books discussed in this review:
The Rise of Viagra: How the Little Blue Pill Changed Sex in America
By Meika Loe
New York University Press
288 pp., $37
The Joy of Sex: Fully Revised and Completely Updated for the 21st Century
By Dr. Alex Comfort
256 pp., $29.95
When I was twelve, my best friend scratched a line in the dirt with a stick and drew three dots along it. This was the female genitalia, he said. There were three openings: one for childbirth, one for urinating, and one for sex. “If you pick the wrong one,” he told me, “she’ll die instantly.” Boys learned the nuances of sexuality from older brothers or the schoolyard medical expert. Girls were warned by their mothers. These armies clashed in the Chevrolets of the nation.
Other sources were equally arcane or limited: a grainy, black-and-white, war-era film screened in grade-seven health class that warned soldiers about venereal disease, perhaps, or a cursory parental chat. Our desires were contained within us, isolated and abnormal, each adolescent a separate freak. But we were saved by books, among them The Joy of Sex, read in guilty instalments at the local Coles bookstore.
The rise of sex literature was a surprisingly tortuous and unentertaining evolution. In the 1930s, the Freudian scientist Wilhelm Reich wrote that the orgasm was fundamental to our emotional health, a view that was considered subversive. His journals and research notes were burned, and he eventually died in Lewisburg Penitentiary, where he had been imprisoned for contempt of court. In 1948, Alfred Kinsey, a biologist at Indiana University, interviewed 5,300 men and published Sexual Behavior in the Human Male. Five years later, he interviewed 5,900 women and published Sexual Behavior in the Human Female. He was called the “Father of the Sexual Revolution” and his work was condemned by right-wing groups as being dangerous and immoral. His research was later denounced as skewed and his own sexual character impugned as sadomasochistic. Kinsey is now the subject of a film (Kinsey, starring Liam Neeson). But when his work was first published, there was a fear that it would under-mine the institution of marriage and, by extension, American society. Efforts were still being made to preserve sex-within-the-bounds-of-marriage as something between a right and a duty, depending on your gender.
It wasn’t until the mid-Sixties that the self-help sex book came into its own. In 1966, William Masters and Virginia Johnson published their landmark study, Human Sexual Response. Times were changing and, although the book did come under some criticism, it became a best-seller and its authors were celebrities. Human Sexual Response was authoritative and groundbreaking, though, as the title suggests, still a bit clinical.
Three years later, Everything you always wanted to know about sex *but were afraid to ask, by Dr. David Reuben, was published, and it marked the crossing from research to popular advice. Structured as a Socratic dialogue between a naïf and a doctor, it was, in retrospect, a catalogue of clichés, homophobia, and idiosyncratic judgments. (lsd is an aphrodisiac; preferring oral sex to intercourse is “a probable sign of an emotional problem.”) Its value lay not in the choice of subject (sex permeated the culture in 1969) or in the information it provided, which occasionally duplicated the advice we had been getting in pool halls for decades, but in its very existence. Here was a book displayed and sold in staid book-stores that openly addressed the subject of sex and offered a level of detail that was otherwise unavailable. Where else could a fifteen-year-old find a clitoris? Reuben wasn’t a graceful writer, or a reliable source, but that brilliant title reverberated across the continent. Woody Allen seized its inherent comic potential and broadly adapted the material to a film of the same name. When the book was updated and repackaged in a thirty-year anniversary edition a few years ago, the publishers said that more than 90 percent of the information in it was new.
The other classic of the era was, of course, The Joy of Sex, by Dr. Alex Comfort, which is also available in a revised thirtieth-anniversary edition, though it has aged more gracefully. The gentle line drawings are still maddeningly unerotic, accompanied in the new edition by tame photographs of models nuzzling in pre- or post-coital embrace. The positions are French (cuissade, négresse) or lyrical (Birdsong at Morning), the tone avuncular, the range a bit suburban. Like The Joy of Cooking, it is a practical, if slightly unadventurous, guide, and it, too, was a best-seller when it first appeared, in 1972. We were still in the authoritative, sterile hands of the medical profession, a portent of what was to come.
A flood of books on sex followed over the next thirty years, books that offered judgments, illustrations, interpretations, and, usually, assurance. It is a literature of inclusion. No matter how dark our thoughts, how unChristian our desires, how unreliable our flesh, we are not alone. Our need to dress up as Little Bo-Peep, our dreams of having sex with Margaret Thatcher, our onanism, frottage, our rubber fetish — all of this is normal.
It took a generation for the normalization of sex to take root in North American society. Sex literature has now reached middle age; it has seen positions replaced by politics, and it’s grown a bit tired. The spirit is willing but the flesh is weak. And now there are books that address this issue. The Boomer’s Guide to Sex That Sizzles is one optimistic title. Sex May Be Wasted on the Young: For Boomers and Beyond is another, and this one is overt in its endorsement of the Viagra ethos. Back to Great Sex: Overcome ED and Reclaim Lost Intimacy has a foreword by a Nobel Prize winner in medicine, and its author links erectile dysfunction not just to sexual health, but to human rights. There is a shelf full of other books that reassure us that post-retirement sex is normal, given the right medication. No strangers to drugs, boomers are happy to embrace this new ethic (“One pill makes you larger . . .” ).
In her book, The Rise of Viagra: How the Little Blue Pill Changed Sex in America, the sociologist Meika Loe argues that the concept of normal is being redefined. She examines the cultural impact of Viagra in the six years since it was introduced. Viagra became the fastest-selling drug in history, and quickly transcended the medical world. Along with its competitors, Levitra and Cialis, it is aggressively advertised directly to the consumer, using both sports metaphors (“Step up to the plate,” “Stay in the game,” “Light the flame”) and sports figures. “Iron Mike” Ditka, the former coach of the Chicago Bears, a caricature of the hard-nosed, blood-and-thunder football deity, endorsed Levitra in a Super Bowl ad. The retired Brazilian soccer star Pele pitched Viagra, albeit with the caveat that he didn’t need it himself. But if he did, he said, he’d use it. The drug remains a staple of comedy routines (Viagra is like Disneyland: a one-hour wait for a two-minute ride), and it is used as a verb in the business world. Viagra grossed more than a billion dollars (U.S.) the year it was introduced. From a pharmaceutical company’s perspective, this was the perfect storm, a condition that was common but not normal. But defining normal, branding normal, became the marketing challenge.
Before you sell the drug, one physician noted, you have to sell the disease. The language has been refined, with impotence replaced by “erectile dysfunction” and shortened to ED, and it has shifted from a problem that had both physical and psychological causes, to a purely medical condition. It has been further refined to an “organic” problem, and Pfizer, the manufacturer of Viagra, advertises its product as the natural solution. Pfizer salespeople are armed with the statistic that 52 percent of men over forty suffer from ED.
This number comes from a questionnaire given to 1,290 men, who were asked to rate their potency on a four-step scale ranging from not impotent, through minimally and moderately, to completely impotent. If you were occasionally too drunk, or suffering from stress, or weren’t in the mood, or were no longer attracted to your partner, then you could be suffering, in effect, from a disease. This shifted the foundations for normal, and they continue to shift. The natural process of ageing has been replaced by sexual possibility. An eighty-one-year-old man can have the erection he had when he was eighteen, a consistent, blue-steel ally. A veteran Pfizer salesperson is quoted as saying that “the real use of Viagra — is not in cases of absolute medical need . . . I think the real use of Viagra is, say, for the guy who is probably forty-plus to age sixty-five that just isn’t what he used to be.”
The drug industry is the most profitable, and powerful, in the U.S. (In 2000, it had 625 lobbyists in Washington, out-numbering Congress.) Drug companies are the principal source of research funds, and are able to define the parameters of debate to some degree. In 1994, two prominent sociologists and sex researchers reported that between 30 and 50 percent of American men and women complained of “sexual dissatisfaction.” As this research entered the industry machinery, “dissatisfaction” became equated with “dysfunction.” There was a subtle and effective medicalization of sexuality. Dissatisfaction could mean a crumbling marriage, or ennui, but dysfunction signalled a medical issue. At one symposium, held in Boston, urologists disdained the input of psychiatrists, psychologists, and sex therapists. “As urologists we embrace the scientific method,” one said later. “But the others . . . they don’t embrace the scientific method at all, and they are there singing ‘Kumbayah’ and holding hands.” The medical model quickly became accepted wisdom: ED is a disease, and if we’re not sick now, we will be. The literature has responded with chapters dedicated to dysfunction and its various cures.
What is being treated here? Meika Loe argues that men have been losing status and power in the workplace, the home, and the bedroom for years. Like teenaged anorexics, they are concentrating on the last place where they still have some control: their bodies. Give it steroids to make it strong, Viagra to make it work. Viagra promises power, and at the individual level, where is the crime? A fifty-three-year-old man tells Loe that the world relies on drugs; what is wrong with a drug that enhances “the full and most zestful part of being human? ” But, at the societal level, it could be changing the definition of what it is to be human. Male sexuality, notoriously amoebic already, is in danger of being further simplified by the drug companies.
The response of women to Viagra has been mixed. A cartoon shows an elderly man asking his doctor for a Viagra prescription. Behind him, his wife is holding up a sign that reads, “Say no.” This view is seen in letters to Ann Landers (represented in Loe’s book and stirring again those nagging doubts about their provenance) where women as young as fifty write in to say that after thirty years of marriage, they have “earned a rest.”
Well, it turns out that perhaps they, too, have a disease — “female sexual dysfunction” (fsd)—though as yet there is no cure. The search for a female Viagra may be hampered by the anticipation of less profit, and by the perceived complexity of female sexuality. Male sexuality has been brilliantly stripped of all context, reduced to a singular empirical focus. How big? How long will it last? It’s like shopping for fruit.
But the attempt to medicalize female sexuality doesn’t have the same reductive advantages. In laboratory tests, some women who watched pornographic videos demonstrated increased blood flow but reported that they weren’t aroused. There was a disconnection between physiological and psychological responses. In her wonderfully observant book Talk Dirty to Me, Sallie Tisdale wrote that her mind often reproved what her body responded to. Such is the nature of sex, a naturally conflicting area where libido, history, intellect, and politics all vie for position. A cartoon reproduced in Loe’s book has the tag line “Viagra Supplements,” which include Talkra (“Revives flagging interest in what she has to say”) and Anniversra (“Rekindles a passionate drive to remember birthdays, anniversaries, etc.” ). The message is that sex can’t be reduced to its physical essence for everyone. Viagra is a simple solution to a complex issue.
Viagra hasn’t been promoted as a recreational drug, but recreational use has been an inevitable and highly profitable market for Pfizer. You don’t want to be seen hawking the sexual equivalent of Ecstasy, but it certainly helps the bottom line. And how do you discern between recreational and medical use? If you are a seventeen-year-old who is nervous at the prospect of post-prom sex, do you have a legitimate medical condition? It is an increasingly fine line.
At any rate, you can now be the judge of whether you are suffering from a disease. It is no longer necessary to have an awkward chat with your doctor. You can get “diagnosed” on-line and have thedrug delivered. If the medical perspective is flawed and self-serving anyway, why not skip the middleman? The drug companies themselves may eventually be usurped by more familiar hawkers. Wrigley has patented a chewing gum that enables erections (and gives you fresh breath). In Japan, a health tonic imported from China that contained sildenafil, the active ingredient in Viagra, stayed on the market for a year before authorities ordered it withdrawn. The McRigid burger and Stud Suds can’t be far behind.
The Rise of Viagra isn’t likely to be a best-seller. It reads, in places, like a slightly disguised doctoral thesis, and the subtext is failure, always a tough sell. But Loe raises interesting issues. The battle for men’s sexuality has been fought and won by the drug companies. Admittedly, we didn’t put up much of a fight. But, for women, the enemy has yet to be engaged. A clinical psychologist is quoted as saying that she sees sexuality as a boxing ring. “It’s not just us versus the pharmaceutical industry. It is a vision of women’s sexuality that we’re struggling over.”
Historically, the magic-bullet theory has been a seductive one for the medical profession. In manufacturing drugs to treat the major mental illnesses, the pharmaceutical industry has done brilliantly, the patients less so. But at least there is (relative) consensus on the illnesses, on schizophrenia, depression. With sex, there was first a need to manufacture consensus on what is normal, what is disease. That perspective might remind some of an earlier expert opinion. Only now it is the drug companies that are drawing a line with three dots, implying that the wrong choice will end badly.