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Viagra: The Little Blue Pill with Big Repercussions Zoe L Barnett Nancy A Pachana Overview Psychological Research on Viagra Reveals • • • • 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) • • • • • • • 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 • Huge public interest in Viagra • Men with and without ED share Viagra stories • Complex interplay self image, belief systems, interpersonal relationships (Potts et al., 2003) • Partners are largely peripheral ( McCarthy & Fucito, 2005) • • 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 • Proliferation of efficacy literature re men's physiological response ( Boisaubin & McCullough, 2004) • Common for research to vicariously assess partners response ( Tomlinson & Wright, 2004) • Assumption that women automatically benefit from Viagra ( Potts et al., 2003) • Women report unwanted advances, unwanted stress and vaginal injury ( Katz & Marshall, 2003) • Lack of serious consideration of women’s perspectives ( Bancroft, Loftus & Long, 2004) • Sexual dysfunction not always related to dissatisfaction (Bancroft, Loftus & Long, 2004) • Many women report a sense of obligation and guilt (Loe, 2004) • Confusion re: sexual health and risks (Loe, 2004) Viagra and Ageism Viagra and Ageism • • Group poorly represented in the research on Viagra Research tends to calculate research results and apply to older men ( Calasanti & King, 2005) • • Sexuality does not equate with ageing Restoration of youthful sexual vitality • • Viagra as a fountain of youth Terms including “ageing well” – “growing old without ageing” (Katz & Marshall, 2003) • Erections through the lifespan equate to successful living ( Katz & Marshall, Potts et al., 2003) • Some research older people have described Viagra as interfering with the ageing process (Potts et al., 2003) Conclusions • Many individuals report disappointment with Viagra’s results • Refill rate for Viagra prescriptions < 50 % • Many older users report erection did not solve their relationship problems • Couples are forced to deal with more profound troubles in the relationship • Consultation is an opportunity to discuss distorted cognitions • Some physicians lack the counselling skills to address these • 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