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The Medical Treatment Approach & The Little Pill that Could

Lorraine Benuto, Ph.D., edited by C. E. Zupanick, Psy.D.

In 1998, something quite revolutionary happened. Pfizer Pharmaceuticals obtained U.S. Food and Drug Administration approval for a medication said to treat impotence. This completely shifted the way that we viewed sexual difficulties up until that time. This medication was named Viagra© (Sildenafil Citrate). This name was chosen both because it was close to the word 'Vigor' (meaning strength) and because like Niagara Falls, this little blue pill was thought to have the potential to restore flow, power, and greatness. While the marketing is clearly smart, the question remains: how healing is that little blue pill called Viagra©?

medication bottle Viagra© and now similar medications have been quite successful in the treatment of erectile dysfunction. This has caused a surge in research focused on male sexuality in general, and especially on erectile dysfunction. This tiny blue pill has had a very big impact on the way we treat sexual dysfunctions. For men, this shift certainly has its benefits. Prior to the introduction of Viagra, the treatment for erectile dysfunction involved penile injections, the use of suppositories, vacuum devices, etc. Certainly Viagra© offers a much less invasive route of treatment than previous alternatives. On the down side, many men enter the doctor's office complaining of erectile dysfunction and walk out the door with a prescription in hand thinking their problems are solved. Many of these men are soon back in the doctor's office happy that they achieved an erection, but disappointed that the problems in their relationship remain. In short, this pill has shifted our treatment of sexual problems to a medical approach.

Pacey (2008) discussed how the medicalization of sex has created a barrier to sexual intercourse. He emphasized how treating male erectile disorder with a pill implies that the treatment should be provided to the individual man, rather than to the couple. This shift from treating couples, to treating individual men, has furthered an existing controversy: is sex about a male's physiological potency (i.e., the ability to perform sexually) or is sex about a shared experience between two (or more) people?

The shift to treatment focusing on the individual man, rather than the treatment of a couple, clearly impacts the partners of these men (generally women). Thus, we must ask ourselves, how does men's ability to be "potent" forever impact female sexuality? From the perspective of a clinician who has worked with people reporting sexual dysfunction, for many women the impact of the natural aging process on their male partner's sexuality has served as a relief. Recall that research has clearly established that men think about, and want sex more than women do. In effect, the natural aging process has tended to equalize male and female desire for sex. With the passage of time, male testosterone levels decline and as a result, sex drive and arousal go down as well. To some extent, the natural aging process "feminizes" male sexuality making it more like that of women. However, with the advent of erectile dysfunction medications, this has changed. Men are now able to perform sexually for as long as they are eligible candidates for the medication. This non-stop ability to perform sexually is not a welcome change for many women. One cannot help but wonder is there a little pink pill in the making? Pharmaceutical companies have tried to create a similar treatment option for female sexual dysfunction, but to date have not been successful.

However, for other women Viagra and similar medications are a welcome relief. For these women, the natural aging process brings with it a greater freedom from child-rearing tasks and increased time and intimacy with their partners, making sex more enjoyable, and more frequent. Thus, the medication enables their male partners to match their increased desire for sex.

As mentioned above, it appears that we have begun to conceptualize sexual dysfunction from a medical perspective, implying that sexual dysfunction can be treated with pills. The lack of a pill holding similar promise of a "cure" for female sexual dysfunction, should cause us to question whether we should conceptualize female sexuality from this medical model. We have emphasized the importance of recognizing gender differences in determining normal sexuality. Our perspective on the treatment of sexual dysfunction is no different. Given that many women would qualify for a diagnosis of sexual dysfunction (i.e., 30% of women "suffer" from low sexual desire), we must consider whether we can really call something "abnormal" when this "abnormality" is experienced by nearly one third of the population. Perhaps the problem is that we have defined what is "normal" and "abnormal" exclusively by male standards. Essentially, we have defined "normal" sexuality using men as the benchmark for what is "normal." But what about what is normal and average for women? It is important that during our discussion of sexual dysfunction we keep in mind that what makes up normal may not always be the same for men and women and that our diagnostic system is not yet sophisticated enough to account for these differences.