longevity requires new definitions of ageing life
• Research focus on the perspectives of older men and women
Questions