Brooke Gladstone: In 1998, when Viagra was approved by the FDA, it suddenly opened up new sexual possibilities for people who had previously none. The drug also sparked a very earnest and very public conversation about erectile dysfunction, one that quickly veered toward late-night punch lines. Yet, despite the millions of prescriptions written during its nearly 25 years of existence, for some, Viagra did not prove to be the quick fix they hoped for. Death, Sex, & Money, a podcast produced by WNYC; OTM's producing station, aired a compelling three-part series about Viagra earlier this year, and we'll be sharing them with you this month. Here's the host of the show, Anna Sale.

Anna Sale: How old were you when you realized that getting erections was not something that was going to be automatic for you?

Brandon: It all started early 20s. I would have been probably about 22, 23 struggling with that problem.

Anna Sale: This is Brandon. He's 27, lives in Toronto. It was around the time that he came out as gay, that he realized he had trouble getting and maintaining erections.

Brandon: I found myself very much avoiding sex, whether it would be leaving a date early, so that wasn't a possibility, or making sure that we were going out somewhere so that we weren't coming back with that daunting expectation of, "Oh, aren't we going to go into the bedroom? What does that going to look like? Am I going to be unable to get hard and to perform sexually?" I think at that point, I realized to myself that you need to do something here.

Anna Sale: Brandon talked to his doctor about it, and his doctor prescribed him Viagra.

Brandon: I found out that erectile drugs were very much a roll of the dice. For me, it was you might be able to get an erection and hold one or you might not, and there's no way of knowing.

Anna Sale: Do you feel sort of lied to by erectile dysfunction drugs about what fix they offer?

Brandon: [chuckles] Yes. Actually, initially, I did. You watch commercials all the time for Viagra and see all these happy guys doing all these activities. That was not my experience. I didn't find myself riding a ski doo through the lake here, or mountain biking in the forest. No, no. None of those things happened after I took these medications.

Anna Sale: I'm Anna Sale, and this is Hard. A series from Death, Sex, & Money about Viagra.

Participant: It's much easier, they just have an erection.

Anna Sale: Erectile dysfunction.

Brandon: I just remember thinking like my Christ have been cursed.

Anna Sale: The ways we do and don't talk about sex relationships and our bodies.

Brandon: Talking about [unintelligible 00:03:14], it did not at all.

Anna Sale: Brandon first emailed us three years ago, the subject line of his email was, "What happens when you're a 24-year-old gay man with ED."

Brandon: The standard is or the expectation is gay men have crazy wild sex all over the place. Whether that's out on the street in nature and the bushes or at home, homosexual gay male culture is very sexually charged. It's everywhere and it's in your face.

Anna Sale: Were you able to talk with anyone about how your body wasn't responding the way you wanted it to when it came to sex about erectile dysfunction?

Brandon: No. I'll be honest with you, really haven't. At the time, I was dating, I had a boyfriend. I did express that this was something that I was working through and that if you wanted to pursue a romantic relationship, this was the qualifier because it wasn't something that I could change or that I had control over in that moment.

Anna Sale: Do you remember how you explained it to him?

Brandon: Yes, very vividly. Three glasses of wine in, and pacing around his townhouse. It just came up like word vomit as, "I have something to tell you. I have erectile dysfunction. I'm not okay with this, and I'm struggling immensely. If we're going to progress in any way, shape, or form, you need to just be cool with this until I figure things out."

Anna Sale: Brandon is still figuring it out. In addition to taking Viagra, he takes medication for depression and anxiety, which can make it more difficult to get aroused. He and his boyfriend eventually broke up after about six months. Brandon got back on the apps, but he says he's had walls up when it comes to starting new relationships.

Brandon: You frame it as a one-night-stand or you frame it as a hookup, then you have nothing to lose. If it's somebody who I'm looking for more of a relationship with or seeing again and again, it could be a potential deal breaker for them.

Anna Sale: For you, when you think about what relationships you want to have in your romantic life, do you wish at this point in your life that you could have a more long-term relationship with one person?

Brandon: Yes, I would definitely prefer something stable and long-term, hopefully, maybe one day, but I think this over-sexualized culture, it doesn't say anything about having sex and not being able to get an erection is okay, is very much big heart exploding everywhere.

Anna Sale: According to a survey from Johns Hopkins in 2007, more than 18 million men in the US are affected by erectile dysfunction. ED can be caused by many different things, physical issues like high cholesterol and diabetes, and psychological ones like stress and depression, sometimes a combination of both. Despite how common it is, the reality of ED can lead to a lot of shame and disappointment for people affected by ED and their partners.

Participant: There is that idea that if you're in your early 20s, you're going to be able to get hard fast and keep it.

Participant: When it doesn't work, you challenge all aspects of your ego, your self-worth.

Participant: You don't flirt in the same way, you don't go on dates in the same way.

Participant: I got really big hurt feelings and big feelings of rejection.

Participant: We were having sex and she just stopped and she goes, "You're just not brave enough." [chuckles]

Anna Sale: The introduction of Viagra almost 25 years ago opened up new possibilities for people affected by ED. It blew open the conversation about it. It reinforced a very specific idea of what successful sex is.

Participant: A general that I saw said that when he wanted an erection, he wanted that immediate rock-hard erection. I said, it's not like you're saluting.

Anna Sale: We are doing a three-part series telling the pretty wild story of how Viagra came to be, and how it's led to some big questions about performance and pleasure, but to start, we're going to focus in on people's intimate lives and relationships that have been impacted by both erectile dysfunction and Viagra in ways that the cheeky public conversation about the drug has never quite captured.

Participant: People joke about these medications and there's so many memes and so much pop culture reference in a joking manner. If you think about it, the medication is for them in the plural. It's for the couple. It's for the marriage, the relationship, the partnership, it isn't just about a guy getting a boner.

Anna Sale: A woman we're calling Louise is 47 and lives in New England. She's been with her husband for more than 20 years.

Louise: It was never easy for him, even from the beginning to get erections. He wasn't the kind of guy who just had them all the time.

Anna Sale: After Viagra became available in 1998, Louise's husband got a prescription. For him, the drug worked well, but their insurance didn't cover it.

Louise: When these pills first came out, you'd get a prescription, you'd go to pick it up to $800. We'd say, "No, could we have like one pill?" You think about like how much is it really worth it to you.

Anna Sale: When he had the option of taking Viagra, how did it work when you would choose for him to take it to have time together?

Louise: I think it was never an explicit conversation like a commercial, "Why don't you take Viagra?" Is like one of us would be hinting like, "Hey, you want to--" Then he would take it. One of the side effects of these medications is your nose gets really stuffy. That's how I could tell that he had taken it.

Anna Sale: That's the code.

Louise: Yes. Like your nose gets really stuffy and I can hear him like [mouthing sound], and I would know he had taken it.

Anna Sale: I've never heard that before. That is so interesting. It's like a mating call.

Louise: It's very obvious.

Anna Sale: Huh. From your point of view, your experience, when he took Viagra, what changed?

Louise: It's a reliable way to get an erection that doesn't involve hurt feelings if things don't work.

Anna Sale: Oh, wait, tell me why you say it like that.

Louise: Because if your spouse or your partner suffers from ED and you're trying to have sex and they can't get an erection, that's devastating for them. It's just like this whole emotional thing. Then, of course, you want to avoid it, so you don't try to do that again. It's scary for the partner of someone who has ED to initiate or to try because there's always this risk that it's not going to work, and then their feelings are hurt. Then they're just upset and feel like they've let you down. Then you feel like a jerk for pressuring them. When you have this kind of medications, it just takes that emotional burden off of you.

Anna Sale: Also gives you a little space to have your own needs and desires.

Louise: Yes. It definitely makes it so that you don't feel like a bad person asking for sex. Especially now that my husband has had cancer, it's not his fault. I would feel like such an asshole if I was in any way criticizing his performance because how do you criticize someone who had cancer and had an important part of their anatomy removed.

[music]

Anna Sale: Louise's husband was diagnosed with prostate cancer a few years ago. He was in his late 40s at the time. As part of his treatment, he had his prostate removed. Prostate surgery often impacts nerves in the area. For Louise's husband, it made his ED even worse, and Viagra worked less reliably for him. According to Johns Hopkins, nearly everyone who has prostate cancer treatment has some form of erectile dysfunction afterward.

Louise: I don't think there are a lot of men who are really comfortable talking about this. I know I've been in support groups for people who are spouses of prostate cancer survivors. There's a lot of women out there suffering with the same issue where they have a really hard time talking about it. Some people will find sex outside of the marriage. Some people will just keep trying. Some people will settle for a sexless marriage. It's really complicated.

Anna Sale: In the support group for prostate cancer survivor partners, were you able to talk about how intimacy works in your marriage?

Louise: I did post once and I was told, "Well, there's lots of other ways to have sex. You should buy some sex toys." Really, what I thought was a tone-deaf response. I really didn't engage after that, and I left that group. The reality is most prostates cancer survivor wives are not in their 40s. For someone to be diagnosed at his age is very unusual. That's a really daunting thing to be 43 years old and think about never having sex again your entire life.

Anna Sale: Do you think about that? Do you think that's a possibility for you?

Louise: Sure. It definitely has been a thought in my mind. It has definitely been a possibility for me. Then, sometimes, I think, 'Well, there's Tinder", but I live in a really small town, in a really small state, and everybody knows me. There is just no way I could do something like that.

Anna Sale: The idea of having a partner outside the marriage if it was in a way that you wouldn't get caught socially has an appeal?

Louise: If my husband never knew, because I would never want to hurt his feelings, and I am not looking for a boyfriend, if purely sex, sure. If he didn't know about it, if it didn't have any possibility of just devastating him, sure.

Anna Sale: Now that we're talking about it, do you have that sense of just that craving? Not with intimacy with your husband, but just a craving for sex.

Louise: It comes and goes, I would say. A couple of glasses of ALDI wine, sure.

Anna Sale: Did you say ALDI wine? Like A-L-D-I, the grocery store?

Louise: Winking Owl. Do you not know the Winking Owl?

Anna Sale: No. [laughs]

Louise: $2.49 for a beautiful bottle of Pinot Grigio? Come on now.

[laughter]

[music]

Anna Sale: One more thing Louise told me, since generic Viagra became available a few years ago, her husband has been able to take it more regularly because the cost is lower.

Louise: It actually is working much better. He actually told me the other day that he woke up in the middle of the night with [unintelligible 00:15:23] erection, which hasn't happened in years.

Anna Sale: Coming up.

Participant: I would say, if you love him and you keep working together, you will eventually find what works for you.

Anna Sale: We hear from a couple for whom Viagra was just one solution of many as they tried to solve a sexual problem together.

Participant: One of your topics is death. Let's enjoy the journey until we get there because we're all going to get there.

Anna Sale: This is Hard. A series from Death, Sex & Money. I'm Anna Sale. Erectile dysfunction is not a new problem. It was referenced by the ancient Egyptians and Greeks, the Old Testament, and the oldest known text in Chinese medicine. A lot has changed in the way ED has been addressed in just the last few decades. For starters, what we call it has changed. In 1992, the National Institutes of Health officially recommended that the term erectile dysfunction be used. That was a big shift from just two decades earlier when this training film was made for medical students called The Impotent Husband.

[music]

Announcer: We are about to observe a conjoint marriage counseling session with a middle-aged couple. The problem presented by Mr. and Mrs. Palmer is one of the most frequent encountered by physicians and counselors.

Anna Sale: Death, Sex & Money producer, Katie Bishop, is here with me. She dug up this video in the course of her research.

Katie Bishop: I did. I found this on the National Institutes of Health website in their digital library. Just to paint a picture here, we're seeing a sound stage where there's a marriage counselor sitting across from a couple, a husband and wife. He looks like he's just come from the office. He's wearing a suit. She's wearing a nice dress. She's chain-smoking throughout the entire session. They've come in together to talk with this marriage counselor, because a few weeks prior, they'd had a failed attempt at having sex. Ever since, they've been having difficulties.

Marriage Counselor: Now, these days, let's suppose you were to make a romantic advance tonight, what would go on in your mind?

Husband: Failure. [laughs] Stop.

Marriage Counselor: I don't want to touch you with a--

Husband: Do not pass go.

Wife: He doesn't even want to try anymore. Why doesn't he want to try anymore?

Husband: That's because you fail so many times, and then it's no longer worth trying.

Wife: I've never held that up to you, have I?

Husband: Oh, I didn't say you did. That's not what we're talking about. We're talking about the fact that in my feelings, my mind-- The whole situation is embarrassing. Let's face it. I can't cut the mustard, and that's what we're really talking about here.

Katie: It's unclear to me if these are actors or an actual couple, but I really believe this bickering. I think it's legit. The couple keeps talking together throughout the film. At the end, the marriage counselor really helps them to talk to each other about what's been going on. At the end, they're able to be a little less angry at each other.

Marriage Counselor: How do you feel now about coming in? Is any [crosstalk]

Husband: It's a little better now.

Marriage Counselor: You talked with each other and it helps, right?

Husband: Yes.

Marriage Counselor: That's my commercial.

Wife: Thank you.

Katie: What I thought was really interesting about this film is back in the 1970s, there just was not much understanding about how erections worked and why they stopped working.

Doctor: Many people came in for treatment, but the GP or the urologist really didn't have tools or answers to address problems with erectile dysfunction.

Katie: I called up Dr. David Rowland. He's an expert in human sexuality. He's also a psychologist, and he started his career back in the 1970s, right around the time when this film was made.

David Rowland: There was a general misconception I think that most of men's erectile dysfunction was created because of their anxiety. At least in so far as we suspect today, most men's problems are more likely to be biologically based.

Katie: If the husband in this film had had some sort of medical condition going on, there just wasn't a lot that doctors could do for him.

Bob: Psychosexual therapy has an important role, but it doesn't cure a problem that is biologically based. If you think of the penis as a piece of equipment, and the equipment doesn't work, you need to have something that fixes the equipment. I think back then, it was looked upon as, "Yes, okay, you're getting older, and this is going to happen, and there's nothing you can do about it type of thing." That's life, guy.

Anna Sale: In the course of her research, Katie also met Bob. She found him on a website called FrankTalk. It's an online forum for people experiencing ED. Bob was in his early 50s when he first noticed something was different in the bedroom. It was the early '90s before Viagra.

Bob: Straight out, the erections wouldn't last. That became a frustration. Yes, we're getting older, but why is this happening? Within a year or so, that's when I started going to urologist, trying to find out what was wrong. The first urologist led toward being psychosomatic. In other words, it was all in my head. Believe me, it was not.

Anna Sale: I called out Bob and his wife Joanne at their home in Omaha. They're now in their 70s, and they've been married for more than 50 years. When Bob first started experiencing ED, they were recent empty nesters.

Bob: Well, as soon as we got rid of the two animals--

Anna Sale: You mean your kids?

Bob: Yes. As soon as we pawned them off on others, it was okay with us that there was that frustration of Bob couldn't get it up and stay. That was the big thing. How much, I can't yell at him about it. It's not something yelling would do. Truthfully, he would always say, "I feel so bad that you're not getting anything out of this." Well, if you love the guy, you want to help him.

Anna Sale: For a while, both Bob and Joanne felt like there wasn't much they could do, but then in the mid-'90s, Bob started seeing a different doctor.

Bob: He was younger and basically said "No, there's other options that you have that will assist. Not necessarily cure it." Viagra was just in its second phase studies, and he led me to one of the trials. It's like, "Hey, if I get a placebo, nothing's going to happen, and if I get the real drug, maybe something will happen, and maybe it will help somebody else." It was an interesting start to the journey.

Anna Sale: Yes. Did you notice any change in your erections?

Bob: Yes. Absolutely.

Anna Sale: When you realized that this drug was one that could help you, how did it change your sex life?

Bob: Oh, it greatly improved. In most all respects, with the exception of spontaneity. Even with intimacy, and touching, and closeness, it would take a while. It led away from the timing factor.

Anna Sale: It led more to scheduling.

Bob: Yes. I'm going to put you on the calendar for next Thursday, three o'clock.

Anna Sale: Bob took Viagra and eventually other ED drugs like Cialis and Levitra for about seven years, but over time, Bob says the drugs lost their effectiveness.

Bob: Oh, you start out at 25 milligrams, and you're up to 50 milligrams, then you're up to 100 milligrams, and the doctor says you can take 100 and you can split 100 into 50s. Take 150. That was when it's like, "Okay, what other alternatives do we have?"

Anna Sale: Was there a time after you started taking Viagra afterward those drugs for a series of drugs stopped working as well for you, when you had a conversation between you two that maybe intimacy is really important to us, touch is really important to us as a couple, but maybe the sex life we used to have we're just not going to have any more in the same way?

Joanne: No, we never reach that point. No. It's because of the fact of the one doctor who said, "There's so much out there, there's a pump. There's different things that can be done."

Anna Sale: Bob and Joanne tried a lot of different interventions. Then three years ago, Bob decided to get a penile implant. It's seen as a last resort for ED patients and involves surgically putting a device inside the penis that can make it firm. Bob, why did you want this surgery? What made you ready for deciding to take this step to do an invasive procedure?

Bob: Spontaneity.

Joanne: No drugs.

Bob: There's no drugs involved. There's no restriction rings. There's no pellets that you put you don't want to know where. It is an unbelievable relief. I think I'll speak for myself for me to be able-- She says, "Hey, how about 1:30 today? It's like, "Okay."

Joanne: I can do that.

Bob: I can do that.

Anna Sale: Is that one of your good lines that you use, Joanne, "How about 1:30 today?"

Joanne: Well, here's the funny part about this, we are now back on schedules, twice a week. We decided, well, Mondays and Fridays would work, but until hockey season began, Fridays are difficult at our age to get set up for Friday afternoon, and then leave at six for a hockey game for three hours. [chuckles] It's to the point of yes, there's spontaneity. It depends on, okay, do the grandkids need us? We try to do it twice a week. Right now we got, let's see, it was Tuesday of this week. Oh, and on my birthday a week go. Yes, we time that a week ago.

Bob: If she had said no at any point, prior to that surgery, I would have never done it. Period, end of statement.

Joanne: The night before the surgery, he turns to me and said, "Number one, are you with me for future sex? Are you with me for this surgery?" I said yes on both because it's just part of the journey.

Bob: It makes stuff a hell of a lot easier if you work together. That's where we're at right now. It makes it fun.

Joanne: "You don't have problems," Dale Carnegie says, "You have situations, you work through." In that work through is what we do in this marriage.

Anna Sale: I love that quote, but a quick fact check here. We actually couldn't find evidence that Dale Carnegie actually said those words. We asked Joanne about it, and she said that Bob took a Dale Carnegie's sales workshop in the '80s and told her she might just be remembering the gist of one of his textbooks. Anyway, they had that idea in their back pocket, when Bob entered the Viagra trials in the '90s.

You got to sample Viagra before it was out in the wide broad marketplace and see how it would affect your intimate life. Then it becomes this cultural phenomenon where it's all anybody's talking about. All of a sudden, erectile dysfunction is a term that people know. What did you make of that? All of a sudden this thing that had been secret within your bedroom was now something that was much more open in the culture.

Bob: From a cultural standpoint, of course, we were very much into NASCAR, and of course, there was one driver that had a whole car that had the blue pill on it. I took it as, well, it's an awakening, and guys are starting to talk about it, to think about it. Instead of just accepting it, they were finally talking to their doctors, like the old commercial. "You talk about Viagra".

Participant: To learn more, race over to viagra.com.

Anna Sale: On the next episode of Hard, we're going back to that time when Viagra entered the public consciousness.

Participant: Viagra was going to be the first drug that was going to put Pfizer on the map.

Anna Sale: Viagra was approved by the FDA in 1998. Just a year after the FDA started allowing prescription drug companies to market directly to consumers.

Participant: You want better sex, Viagra Is a way to have better sex.

Participant: Our phones do not stop ringing.

Participant: They come to the urologist, they heard the urologist might have something that might help them.

Anna Sale: In the next episode, we talk about the collision of medicine, science, money, and marketing that created a Viagra explosion.

Participant: He basically said you've wasted money for eight years, David.

Participant: Was this going to be so offensive to people?

Participant: It was exciting on that day.

Participant: He says the words, "Oh, hell" in a British accent and takes his pants down in front of freaking everybody. He had this massive erection.

Anna Sale: This series was conceived, reported, and produced by Katie Bishop. The original music in this series was composed by our engineer Andrew Dunn with additional help from Rachel Han. The rest of our team includes Afi Yellow-Duke and Emily Botein. Special thanks to Caitlin Pierce and Alex Barron. Our intern is Gabriela Santana. I'm Anna Sale and this is Death, Sex & Money from WNYC.

[music]

Brooke Gladstone: Thanks for listening to this week's midweek Podcast. In the week's big show out on Friday, we'll be following the rise of the so-called Parental Rights Groups in America. See you then. I'm Brooke Gladstone.

[music]

[00:31:51] [END OF AUDIO]

 

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