Brooke Gladstone: This week we air the third and final episode of Hard, the series about Viagra from our colleagues at Death, Sex & Money. In this episode, we hear from Viagra users past and present whose ideas about sex have shifted from being a goal-oriented pursuit to one that is much more about pleasure and acceptance. Here's the host, Anna Sale.
Anna Sale: Hey, it's Anna. This is the final episode in our three-part series called Hard. If you missed either of the last two episodes, I definitely recommend going back and taking a listen first. I want to give you a heads up that, in this episode, we get pretty detailed about sex, more than usual on the show. Hold on to your hats.
Carson Tueller: I absolutely know that there is a sense of loss in breathing that comes when you lose physical function. If you could previously have an erection and have penetrative sex with your partner in a really fulfilling way, and you can't anymore, the grief in the loss from that is totally legitimate. That doesn't have to mean that something is wrong with you. It just means it's time to learn how to have sex differently.
Anna Sale: Carson Tueller knows both the loss and learning that comes with the big change in physical function. Nine years ago, he was in an accident that left him paralyzed from the chest down. As somebody who takes Viagra sometimes, do you identify as having erectile dysfunction?
Carson Tueller: That's so funny because I actually don't, even though I absolutely do. I think it's because I know it's a symptom of paralysis, so I 100% do. It's just a part of the package.
Anna Sale: If you were speaking to somebody who has struggled with erectile dysfunction and who has turned inward and away from romantic connection because of the pressure of that, what would you say?
Carson Tueller: I would say, "Let's name this. Let's name what's happening here." I would say, "You are experiencing the impact of internalized ableism. That's what you're experiencing, which is adding judgment to your physical function because what's so, what is true is that your penis works the way that it does, and the way that it doesn't. There's nothing good or bad about that. There's nothing wrong or right about that." Then I would tell this individual, "You can have a better sex life than you have ever experienced or ever had without the use of your penis, or without it working and popping up the minute you think about something.
There are so many ways to have sex, and it would be of great benefit to you to consider that sex is so much more than you've ever considered it to be."
Anna Sale: I'm Anna Sale and this is Hard, a series from Death, Sex & Money about Viagra.
Male Speaker: I have to go to the bathroom and put cold water on my erection.
Anna Sale: Erectile dysfunction.
Female Speaker: Sometimes you shouldn't have an erection.
Anna Sale: And the ways we do and don't talk about sex, relationships, and our bodies.
Male Speaker 2: I try to keep things as confusing and messy as possible so that you can't pin me down.
Anna Sale: For the past few weeks, we've been hearing from people who have experienced erectile dysfunction and from people who were involved in creating Viagra, the first pill to treat ED. In the past quarter century, millions of individuals' sex lives have been impacted by Viagra and drugs like it. As we heard in the last episode, the messaging in Viagra's ads evolved over the years and became less about the problem of ED and more about the idea that Viagra can help you have better sex. Sex, though, is complicated, and there are a lot of parts of a sex life that Viagra has nothing to do with. Producer, Katie Bishop is here with me. Hi, Katie.
Katie Bishop: Hi. Yes, this is something that I heard over and over again from psychologists and sex therapists that I talked with including Dr. Jenn Bossio. She practices in Ontario, Canada.
Dr. Jenn Bossio: Certainly, Viagra doesn't teach people what are the ingredients to having this really enjoyable sex life like with communication, like novelty, like not sticking to one particular sexual script but switching it up now and then.
Anna Sale: You may remember from earlier in the series, that before medical interventions like Viagra were available, ED was mostly seen as a psychological issue, and people were referred to therapists or couples counselors for help. That couldn't really solve an equipment problem for people who had underlying medical issues like those stemming from prostate cancer, for example. Then, as more was learned about how erections worked, ED became something that doctors could treat with drugs, but this left a lot of therapists concerned that all these other really critical elements of a healthy relationship and sex life that you might talk about if you did see a counselor could be skipped over if you've got this pill that can offer a quick fix.
Dr. Jenn Bossio: I think there is really good evidence to suggest that perhaps something like Viagra and therapy in combination might be really helpful. This pill might help, but what might be even better is if we look at all parts of you, the brain, the body, and your relationship. Then from there, we get a really good idea of what's going on, what's contributing to these sexual health problems, and we start building up tools that yes, might help with a more enjoyable sexual response. Really, it's also helping reducing stress, learning ways to manage the stress of living a difficult human life.
It's learning tools to help manage mood, it's learning tools to help manage anger, assert yourself in relationships, build healthy relationships, and all of those are the foundations to really good mental health. There's a ton of these psychosocial elements of having this good sex life that a pill can't address.
Octavia Leona Kohner: I was noticing an effect on Viagra and that was really helpful, but that wasn't fixing the core problem I was having, which was feeling like shit or feeling like nothing.
Anna Sale: Octavia Leona Kohner is 30 and lives in New York. About 10 years ago, she says she started struggling with her mental health. She's a transwoman and had started hormone replacement therapy, and then her doctors prescribed her an SSRI. When she started experiencing ED, she asked her doctors about Viagra.
Octavia Leona Kohner: I think the thing that caused the most erectile dysfunction if it was not the SSRIs, it was the constant verbal and physical assault I was experiencing as a transwoman, giving me extreme anxiety, and depression, and PTSD. I was really going through it. It was the early 2010s, which were not the hardest time to be a transwoman and person for sure, but definitely not the easiest time.
Anna Sale: Your interest in medication like Viagra, was it prompted at all by any of your partners' reactions to you?
Octavia Leona Kohner: You're in your early 20s and you're sleeping around, and there's, people are going to be like, "Hey, why can't you get hard?" because I think there is that sort of idea that if you're in your early 20s, you're going to be able to get hard fast and keep it. Like virility, and youth, and all these other things, you're just like, if you can't do this, then it's noticeable.
Anna Sale: What did you notice when you started taking Viagra? How did your body work differently?
Octavia Leona Kohner: I was able to maintain an erection easier, and/or achieve an erection easier. I did notice a change in the efficiency from my erections. I noticed that but still was very much like, "Maybe if the problem is medication, I shouldn't have to fix it with medication. Maybe actually what the solution is, is that I skill build and learn how to deal with my problems in a way that doesn't super require SSRIs all the time or different SSRIs.
Anna Sale: Did you discontinue taking Viagra?
Octavia Leona Kohner: Eventually, yes. I've since done it occasionally, especially at times of high stress or at times where I'm maybe on different medication. I tried taking it recently, for example, because I was on medication that I think was negatively affecting my-- I'm going to rephrase that. Not negatively affecting, but I was on medication that was making it difficult to achieve and maintain an erection, and so I had tried it again recently, and it worked fine.
Anna Sale: Octavia, I wanted to pause and just talk about words for a minute because we've been using the term erectile dysfunction. Is that a term that you're comfortable using?
Octavia Leona Kohner: I think that's why I keep stopping myself when I say erectile dysfunction because I understand that it is a sort of direct descriptor of dysfunctional erections. In my most saintly of days, I try my hardest to just describe the mechanics of a situation rather than using perhaps words that people associate with judgments such as dysfunction. If you hear someone is dysfunctional or something is dysfunctional, I think that is not the most savory of words one could use. I don't really want to use that language because I think that language will inform my own feelings. I don't want to feel bad about not getting hard sometimes.
Anna Sale: How do you think about that term, Erectile Dysfunction?
Conor Creighton: I don't know. Personally, I prefer to say floppy dick.
Conor Creighton: Do you know what I mean? Let's bring a little bit of humor into it. Erectile dysfunction sounds like something that might happen in a factory. Oh my God, the cranes won't come down. We've been erectile dysfunctioned.
Anna Sale: Conor Creighton is in his early 40s now, but he started experiencing erectile difficulties in his teens. He remembers vividly the first time he wasn't able to maintain an erection. He was 17 and having sex for the first time.
Conor Creighton: I don't know if I technically lost my virginity then. It was an interesting thing where I had an erection for part of the experience and then lost the erection. For me, I was like, "Oh, shit, am I Virgin-ish, or did I lose it a bit, or--" You know what I mean.
Anna Sale: [laughs] "Did I lose it a bit?" Did part of it float away?
Conor Creighton: I didn't know what to make of it.
Anna Sale: What did you think was happening inside your body?
Conor Creighton: Oh, my God, I thought I was defective. It was horrific. I was always quite anxious. I sometimes say that I feel like I came out of the womb chewing my nails, and it was clearly, anxiety was a big part of my ED, but then what would happen is that sometimes I would meet someone who I really liked, and they liked me. Then I would almost avoid going further with it because I just felt like, oh fuck, I can't face the potential humiliation of not being able to get it up for someone who I really like. On those moments I would sometimes then go home with someone who I didn't like as much.
Anna Sale: Did you ever have a partner shame you for not being able to perform in the way that she thought you ought to?
Conor Creighton: Oh God, yes, but that was back in the days when I used to date alcoholics. Those relationships were also just a reflection of where I was at that time, but yes, there were. I remember one partner, in fact, we were having sex, and she just stopped me, and she goes, "You're just not brave enough." [laughs]
Anna Sale: Oh.
Conor Creighton: Something like this. I stopped the sex, and I don't think we lasted very much longer after that.
Anna Sale: That would ruin the mood, I would say.
Conor Creighton: Yes, kind of, right?
Anna Sale: Yes.
Conor Creighton: More than a fart.
Anna Sale: Conor eventually started taking Viagra. He says he first stole a few from his dad's sock drawer. Then, in his mid-20s, he asked his doctor for a prescription.
Conor Creighton: The conversation was very brief. I just said, "Yes, I sometimes get erection problems." I just was like, "Is it possible for you to prescribe me something?" Yes, he did. He didn't really ask an awful lot about it. I think he checked my heart and checked my blood pressure, things like this, but there was no question about, "Are you anxious, or are you stressed out, or do you have problems or anything like that?"
Anna Sale: Conor told me he typically used Viagra at the start of a relationship to build up his confidence and then stopped using it. Then, in his 30s, he decided he didn't want to take it anymore.
Conor Creighton: This is also when I began to meditate, and when I began to take my mental health seriously. Part of that was just allowing myself to be, whatever lover showed up, I was okay with that. I was becoming better, like if I didn't have an erection, being able to say little things, like I would just say, "Oh, hey, look, I'm just a bit nervous. Do you mind if we hold off to the next time?" Things like this, I became better at saying that, and that helped a lot actually. That helped a lot. I generally found that that was always really well received.
Anna Sale: Do you think it was helpful for you to have Viagra available when you were in your early 20s and trying to figure out how to have sex?
Conor Creighton: Yes, definitely it was helpful, in that, maybe I would have turned to-- I don't know what else I would have done at that time. I think having an environment where people could talk about anxiety and mental health issues in young men, would have been much better than having Viagra. It was very useful at helping to tackle the problem, but the real curing that I needed, I just didn't feel that there was anything available at that stage. I think also you got to consider that when you are taking these performance-enhancing pills, you're not really in your body, and you're not really in the moment.
If it's all about performance, you're missing everything. You're missing all the nuances of sex. There's something extremely, I want to call it capitalistic about performance-enhanced sexual interactions because it's very much result orientated. As my more mature understanding of sex is that sex is a much more copacetic and enjoyable experience when it is about the experience rather than the result.
Anna Sale: Coming up.
Carson Tueller: I will tell you that I have so much sex right now that does not include me having an erect penis, and it's just really fucking fantastic.
Anna Sale: We hear more from Carson Tueller about exploring new ways of finding pleasure while also taking drugs to have his body work the way it once did. This is Hard from Death, Sex & Money. I'm Anna Sale. Dr. Gail Wyatt is a clinical psychologist and sex therapist at UCLA. She's been conducting research and seeing patients in private practice for 50 years.
Dr. Gail Wyatt: I don't think that penetration has to be the only method of sexual pleasure or gratification.
Anna Sale: Dr. Wyatt told me that when she sees patients, she wants to really understand the details of their sexual history and their current sex lives, but when Viagra became available in the late '90s, she says she noticed a shift in what some of her patients wanted.
Dr. Gail Wyatt: They would only see the absence of a firm erection as the issue. A general that I saw, that when he wanted an erection, he wanted an immediate rock-hard erection. I said, "It's not like you're saluting. That's not how the body works." A lot of people just, they wanted a technician. "Just give it to me." I don't prescribe medicine, so I obviously wouldn't be the person to do that. As a couple grows older, I think their expectations need to change. Some couples do that begrudgingly, but they find their way. It's not easy.
It's like saying, "My partner has only one arm."
What do I do? Do I begrudge the fact that that's gone, or do I find new value in the partner no matter what my partner has or doesn't have?
Carson Tueller: I hate the idea that disabled people think they're relegated to poor sex lives. That also translates to able-bodied people because if you have the privilege of aging in this life, you will become disabled.
Anna Sale: I called up Carson Tueller at home in Salt Lake City. He's from there originally and moved back there from New York after ending a relationship last year. He works as a coach and professional speaker. He often gets hired by companies to talk about resilience, and empowerment, and disability.
Carson Tueller: If I'm talking about ableism, anti-ableism disability in corporate settings, they're not usually eager to hear about how my penis works.
Anna Sale: Carson became disabled in 2013. He was at a trampoline park with his family when he landed in a foam pit and shattered one of his vertebrae. He was 23 years old, paralyzed from the upper chest down, and newly out of the closet. Had you had sex with a man before your accident?
Carson Tueller: No. I had only kissed a man or held a man's hand. When I was coming out, I was so deliberate because homosexuality or an LGBTQ identity does not mesh well with the Mormon experience. I was very deliberate about not doing anything that I would regret later, and the irony is that I chose not to have sex with my then-boyfriend, and then became paralyzed, and I will never know now what it's like to have sex with an able-body.
The irony is that sometimes I do regret that, the decision to wait.
Anna Sale: Have you always, since your accident, been able to achieve erection?
Carson Tueller: Yes and no. I can achieve manual erection on my own just by manual stimulation. The only time that that erection is hard enough to be functional, and I mean functional for penetration, for example, would be in the morning. Later on in the day or in any other moment, I am using Viagra to sustain an erection for sex.
Anna Sale: When you take Viagra for sex, does it feel good from the physical sensation in your penis?
Carson Tueller: No, I don't have much sensation in my penis. Actually, I have some here and there with certain kinds of touch, certain kinds of pressure, but my penis itself does not have much sensation.
Anna Sale: If you don't feel it in your penis, why do you take Viagra to have penetrative sex?
Carson Tueller: I do it for a couple of reasons. One is for my partner. If we're going to have penetrative sex, then using my own penis is both exciting, it's arousing, it's validating. It helps me feel like I'm in touch with my body still because there are some disabled people who are born with a disability, and I happen to acquire a disability. There's still large parts of my identity that are linked to how I used to feel, how my body used to function. I feel like me, I feel like myself, I feel at home when I'm in touch with that part of me, or when I can see that my penis is working the way that it used to.
It's a psychological piece. I find that so much of the sexual experience is deeply psychological. Even seeing myself again erect, or having penetrative sex and ejaculating is all incredibly arousing even if it doesn't feel the same way that it did previously.
Anna Sale: When you think about who it's for when you're having sex with a partner, and you are penetrating your partner, do you feel like it's more arousing that you are pleasing your partner, or is it arousing to look down and see that your body is capable of this?
Carson Tueller: It's both of those pieces. It's definitely both of those pieces, the visual of it, and also the connectedness. There's something about, for me, penetrative sex that is connected, like parts of bodies inside of other bodies, is both connected and intimate for me. I love that piece.
Anna Sale: Say you're with a partner and you've had penetrative sex, you've topped, and you're up for feeling more, what do you ask for?
Carson Tueller: I ask for any kind of stimulation in the places that I feel. I don't have a lot of skin sensation anymore. I think probably 85% of the real estate of my body, my actual epidermis is no longer sensitive. When I am aroused or I'm in a sexual experience, all of that becomes heightened and incredibly sensitive and responsive to touch. Any kind of stimulation like just rubbing hands across my chest when I have chest hair, or even a little bit of stubble on my beard or on my neck, especially on the back of my neck, sometimes I will intentionally make sure that I have hair because the sensation is all that much higher and intense.
I will ask for a partner to rub a hand, like an open palm across the top of my chest. That always literally makes me gasp with pleasure. Actually, the inside of [unintelligible 00:24:47] this all sounds so-- I'm listening to me say this and wondering what abled people must feel. When it comes time for me to actually experience the height of pleasure, I usually am asking or training a partner to kiss the front of my neck up to my ear, and while they're on my ear, to take their fingers and run it against my scalp on the same side of that ear.
There's something about that combination that literally takes me from, if I'm at a 6 of pleasure and arousal, to a 9 and a 10, where, with that sequence and staying there, I am climaxing within probably a couple of minutes. Then if a partner just stays there and continues to do that, I will continue to stay in that climax space for as long as that partner is there or until it becomes unbearable for me.
Anna Sale: When you say climax space, is it orgasm? Is that what it feels like?
Carson Tueller: Yes. It feels different from how I experienced orgasm as an abled person, but the way I've explained it before is it feels like there's sunlight in my veins. Like everything inside me turns white and euphoric, my whole body disappears into this state of pleasure. It feels like I'm injected with pleasure down to my toes, in a way that is pretty indescribable. I used to think that disabled sex and sex as a paralyzed man was always going to be somehow a demotion or a step down from the pleasure that I would have experienced otherwise, but paralysis, the pleasure I feel during sex, there is no piece of that, that feels inadequate, or not enough, or that I leave wanting more of.
It is completely and entirely fulfilling, and it also lasts so much longer than my orgasms used to be when I was abled. I can orgasm now for much longer periods of time and repeatedly because of how my body works now.
Anna Sale: It sounds also like how you've practiced and gotten to know your body.
Carson Tueller: Yes, 100%.
Anna Sale: I was struck, you said, "If I'm instructing or training," I think you said if you're basically-
Carson Tueller: I said training, yes.
Anna Sale: -training a partner, what to do, that kind of communication, do you think that being able to be so clear and direct about what you like and what brings you pleasure, do you think you would have been able to communicate like that in sex had you not become paralyzed?
Carson Tueller: I think I wouldn't have because I would have had no need to. I would have had a feeling penis, and I would have found a male partner who probably knew, or had a natural inclination to focus on my penis. I just would have, I think, assumed, "Oh, this is how sex is. It's very genital-centric. This is just how it goes. A plus B equals C, and then you both climax, and that's what we call sex."
Anna Sale: Yes.
Carson Tueller: Now, because none of that works on me, someone will go to town on parts of my body that I don't feel very much of, and so I have to say, "Well, if I'm going to experience pleasure, which is my intention here, and connection, then we're going to have to do that in a different way." That's going to require exploration and a lot of communication because there's no way that an individual could just deduce how I'm going to get off. Just, it's different for me.
Anna Sale: It sounds like you're sexually active now. You're single and sexually active. Is that right?
Carson Tueller: That is correct. I would like to be more sexually active. I've been working through my own internalized ableism, Anna. Just leaving a relationship, a monogamous relationship where I just didn't have to explain this shit to my partner. We could just be together, get each other off, have a good time. Now it's like it feels exhausting to think about a hookup or anything like that because of everything we're talking about. Both, I have to come in thinking, "Okay, what does this person know or not know about my sexual function? What questions might they have?
I'm going to be a disappointment to them because they're going to want to just like, get in, get off, get out." That doesn't work for me, or, "Is this person even the kind of person that wants to take the time to learn how to get me off?" Sometimes that whole piece just feels so emotional, and heavy, and too much that I'm just like, "Ugh, forget it," you now?
Anna Sale: Yes.
Carson Tueller: It's an investment, and so I'm constantly talking with myself, and I'm like, "Look, bitch, if you want sex, this is how it's going to work."
Carson Tueller: "This is how it has to go down. You're going to have to have a conversation, and it's worth it. Just do the work and put in the investment. That's going to pay off."
Anna Sale: Oh, "Oh, look, bitch, this is an investment," that's going to be a mantra that I come back to for many parts of my life, Carson. You've given me a gift.
Anna Sale: That is Carson Tueller in Salt Lake City. Thank you to everyone who shared their experiences as part of this series. If you missed any other previous episodes, I'd highly recommend going back and taking a listen. If you want to tell us about your own experiences with Viagra or ED, write to us at email@example.com. This series was reported and produced by Katie Bishop. Andrew Dunn composed the music in addition to mixing our episodes as he always does so wonderfully. The rest of our team includes Afi Yellow-Duke and Emily Botein.
We want to welcome our new producer, Zoe Azulay who joined us starting this week. Our intern is Gabriela Santana. Special thanks to Mike Barry, Michelle Xu, Theodora Kuslan, Andrea Latimer, Kim Nowacki, Dalia Dagher, Caitlin Pierce, and to Radiolab's Lulu Miller, who suggested that we reach out to Carson. Death, Sex & Money is a listener-supported podcast. Please make a contribution today at deathsexmoney.org/donate. If you are new to our show, we have a starter kit of our favorite episodes. Check it out at deathsexmoney.org.
We also have a weekly newsletter. You can sign up for that at deathsexmoney.org/newsletter. I'm Anna Sale, and this is Death, Sex & Money from WNYC.
Brooke Gladstone: Thanks for listening to this week's podcast from our friends at Death, Sex & Money. Tune into the big show this week out on Friday to hear how the Russian propaganda machine has switched gears since the invasion of Ukraine. I'm Brooke Gladstone.
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