The downside of Viagra: women's experiences and concerns

Sleeping With Younger Men: Women's Accounts of Sexual Interplay in Age-Hypogamous Intimate Relationships

Influenced by cultural representations of "cougars," society commonly imagines women who date younger men as challenging some of the gendered expectations regarding appropriate sexual desire and behavior. Based on 55 semistructured interviews with women ages 30 to 60 who date younger men, I explore how having younger male partners relates to women's desire and ability to reproduce/disrupt the traditional cultural script for heterosexual sex. I found that compared to their experiences of sex with men of their own age or older, women perceived age-hypogamous intimate relationships as a context in which they can more easily disrupt some facets of that script, namely those regarding (a) the expression of sexual desire, (b) sexual assertiveness, and/or (c) the importance of female pleasure. However, the participants reproduced certain facets of the cultural sexual script, such as the emphasis on penile-vaginal intercourse. In light of women's experiences, I show that younger men's stamina and erectile capacities influenced women's ability to challenge certain facets of the script. Furthermore, I argue that women's perceptions of younger men as fantasizing about sexually experienced women altered the gender power dynamics, ultimately facilitating the modification of interpersonal sexual scripts. This study contributes to improving our understanding of the way age, age differences, and gender interact and influence interpersonal sexual scripts.

Views of family physicians on heterosexual sexual function in older adults

Background

Sexual functioning among older adults has received little attention in research and clinical practice, although it is an integral part of old age. As older adults tend to consume health services and to visit family physicians more frequently, these care-providers serve as gatekeepers in the case of sexual concerns. The present study evaluated the perceptions of family physicians regarding sexuality in older adults.

Method

Qualitative interviews with 16 family physicians were conducted. We used in-depth, semi-structured interviews.

Results

Three main themes emerged: 1. Family physicians described having difficulty in raising questions about sexuality to older patients. 2. Family physicians tended towards the biological side of the spectrum, focusing on the patient’s medical problem and asking physiological questions. 3. Family physicians mainly related to medication administered to their male patients, whereas a minority also described the guidance they provided to older individuals and couples.

Conclusions

The study shows that family physicians tend not to initiate discourse with older patients on sexuality, but rather discuss sexuality mostly in conjunction with other medical conditions. Implications for research and practice are discussed.

Sexual dysfunction or sexual discipline? Sexuopharmaceutical use by men as prevention and proficiency

In the first decade following Viagra’s appearance, feminist and critical scholars documented the sexuopharmaceutical expansion of definitions of erectile dysfunction and its target consumer. As we approach Viagra’s 30th anniversary, while feminist scholarship on the medicalization of sexuality flourishes, the impact of erectile medication has received much less attention. This paper (re)casts a critical lens on popularized erectile medication sexual health messages in the context of current pharmaceutical marketing targeting users as neoliberal aspirational sexual subjects. Discourse analysis reveals that online advice about erectile medication use leverages the increased preoccupation with health risk assessment and prevention technologies to normalize erectile dysfunction as a risk for all men, irrespective of age and health status. Erectile dysfunction is presented as inevitable, pathological, and requiring vigilance and expert consultation; penile performance acts as a predictive health gauge. Erectile medication users are situated as model masculine subjects, (medically) augmenting sexual proficiency in romantic or sexually experimental contexts.

How Did Erectile Dysfunction Become "Natural"? A Review of the Critical Social Scientific Literature on Medical Treatment for Male Sexual Dysfunction

This article reviews the multidisciplinary social science literature assessing the social consequences of medical treatment for male sexual dysfunction. This literature applies medicalization theory and social constructionist approaches to gender to assert that Euro-American cultural ideals of masculinity and sexuality, as well as ageism and ableism, determine which sexual changes and experiences get defined as "dysfunction" and shape the marketing and use of medical treatments for those changes. These medical responses assuage the suffering of men who become unable to meet cultural ideals for sexuality but in the process make reductive norms for male sexuality seem biologically natural. In addition, the critical social science research suggests that an economic logic underlies the process of redefining diversity and change in men's sexual function as medical pathology. However, comparative qualitative data on men's and their sexual partners' experiences of sexuality and aging across world regions suggest that people do not universally accept the narrow ideals of male sexuality embedded in medical discourse regarding men's sexual dysfunction. The diversity in people's sexual desires across the life course and their responses to sexual function change highlight the cultural nature of medical definitions of sexual dysfunction.

Trans Women Doing Sex in San Francisco

This research investigates the sexuality of trans women (individuals who were assigned male status at birth who currently identify as women), by focusing on the "bodily techniques" (Crossley, 2006) they use in "doing" sexuality. The "doing sexuality" framework not only is modeled after the "doing gender" approach of West and Zimmerman (1987), but also utilizes the idea of "sexual embodiment" to emphasize the agency of trans women as they conceptualize and organize their sexuality in a socially recognized way. This is often difficult as they confront discrimination from medical and legal professionals as well as intimate partners who may find it difficult to adapt to the trans woman's atypical body and conception of gender. However, with a study group of 25 trans women from San Francisco, we found the study participants to be adept at overcoming such hurdles and developing techniques to "do" their sexuality. At the same time, we found trans women's agency constrained by the erotic habitus (Green, 2008) of the wider society. The interplay between innovation and cultural tradition provides an opportunity to fashion a more general model of "doing" sexuality.

Bad Bedfellows: Disability Sex Rights and Viagra

The disability rights movement grounds material critiques of the treatment of people with disabilities in a social constructionist perspective, locating disability in the social rather than physical realm, and demedicalizing the concept of disability. However, this conceptualization is threatened by the medicalization of nonnormative erections as the biomedical pathology erectile dysfunction (ED). Although use of medical treatments for ED can have positive outcomes for individuals, the medical community's tendency to include sexual difference in the rubric of disability threatens to remedicalize that category. Furthermore, medicalized conceptions of ED often serve to refocus sexuality around phallocentric, normative sex acts and gender roles, undoing the deconstructive work of disability sex studies. Finally, although aging Western populations targeted for ED treatment represent potentially expanded bases for disability movement activism, the pathologizing of nonnormative sexuality may have the power to instead focus this group on individualistic use of medical interventions geared toward “normalcy.”

Effect of the aqueous extract of the aerial parts of Monsonia angustifolia E. Mey. Ex A. Rich., on the sexual behaviour of male Wistar rats

Background

Monsonia angustifolia (Geraniaceae) is a medicinal plant traditionally used in South Africa to increase libido and to treat erectile dysfunction.

Methods

In-vivo aphrodisiac activities of the crude extracts of the plant prepared in water at 3, 30 and 300 mg/kg body weight were evaluated for 7 days using sildenafil citrate (Viagra) and 1 % ethanol in distilled water as positive and negative controls respectively. Male rats were selected and monitored in each group for sexual behaviour by exposing them to sexually receptive females on days 1, 3 and 7 for 60 minutes each between 7:00 pm and 3:00 am. The following male sexual parameters were observed: Mount Frequency (MF), Intromission Frequency (IF), Mount Latency (ML), Intromission Latency (IL), Ejaculation Frequency (EF), Ejaculatory Latency (EL) and Post-Ejaculatory Interval (PEI).

Results

The administration of the extract resulted in significant increase (p < 0.05) in mount frequency, intromission frequency, ejaculation frequency, ejaculation latency and serum hormone concentrations. The computed indices of sexual behaviour such as erection, quick flips, long flips and total penile reflexes were also increased. However, the mount latency, intromission latency and post ejaculation interval were significantly decreased throughout the experimental period. The administration of 300 mg/kg body weight of the aqueous extract produced the best effects in all the parameters.

Conclusion

Generally, the extract of Monsonia angustifolia produced pro-sexual stimulatory effects in the male rats especially when administered at 300 mg/kg body weight. The results validate the use of the plant by the indigenous people to increase libido and treat premature ejaculation and erectile dysfunction in males.

Menopause and Sexuality

Sexuality is an important component in the lives of menopausal women. Despite the importance of sexual function in menopausal women, sexual dysfunction increases with age. Age-related decline in sexual function may significantly reduce quality of life, making recognition of sexual dysfunction by physicians important for getting menopausal women effective care. Sexual dysfunction can result from multiple etiologies including psychosocial factors, medication side effects, vulvovaginal atrophy, chronic illness, or hypoactive sexual desire disorder. Discovering the etiology and identifying modifiable factors of the sexual function will help define appropriate treatment.

Medicated sex in Britain: evidence from the third National Survey of Sexual Attitudes and Lifestyles

OBJECTIVES

To describe the prevalence of medication use to assist sexual performance in Britain and to identify associated factors.

METHODS

Cross-sectional probability sample, undertaken in 2010-2012, of 15 162 people aged 16-74 years, resident in Britain, of whom, 5617 men and 8095 women reported sexual experience (ever) and 4817 men were sexually-active (reported sex in the last year).

RESULTS

Ever use of medication to assist sexual performance (medicated sex) was more commonly reported by men than women (12.9% (95% CI 11.9% to 13.9%) vs 1.9% (95% CI 1.7% to 2.3%)) and associated with older age in men and younger age in women. It was associated with reporting smoking, and use of alcohol and recreational drugs, as well as unsafe sex (≥2 partners and no condom use in the last year) in both men and women. Among men, the proportion reporting medicated sex in the last year was higher among those reporting erectile difficulties (ED) than those not doing so (28.4% (95% CI 24.4% to 32.8%) vs 4.1% (95% CI 3.4% to 4.9%)). In all men, medicated sex was associated with more frequent sexual activity, meeting a partner on the internet, unsafe sex and recent sexually transmitted infections diagnosis; associations that persisted after adjusting for same-sex behaviour and ED. However, there were significant interactions with reporting ED, indicating that among men with ED, medicated sex is not associated with same-sex behaviour and ever use of recreational drugs.

CONCLUSIONS

A substantial minority of people in Britain report medicated sex, and the association between medicated sex and risky sexual behaviour is not confined to high-risk groups.

Sexual desire, erectile dysfunction and the biomedicalization of sex in older heterosexual men

AIM

To examine sexual desire in older age and the use of pharmaceuticals for sexual enhancement in the context of erectile dysfunction.

BACKGROUND

The ability of the older person to fulfil sexual desire has not been well supported in Western society.

DESIGN

The paper draws on themes that emerged during a phenomenological study of sexual desire in older age.

METHOD

Narratives were collected between 2008-2010 from in-depth interviews with six men and two women aged 65-84 years who were part of a larger Australian study of sexual desire in older age.

FINDINGS

Emergent themes reveal that for some older people, the biomedicalization of sex can be a disappointing experience.

CONCLUSION

The findings illuminate the need for nurses who are at the front line of health care, health policy makers and educators, to consider sexual desire experienced in older age in the context of sexual health and healthy ageing. This study will contribute to a growing body of knowledge about sexual desire in older age.

Constructions of sex and intimacy after cancer: Q methodology study of people with cancer, their partners, and health professionals

BACKGROUND

The increasing number of individuals living with cancer has led to a focus on the quality of life of survivors, and their families. Sexual wellbeing is a central component of quality of life, with a growing body of research demonstrating the association between cancer and changes to sexuality and intimacy. However, little is known about patient and professional understanding of cancer and sexuality post-cancer. This study was designed to explore the complex perspectives that people with personal and professional experience with cancer hold about sexuality in the context of cancer.

METHODS

An interview study using Q methodology was conducted with 44 people with cancer, 35 partners of a person with cancer and 37 health professionals working in oncology. Participants were asked to rank-order 56 statements about sexuality and intimacy after cancer and asked to comment on their rankings in a subsequent semi-structured interview. A by-person factor analysis was performed with factors extracted according to the centroid method with a varimax rotation.

RESULTS

A three-factor solution provided the best conceptual fit for the perspectives regarding intimacy and sexuality post-cancer. Factor 1, entitled "communication - dispelling myths about sex and intimacy" positions communication as central to the acceptance of a range of satisfying sexual and intimate practices post-cancer. Factor 2, "valuing sexuality across the cancer journey," centres on the theme of normalizing the experience of sex after cancer through the renegotiation of sex and intimacy: the development of alternative sexual practices. Factor 3, "intimacy beyond sex," presents the view that even though sex may not be wanted, desired, or even possible following cancer, quality of life and relationship satisfaction are achieved through communication and non-genital intimacy.

CONCLUSIONS

This study has demonstrated the complexity of perspectives about sexuality and intimacy post cancer, which has practical implications for those working in cancer care and survivorship. Therapists and other health professionals can play an important role in ameliorating concerns surrounding sexual wellbeing after cancer, by opening and facilitating discussion of sexuality and intimacy amongst couples affected by cancer, as well as providing information that normalizes a range of sexual and intimate practices.

Dez anos de epidemia do HIV-AIDS em maiores de 60 anos no Distrito Federal - Brasil

INTRODUÇÃO: O aumento progressivo no número de casos de HIV/AIDS em idosos traz a necessidade de estudos sobre as especificidades deste fenômeno por região. OBJETIVO: Descrever as características dos casos de AIDS em indivíduos com idade > 60 anos ou mais no Distrito Federal - Brasil. MÉTODO: Realizou-se um estudo de série temporal, com dados secundários do SINAN/AIDS, no período de Janeiro de 1999 a dezembro 2009. RESULTADO: Neste período foram diagnosticados 4258 novos casos de AIDS; destes, 89 (2,0%) são idosos. Embora seja uma porcentagem pequena, o crescimento anual foi contínuo. A categoria de exposição mais frequente foi a de heterossexual, a faixa etária mais acometida foi de 60 a 69 anos com 71 (79,8%) casos, e a proporção de casos homem/mulher vem mudando ao longo dos anos, sendo que em 1999 era de 1:1 e, em 2006, de 0,7:1. CONCLUSÕES: A epidemia de HIV/AIDS pode ser considerada estável entre os idosos no Distrito Federal.

Contested psychiatric ontology and feminist critique: 'Female Sexual Dysfunction' and the Diagnostic and Statistical Manual

In this article I discuss the emergence of Female Sexual Dysfunction (FSD) within American psychiatry and beyond in the postwar period, setting out what I believe to be important and suggestive questions neglected in existing scholarship. Tracing the nomenclature within successive editions of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM), I consider the reification of the term 'FSD', and the activism and scholarship that the rise of the category has occasioned. I suggest that analysis of FSD benefits from scrutiny of a wider range of sources (especially since the popular and scientific cross-pollinate). I explore the multiplicity of FSD that emerges when one examines this wider range, but I also underscore a reinscribing of anxieties about psychogenic aetiologies. I then argue that what makes the FSD case additionally interesting, over and above other conditions with a contested status, is the historically complex relationship between psychiatry and feminism that is at work in contemporary debates. I suggest that existing literature on FSD has not yet posed some of the most important and salient questions at stake in writing about women's sexual problems in this period, and can only do this when the relationship between 'second-wave' feminism, 'post-feminism', psychiatry and psychoanalysis becomes part of the terrain to be analysed, rather than the medium through which analysis is conducted.

All Shook Up: Sexuality of Mid- to Later Life Married Couples

The authors integrate theoretical work on the performance of gender with a life course perspective to frame an analysis of in-depth interviews with 17 long-term married couples. The findings indicated that couples' sexual experiences are characterized by change over time, yet that change is shaped by the intersection of gender and age. Midlife couples (ages 50 - 69) were distressed by changes in their sex lives likely because they impede couples from performing gendered sexuality. The source of this distress stems from age-related physical changes; however, it manifests in different ways for husbands and wives. In contrast, later life couples (ages 70 - 86) were more likely to emphasize the importance of emotional intimacy over sex as they age. Marital sex is a source of conflict for many midlife couples because of husbands' and wives' incongruent experiences, but later life husbands and wives tend to have more congruent experiences of marital sex.

Viagra: the little blue pill with big repercussions

Erectile dysfunction (ED) affects millions of men, and their partners, worldwide (Fisher, Meryn, et al. 2005). Viagra, widely used to treat ED, impacts on both individuals and interpersonal relationships yet social and psychological aspects of treatment are absent from the majority of research on the drug. The advent of Viagra has seen diminishing sexual capacities once linked with normal ageing now viewed as dysfunctional, with possible alternative psychological factors largely ignored. Research reveals a lack of discussion relating to the key users of Viagra (older men), with partners largely absent from the consultation process. We identify gaps in the extant literature on Viagra, including the social, psychological and emotional impact on sexual relationships and the experiences of older men and women.

Medicalization and the refashioning of age-related limits on sexuality

This article explores the convergence of sexual medicine and anti-aging medicine as they have refashioned standards of sexual functionality and reconstructed sexual life courses. Reversing the long-held stereotypes of asexual or post-sexual seniors, expectations of continued sexual functionality as an indicator of health in later life now underpin a growing medical and therapeutic industry. While more positive images of eldersex are certainly an improvement over past views that saw older people as both undesiring and undesirable, this article suggests that caution should be exercised regarding an overly celebratory reading of the medicalized construction of "sexy seniors."

The graying of "sexual health": a critical research agenda

This paper critically interrogates the concept of sexual health as it has evolved in relation to older adults. I draw on social and cultural studies of aging, feminist studies, and science and technology studies to outline a research agenda which treats sexual health as a point of articulation for a range of technologies and processes which shape mid- and late-life sexualities. Such an agenda may be able to more fully interrogate the sites and processes by which sexualities are being shaped, the forms of sexual agency on offer to older people, and the contemporary reconstruction of sexual life courses.

Aesthetic anti-ageing surgery and technology: women's friend or foe?

This study investigates women's attitudes about, and experiences of, aesthetic anti-ageing surgeries and technologies against the contextual backdrop of the growing commercialisation of medicine in the United States. Drawing from 44 intensive interviews with a spectrum of women between the ages of 47 and 76 who use, refuse, and are currently undecided about whether or not they will have or use aesthetic anti-ageing surgeries and technologies in the future, this study asks the following question: in what ways does the increasing availability, accessibility, advertising, and use of aesthetic anti-ageing surgeries and technologies interact with and inform women's perceptions and attitudes about growing older? Data analysis occurs in dialogue with the paradigms of successful ageing and agelessness and draws from, and contributes new readings of, contemporary cultural constructions of femininity.

'Not the swab!' Young men's experiences with STI testing

In Canada, STI rates are high and rising, especially amongst young men. Meanwhile, the needs of young men regarding STI testing services are poorly understood, as are the socio-cultural and structural factors that influence young men's sexual health-seeking behaviours. To better understand this phenomenon, we draw on interviews with 45 men (ages 15-25) from British Columbia, Canada. Our research reveals how structural forces (e.g. STI testing procedures) interact with socio-cultural factors (e.g. perceptions of masculinities and feminities) to shape young men's experiences with STI testing. STI testing was characterised as both a potentially sexualised experience (e.g. fears of getting an erection during genital examinations), and as a process where young men experience multiple vulnerabilities associated with exposing the male body in clinical service sites. In response, participants drew on dominant ideals of masculinity to reaffirm their predominately hetero-normative gender identities. Despite growing up in an era where sexual health promotion efforts have been undertaken, participants did not feel they had permission to engage in discussions with other men about sexual health issues. Attending to young men's perspectives on STI testing represents a starting point in reforming our approaches to addressing how socio-cultural and structural factors shape these experiences.

Not just old and sick – the ‘will to health’ in later life

The end of the ‘Golden Age’ of welfare capitalism in the 1970s was the prelude to a period of greater individualisation within societies and was accompanied by an increase in the importance of consumption as a way of organising social relations. During the same period there was also an expansion in the discourses aimed at enhancing the government of the autonomous self. One such discourse operates around what has been termed the ‘will to health’: it suggests that health has become a required goal for individual behaviour and has become synonymous with health itself. The generational groups whose lifecourses were most exposed to these changes are now approaching later life. We explore the extent to which social transformations related to risk, consumption and individualisation are reflected in the construction of later-life identities around health and ageing. We examine how the growth in health-related ‘technologies of the self’ have fostered a distinction between natural and normal ageing, wherein the former is associated with coming to terms with physical decline and the latter associated with maintaining norms of self-care aimed at delaying such decline. Finally, we consider anti-ageing medicine as a developing arena for the construction of later-life identities and discuss the implications of the social changes for researching later life.

Pharma in the bedroom . . . and the kitchen. . . . The pharmaceuticalisation of daily life

This paper examines the consequences of a new emphasis on lifestyle in the production, marketing and consumption of pharmaceuticals. Over the past decade, a range of medicines have become available that address aspects of lifestyle, while others have been the subject of lifestyle marketing. We argue, with recourse to a broad literature from the social sciences, economics and health services research and from our study of pharmaceutical consumption, that two processes can be discerned. First, there is a domestication of pharmaceutical consumption, with drugs available via home computers, and marketing of pharmaceuticals that focuses upon private or personal conditions and addresses domestic activities such as sex and cooking. Secondly, there is a pharmaceuticalisation of everyday life as the pharmaceutical industry introduces profitable medicines for a range of daily activities and pharmaceuticals come to be seen by consumers as a 'magic bullet' to resolve problems of daily life. We suggest that the pharmaceuticalisation of daily life links the economics and politics of pharmaceutical production to the private lives of citizens.

Generating best evidence from qualitative research: the role of data analysis

OBJECTIVE

To outline the importance of the clarity of data analysis in the doing and reporting of interview-based qualitative research.

APPROACH

We explore the clear links between data analysis and evidence. We argue that transparency in the data analysis process is integral to determining the evidence that is generated. Data analysis must occur concurrently with data collection and comprises an ongoing process of 'testing the fit' between the data collected and analysis. We discuss four steps in the process of thematic data analysis: immersion, coding, categorising and generation of themes.

CONCLUSION

Rigorous and systematic analysis of qualitative data is integral to the production of high-quality research. Studies that give an explicit account of the data analysis process provide insights into how conclusions are reached while studies that explain themes anchored to data and theory produce the strongest evidence.

Flaccid theory and the geographies of sexual health in the age of Viagra™

The discipline of geography is largely absent in discussions and debates about drug use practices and their relationships to sexual health. Given the important relationships among the use of drugs, performances of sexualized identities, and the practices of sex, it behooves medical and health geographers particularly, and social and cultural geographers more generally, to engage in the wider interdisciplinary debates about these relationships. Through a discussion of one drug, Viagra, this brief intervention offers an agenda for studying the geographies of sex, sexuality, and drug use. It is argued that drug use is an inherently geographic practice that reshapes how places are resituated in relation to the fluid and dynamic meanings of sex, sexuality, and sexual health, areas of research and practice that medical and health geographers ought to consider more seriously.

La pharmacologisation de la ménopause

La littérature souligne le rôle central que jouent les médicaments dans l’expansion du processus de médicalisation. Les traitements pharmaceutiques modifient également la façon dont les individus perçoivent leur action sur le corps. Cet article, basé sur 26 entretiens semi-directifs réalisés auprès de femmes françaises, s’interroge sur les fonctions qu’elles attribuent à l’hormonothérapie, les comparant à celles rapportées dans les recherches chez les utilisateurs du Viagra. L’analyse met en évidence des usages communs de restauration, de normalisation et d’extension des capacités corporelles. Des différences sont observables concernant l’inscription du médicament dans le corps, qui est interprétée en termes de naturalité ou d’artificialité.

How do men perceive erectile dysfunction and its treatment? A qualitative study on opinions of men

INTRODUCTION

Erectile dysfunction (ED) is a common medical disorder affecting the aging male. A man's perception of a disease affects his health seeking behaviour. This study aimed to explore perceptions of ED among men with ED and how these perceptions came about.

METHODS

This qualitative study utilized in-depth interviews involving 17 urban men aged between 40 and 75 years old.

RESULTS

Misconceptions existed regarding the definitions of ED. Most men perceived impotence to be more serious than ED. Although most were aware of the medical causes of ED, 'overuse of penis' and black magic were mentioned as culturally-related causes. ED was perceived as a serious problem associated with loss of manhood and it had a significant impact on relationships with their partners. However, some adopted an 'accepting' view and attributed it to aging and fate. Most men were only familiar with PDE-5 inhibitors and traditional therapies. PDE-5 inhibitors were perceived to be effective but they were concerned about side effects and costs.

CONCLUSIONS

Identifying men's perceptions of ED and its treatment would help doctors in their consultation, and inform health policy makers in planning appropriate public education and services.

Embodied masculinity and androgen deprivation therapy

This paper describes the findings from an ethnographic study of 16 Anglo-Australian men treated with androgen deprivation therapy (ADT) for advanced prostate cancer. Utilising a social constructionist gendered analysis, participants' experiences, particularly in relation to embodied masculinity, are described in the context of reduced testosterone that accompany ADT. The findings indicated that participants reformulated many ideals of hegemonic masculinity in response to functional body changes. However, hegemonic masculinity strongly influenced participants' philosophical resolve to "fight" prostate cancer. The findings are considered in broader ongoing debates about essentialist sex and the social construction of gender.

'Sex for life'? Men's counter-stories on 'erectile dysfunction', male sexuality and ageing

Discourse on male sexuality in mid-to-later life has exploded in recent years (Gullette 1998). Attention to this topic has been spurred by the advent of (highly profitable) sexuopharmaceutical 'solutions' to erectile changes affecting older men. 'Success' stories abound in the media and in medical literature related to the restoration of faulty erections and ailing sex lives through drugs such as Viagra (sildenafil citrate), Uprima (apomorphine) and Cialis (tadalafil). In this paper we explore some of the ways in which notions about ageing and male sexuality are changing in popular cultural and medical texts in response to the advent of Viagra and the increasing authority of biomedicine in this area. We also demonstrate how the recent biomedical endorsement of 'sex for life' (the imperative to maintain an active youthful masculine [hetero]sexuality - defined in terms of male orgasm through penetrative sex) may be challenged by the very accounts of older men who are, or have been, affected by erectile difficulties and have used drugs like Viagra themselves. We present the perspectives of mid-to-late life heterosexual men in New Zealand whose stories question the contemporary biomedical privileging of erections and intercourse 'at any cost and at any age'. We argue that the current push to identify and treat so-called erectile dysfunction (and restore erections and penetrative sex to relationships) neglects some men's own experiences of alternative modes of relating sexually that they identify as 'normal', 'healthy', 'enjoyable' and 'satisfying' for them and their partners; and undermines their understanding of such changes as positive outcomes of ageing, experience and maturity.

"Viagra stories": challenging 'erectile dysfunction'

Medical approaches to sexual difficulties prioritise the physical aspects of sexuality over other aspects, locating 'disorders' primarily in the anatomy, chemistry or physiology of the body. In accordance with this perspective on sexual matters, physicians look to physical interventions (for example, hormones, drugs, and surgery) to treat any 'abnormalities'. Following the discovery of popular--and profitabl-e-sexuopharmaceuticals such as sildenafil citrate (Viagra) for the treatment of erectile difficulties affecting men, the medical model has gained increasing influence in the domain of sexual health and well-being. However, while medical definitions of--and interventions related to--sexual difficulties are underpinned by an understanding of a 'universal' body (that is, an essential biological body that transcends culture and history), and by the categorisation of the normal and the pathological, the accounts of users of Viagra, and their sexual partners, do not necessarily support such understandings. In some cases, the experiences and perspectives of those affected by erectile difficulties directly challenge the reductionist model of sexuality and sexual experience espoused by medicine. In this paper, we report on a New Zealand study investigating the socio-cultural implications of Viagra, involving 33 men and 27 women discussing the impact of erectile difficulties and Viagra use within relationships. The diverse experiences of participants are discussed in relation to two key issues: the notion of 'sexual dysfunction' itself; and the idea of drugs such as Viagra acting as a 'quick fix' for sexual difficulties affecting men. We argue that the existence of a range of Viagra 'stories' disrupts a simplistic mechanistic portrayal of the male body, male sexuality and 'erectile disorder'.