IMPOTENT NO MORE

Viagra is a funny word, funnier than sex or penis or vagina or intercourse. You don’t need to construct a Viagra joke, because the word contains its own setup and punchline. Just drop it into a conversation and if there are men present in the room you will get a laugh, or at the very least, smirks and smiles.

Viagra is the most famous pharmaceutical in the world, but it’s not the most popular. Lipitor, which lowers cholesterol levels in the blood, is the number-one selling drug on the planet ($8 billion US in 2002). Norvasc, which treats high-blood pressure, and Zoloft, an anti-depressant, are also more popular than Viagra.

But there are no Lipitor or Zoloft joke sites on the web. We don’t laugh at aspirin (“Did you hear the one about the man with two headaches?”) or Neocitrin or Tylenol. We don’t think heroin is funny. Snorting cocaine up your nose looks funny (see movies by Woody Allen, or Cheech and Chong), but nothing about the illegal drug trade is funny. Why is Viagra funny?

Viagra is funny because it’s about sex, still our most powerful taboo, and more specifically, about a man’s inability to have sex, an even more powerful taboo. The clinical phrase referring to this inability to have sex is erectile dysfunction. I prefer the word impotence, which carries an appropriate, almost biblical weight commensurate with the emotions involved.

My doctor thinks Viagra is funny, too. He smiled for the first time when I asked him for a prescription three years ago. “Viagra,” he said, “is a wonderful drug. “

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For seven years, from 1992 until 1999, when I began taking Viagra, I was mostly impotent. During this time I was in a common-law relationship with a woman I’d met in 1982, in Toronto. During this time I ran a small business, taught night school, told amusing, self-deprecating stories, went for lunch with friends, laughed at jokes, sailed my boat, led an otherwise normal life. If you’d been a student in one of my night school computer classes you might have thought, Stephen is a happy, successful man with a great sense of humour and a tremendous enthusiasm for life. You would never have guessed that I had a secret that made me feel guilty, ashamed and depressed. It was a secret shared by two. The woman in my life, whose love and patience kept us together, is the silent partner in this story.

At first I dismissed impotence as a temporary problem, an aberration caused by the stress of leaving a full-time job to run my own consulting business. I’d turned forty. Like many men, I’d had occasional erection problems since my twenties. But in 1992 occasional impotence became a steady pattern of failure in bed.

Impotence is a strange, contradictory beast. You still feel arousal and desire, but your body doesn’t function. You declare war on your body and demand obedience but your orders are ignored. Instead, sexual anxiety invades the bedroom likes a noxious gas. Your partner can smell it. The tiniest trace of it prevents an erection. Aroused, you wait for your body to catch up but it does not. Then your hand stops in mid-caress and you give up. You apologize yet again to your partner, and as you turn away from her and pull the covers over your head you feel overwhelmed by depression. The silence in the room threatens to smother you. In the morning, you feel the dull, steady pressure of guilt and shame.

The infernal core of impotence was my failure to find the courage to talk about it. I was hopeless. I could barely say the word “impotence” let alone talk about it honestly with my partner. I was too afraid that it signified the end of our relationship, or some terrible flaw in my character, or that I was secretly gay and not aware of it. I thought crazy, desperate thoughts but never expressed them.

After two years of denial, of mostly inept, unsuccessful lovemaking, my partner finally forced me to go to a doctor for a physical exam. He did the tests and said I was fine. I think I was disappointed that I couldn’t blame my impotence on a faulty body. That left a faulty mind, some kind of psychological maladjustment, or my worse fears, that I was falling out of love with my partner, or no longer attracted to her.

I ignored the problem for another year and then my partner handed me a brochure from a sex therapist and insisted I go. I agreed and for almost half year discussed the details of my sex life for an hour an week with a woman who seemed sympathetic but couldn’t help me.

More time went by. I am ashamed to admit I still thought the problem would go away. I don’t know how my partner dealt with the terrible sense of rejection she must have been feeling. An impotent man is obsessed with his own feelings of failure; the woman in the relationship is suffering too, but his self-pity and self-absorption keeps her at a distance. This is how impotence, and the man’s response to it, destroys a relationship.

In 1997, again at my partner’s insistence, I went to see another therapist. Tom was a good therapist who helped me look at my entire life, my hopes, my disappointments, my goals, my frustrations, and tried to pry open a few insights that would help me. We did a couples session, where my partner sat beside me and talked about her perspective. The therapist and I talked every other week, and this seemed to help. Slowly, sex started to get better and I began to get my confidence back again.

I stopped the therapy and the impotence came back.

When Viagra was announced in the US in March, 1998, I dismissed it as a crutch for old men. But then I thought about it, and realized I had nothing to lose by trying it. Viagra was not legally available in Canada yet, but the Internet overcame that obstacle. In the fall of 1998, I logged onto a Florida web site that sold packets of 10 pills for $200 US. I filled out a form describing my medical history and read a warning that advised against the use of Viagra for men taking any kind of nitrate heart medication. I knew that heart attack deaths in the US had been reported. I wasn’t taking nitrates but the health warnings made me nervous.

Two weeks later a brown envelope arrived. There were ten small blue pills. I was too scared to try one. I hid the bottle in the hall pantry.

When my partner celebrated a big birthday in the spring of 1999, I planned two surprises: a night in a luxury suite in an expensive hotel, and Viagra. To reduce the dose, I cut one pill in half using a chef’s knife, and put the half pill in a piece of kleenex and put the kleenex in my pocket. We went to our favourite seafood restaurant for dinner and then I surprised her afterwards by not driving home. “Where are we going?” she asked me. “You’ll see,” I said, “Happy birthday.” But even as I said those words I knew I’d lost my nerve. The half-pill stayed in my pocket.

The bellhop took us to a corner suite. I was anxious because I hadn’t taken the pill, but I thought the martinis, the wine, the dinner, the surprise, the kiss in the elevator, I thought all of these things would ease my anxiety and that we would make glorious love in the king-size bed. But my anxiety was not eased and we did not make love. Like a hundred or more times before, I was impotent. This time she said “Don’t worry, it doesn’t matter” and she meant it. I was furious with myself for not taking the pill.

A week later we went out for dinner. As soon as the wine arrived, I excused myself and went to the bathroom, turned on the cold water faucet, reached for the piece of kleenex in my pocket, extracted the pill, put the pill in my mouth and tasted for the first time Viagra’s bitter taste. I sipped some water and swallowed. I looked in the mirror. I thought of a line from a song from sixties, “One pill makes you larger, and one pill makes you small.” I smiled. I went back to our table and sat down.

After twenty minutes my face began to feel flushed and hot. I wasn’t uncomfortable, and I knew it was a common side effect of Viagra. My partner didn’t notice, or if she did, she didn’t say anything. We enjoyed our dinner. My heart seemed to be beating faster than normal. I didn’t know if it was the Viagra, or my crazy fear of a heart attack, or sheer nervousness, or the excitement of taking an illicit prescription drug that might change my life.

In bed later that night I was not impotent. My partner and I fell back into an old rhythm that I had almost forgotten. This rhythm guided the easy connection of two minds and two bodies, the gestures and movements that are known and familiar because you’ve done them a thousand times or more with a woman you know and live with every day and love. This rhythm is so easy and so right. There is even pleasure in the predictability of it, in knowing what is about to happen and what it will feel like.

Did I smile the next morning? I can’t remember. I probably did.

Viagra worked perfectly every time I took it. I found it usually took at least 30 minutes to take effect, although some men report times as short as 15 minutes while others wait up 45 minutes or an hour. I found as well that half a 50 mg pill worked just fine, so I used the chef’s knife to cut all the remaining pills into two.

The drug is not an aphrodisiac. It doesn’t transform you into a sex maniac. It doesn’t turn you on and it doesn’t produce an erection at the dinner table. It produces no sexual effect whatsoever until you are aroused. But by confirming arousal, it makes sex more enjoyable.

Viagra (aka sildenafil nitrate) works by a process of double negation: it inhibits a chemical called PDE-5, present in the penis, that in turn inhibits erections. “The beauty of Viagra,” says Dr. Andrew McCullogh, an American urologist quoted in David Friedman’s book, A Mind of Its Own: A Cultural History of the Penis, “is that it enhances a man’s natural response to sexual stimulation by diminishing its equally natural inhibiting process.” In other words, Viagra doesn’t really create erections, it stops them from disappearing. It defeats a natural mechanism designed to return the penis to its default state, flaccidity.

Friedman isn’t convinced that Viagra is a good thing. He points out that the long-term effects of a PDE-5 inhibitor like Viagra have yet to be determined. The 21 clinical trials that led to the FDA approval of Viagra five years ago, on March 27, 1998, involved 4500 men over three years, a relatively short testing period. The well-established link between Viagra and heart disease is ironic: the drug was first developed in the late 1980s to treat angina patients, who then reported, happily, a side effect of stronger and more reliable erections.

But more than 100 Americans died of heart attacks in the first six months that Viagra was on the market before Pfizer issued strong warnings against the use of the drug by men taking nitrate medication for heart problems. The concern about Viagra’s effect on the heart continues. “Viagra May Cause Heart Attack Deaths In Younger Men With No Heart Problems, Study Finds”, a health web site headline from March 2000, is a typical warning to Viagra users like myself who would rather believe the drug is perfectly safe.

No drug is. When my face feels warm from a Viagra flush, I sometimes think about the health risk. I rationalize it as acceptable, because the alternative is worse. Friedman describes Viagra as a “paradigm shift” that has “reconfigured the male organ, replacing the finicky original with a more reliable model.” He questions the hidden cost of this new ability to control the male body. But over the past fifty years, we’ve pursued an enormous and unprecedented pharmaceutical experiment in reconfiguring our bodies, minds, libidos, reproductive systems and psyches. Pfizer, Merck and Glaxo, the three biggest drug companies, collectively sold more than $120 billion worth of pills in 2002. We are a drug culture, profoundly and inescapably, whether we admit it or not.

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Men of my generation (I am 51) like to think of themselves as sexually enlightened, liberated and sophisticated, but sex is still a deep source of insecurity for us. We worry about size and shape. We dwell on “performance”, a word that suggests that the act of sex is a kind of theatrical event in which a man (the actor) must please a woman (the audience) or risk a bad review. Freud claimed that when we laugh at sexual humour (he called it “obscene wit”) we don’t know what we’re laughing at, but I don’t think that’s true. We laugh at impotence because we’re terrified of it.

Impotence affects almost half the men in North America over forty. Impotence is devastating because it undercuts our masculinity at the root level. This has nothing to do with macho sexual bravado. I’m not a stereotypically masculine man. I stand with my hand on my hip. I like silk shirts. I’ve been mistaken for gay by middle-aged female students (and no, I wasn’t insulted). I prefer the company of women to the company of men. I’d rather talk about love, grief, death, the Sopranos, Indian cooking and my mid-life crisis than the NFL, CFL, NHL and NBA.

To be honest, I no longer know what masculinity means. The word is exhausted by the weight of its historical, social and sexual baggage. But I understand impotence, because it’s visceral, because it tears away your sense of who you are. At a time in your life when you are finally hitting your stride, impotence knocks you down, and lays you flat. You do not want to get up.

A recent TV commercial for Viagra presents a slow-motion ballet of middle-aged couples on a suburban street. It’s summertime and the sun is shining. The men, accompanied by their wives, come running out of their houses and jump for joy. There is no dialogue. The soundtrack is a boomer classic, We Are The Champions, by Queen. The men are plain, unmemorable, dressed indifferently, barely distinguishable from each other, but their faces are filled with happiness, ecstasy and delight.

I love this commercial because it so perfectly captures what Viagra is all about. It takes a secret shame out of the darkness and shines the light of day on it. It reminds impotent men that they are not alone in their suffering, and that other men they know as friends and neighbours are suffering too. It depicts men not as isolated individuals but as husbands whose wives are full participants in the celebration. After the pain, guilt and depression of impotence, I want to jump for joy too.

Go ahead and laugh.