Love, Viagra Style?

Although men of a certain age are undoubtedly thrilled to have their sexual potency restored, maybe their partners’ enthusiasm is a little more subdued. What at first glance seems an obvious win-win situation for both men and women can have a raft of unintended consequences.

Don’t get me wrong; Viagra is a wonder drug. Since the early 90s, when researchers testing a new heart medication called sildenafil discovered that it had a startling side effect in men, ED medication has become a more-than-billion-dollar industry. And because, according to Impotence Australia, more than 50% of Australian men from 60 to 69 years of age experience ED (for reasons ranging from age-related narrowing of the blood vessels to high blood pressure, diabetes, obesity and neurological problems), this medication has been a godsend to millions.

ED drugs can also, indirectly, be lifesavers. Research has shown that 34 to 70% of all men who take antidepressants experience sexual dysfunction as a side effect, and of those who have this problem, almost 90% stop taking the antidepressants so their sex lives can go back to normal.

The hard facts

Sex therapist Brett McCann, CEO of Impotence Australia, assures us that men should not take Viagra recreationally (and women definitely shouldn’t, either). But ED pills are so readily available, so much a jokey part of the cultural landscape, that few of us really know how they work and what the potential dangers are. This leads to misuse, which is not so much life-threatening as it is foolhardy.

Essentially, ED drugs work like this: what gives a man an erection is blood flow to the penis. The vessels dilate, and blood flows in. An enzyme counteracts this dilation. ED drugs inhibit that enzyme, allowing dilation to occur more easily and last longer. They can also diminish a man’s refractory time, meaning that after orgasm he can more quickly get another erection.

The one thing most people know about Viagra and its cohorts is that men who take nitrate medications, usually prescribed for the chest pain of angina, are not supposed to use them. But ask around. That piece of information has translated into: “Viagra is bad if you have a heart condition”.

Not so, says Dr Arthur Agatston, a cardiologist at the University of Miami Miller School of Medicine in the US. In fact, Agatston says, Viagra keeps the blood vessels from becoming “sticky” and helps blood flow through them smoothly, not only in the penis but also throughout the body. So when a man takes Viagra, he has to avoid anything that dilates the blood vessels, not just nitroglycerides. Drinking and lying in the sun are both problematic. Viagra won’t give him a heart attack, but, taken with too much alcohol, it could make him pass out, Agatston says.

Love drug?

Perhaps more damaging than ignorance of the physical ramifications of ED drugs is ignorance of their potential interpersonal implications. When couples don’t discuss it frankly, Viagra can cause a lot of misunderstanding and hurt.

“There’s something about a hard erection that’s extremely important to a man’s identity,” says Dr Steven Lamm, author of The Hardness Factor ($40.99; HarperCollins). “And of course, most couples would prefer that the man be able to have one. But there are some who may have adjusted to life without sex.

Perhaps the woman doesn’t really want it anymore, for one reason or another. And for those couples, the introduction of an ED drug can throw them seriously out of sync.” Which leads to what is perhaps the biggest complicating factor: the reality that a woman’s postmenopausal genital health can put her physically at odds with her partner’s newfound pill-assisted prowess. As women age, their hormonal balances change. Reduced oestrogen levels often mean less sexual desire but also decreased vaginal elasticity and lubrication and thus more potential for sex to be painful.

The problem can be especially daunting for older women who are widowed or divorced or just beginning to date after years of being alone or with one man. Certainly this was the case for Marjorie, a 60-something woman who complained about the drugs on a 50+ website: “Men have been saved from their middle-age sexual issues by Viagra. They can be 30 again, while I have to deal with the sexual issues of being my age. It’s put the world on ‘tilt’.” Andrea, a twice-divorced doctor and over-50s dater, puts it more bluntly. “Viagra has been liberating for men, but unless a woman is taking hormone therapy, she may have vaginal dryness and really not be that interested in the kind of driving, pounding intercourse he’s now capable of.”

The rumour pill

There’s also fallout from the mistaken belief that Viagra causes not just greater blood flow but also greater desire. “It’s not an aphrodisiac!” McCann says. The hormone testosterone is the driving force behind libido; a man with little or no testosterone won’t have any desire to have sex, Viagra or not.

Besides, even with normal amounts of testosterone,Viagra doesn’t just instantly give a man an erection. You have to be in a sexual situation for it to work for you, McCann advises. “If a man hasn’t been intimate for a while and suddenly gets an erection from taking a pill, he might forget about the cuddling and the more gentle side of sex. He just jumps ahead. It isn’t necessarily that men don’t want this part of sex; it’s more that they’re just focused and perhaps scared that the erection won’t last.”

The misunderstandings cut all ways: some women think ED drugs make men amorous and that a female presence isn’t required. “Some women believe it’s the Viagra talking when there’s suddenly an increased interest in sex from their partner, rather than a desire to reconnect with them,” explains McCann.

Game, set, (mis)match

Another big issue for many women: ED drugs drastically shorten the interval between climaxing and achieving another erection. Men look at this differently from how women do. For them, it’s not a bug, it’s a feature. And for the women? “We want maybe 20 or 30 great minutes of sex,” says Susan, a 42-year-old mother of two. “We don’t want an interminable two hours.” Not to mention the fact that prolonged intercourse, particularly without sufficient lubrication, can do damage. It can lead to vaginal abrasions, even tearing, and can expose a woman to the risk of getting yeast infections and—particularly for a woman who’s dating or divorced—to sexually transmitted diseases.

There are single women who worry that men with newfound sexual abilities will be less likely to commit to marriage, and wives who worry that their husbands will be inclined to look outside the marriage for sex.

“A partner’s Viagra use is now another reason some women give when I ask why they’ve come to see me,” says US-based plastic surgeon Dr Lee Gibstein, who has performed breast implants, facelifts and even vaginal rejuvenation on women concerned about turning back the clock. Which is not to say that Viagra hasn’t ever led to straying—but not for the reasons women think.

“It’s common for women to believe sex should be more natural; a frequent misconception is that men get their desire from taking a pill. The problems occur when they think, You shouldn’t have to take a drug to want me,” McCann says. So if the man can’t have erections on his own and the woman shoots down the idea of a pill, the relationship can get into real trouble, because one person wants sex and the other doesn’t or wants it only on her terms.

Three in the bed

So how can you make sure that ED drugs help rather than hamper your relationship? “Couples really need to talk about what each partner expects,” says couples counsellor Jane Greer, PhD, author of What About Me? ($27.99; Alpa Books). “The medication can highlight problems about which member of the couple puts himself or herself first, which one is thoughtful and which one isn’t—creating all sorts of conflict.”

Andrea, whose own dates’ Viagra experiences have ranged from excellent to the emergency ward, adds, “You have to be clear about what works for you and what doesn’t. Because even with someone you adore … sometimes you just want to get back to reading your book!”

Moreover, women need to stop protecting the male ego by lying about what they like and don’t like, because that’s a recipe for sexual dissatisfaction. Instead, we should take responsibility for our own feelings and emotions. This means if you need to buy lubricant to make sex more comfortable, do it; if you need to tell him you’re perfectly happy having intercourse for a few minutes, do that, too.

For more information, contact Impotence Australia (1800 800 614)