Viagra's Other Side Effect: Upsets in Many a Marriage
NY Times June 23, 1998
By JENNIFER STEINHAUER
n the surface, the couple from Queens seemed like perfect
candidates for Viagra.
The woman, 53, has been married to
her husband, 59, for 30 years. A few
years ago, he started to have trouble
achieving an erection. He was
unhappy about it, but learned to see
some good in it. "My eye doesn't
wander anymore," he said, "because I
can't do anything about it." Though
the woman said she "could not
imagine staying in a relationship without sex," she, too, became reconciled
once they learned to have other kinds of intimacy and other forms of sex.
Viagra, the popular new drug for impotence, would appear to be their
ticket back to a more conventional sex life. But like many couples
contemplating Viagra, the two are starkly divided about whether to try it:
While he is looking for a medical panacea for a physical problem that
often comes with age, she has long wondered whether the problem might
be better addressed on a therapist's couch than in a doctor's office.
A few months ago, Viagra was being promoted by everyone from
urologists to drug company analysts as the new miracle drug destined to
help solve millions of Americans' sexual problems. The drug flew off
pharmacy shelves.
But experts on sexuality and therapists are
finding that Viagra and other impotence aids
may actually throw into chaos relationships
that have fallen into their own routine, sexual
dysfunction and all.
The most common problem they say, is that men hope to treat their
impotence as a simple mechanical issue, while women tend to want to
address the emotions related to impotence. In other cases, a man and
woman are forced to confront their divergent views about what it means
to have sex and how often they want to have it -- issues that impotence
had rendered moot.
The result is that many couples are finding that a solution to what they
thought was a medical problem may uncover myriad other issues in the
relationship.
"We are in a very high-tech society, and people are used to having things
done very quickly," said Eileen Palace, director of the Center for Sexual
Health at Tulane University Hospital in New Orleans.
"We saw in the 1960's how the pill could control biology. Later, we saw
how to control infertility. People want a simple, easy, fast solution. And
many physicians assume that just because there is a physical problem
means there is no psychological cause."
Urologists interviewed for this article said they had been writing Viagra
prescriptions by the dozens, many for patients who had never before said
they were impotent.
Some had not even confided in their partners. Instead, they simply
avoided sex.
"The guy sees himself having trouble, and he, out of embarrassment and
lack of communicativity, he says 'I am going to sleep in the other
room,'" said Dr. Walter Bortz, a geriatrics specialist at the Palo Alto
Medical Foundation, in California. "The wife thinks he has a girlfriend.
And it becomes a gulf that enters a well-cemented relationship, because
egos get in the way."
When the possibility of sex resurfaces, a couple is often at a loss. They
never talked much about their problems before, and now they have no
idea how to approach the change. In the meantime, all the issues that
contributed to the impotence or resulted from it have been long swept
under the rug.
"When someone hears about Viagra, they are expecting to get better on
their sexual problems," said E. Douglas Whitehead, the director of the
Association for Male Sexual Dysfunction in New York. "But there are
many issues that affect desire: life stresses, the stock market, other issues.
But most of the time, people don't talk about those problems. They are
the secret of the bedroom. They think Viagra will address them."
The woman from Queens who, like her husband, agreed to be
interviewed if they were not identified, said she had given up trying to
persuade her husband to address the emotional aspects of their sexual
problems in therapy.
"His doctor suggested he go into therapy because he couldn't find any
medical reason for his borderline erections," she said. "I thought therapy
was a great opportunity, but he didn't want to do it. I was frustrated. I am
a believer that therapy is the most noninvasive, and look at all the added
benefits it would bring to your life."
Therapy is where many couples dealing with impotence belong, even if
they use Viagra, many doctors say. The couple may never have discussed
the inevitable resentment and pain that resulted from their damaged sex
lives, feelings that will not disappear with medication. Once Viagra allows
a couple to have sex again, their relationship can change. There might be
divergent views on how often they should have sex, and how they should
plan for it.
For example, Viagra, which must be taken an hour before intercourse,
and other drugs for impotence, leave little room for spontaneous romantic
encounters. What is more, a couple used to not having sex may be out of
practice in the language and gestures of sexual intimacy.
Dr. Palace recalled a man with diabetes, which often contributes to
impotence, who was using injected drugs commonly used to help
impotent men achieve erections.
"He came in in tears, because his wife's romantic gesture was to lay the
syringe on the pillow," she said. "You have to be able to talk about the
role of the treatment in the relationship. And I've learned to trust penises,
because they are good indicators of what is going on in a relationship."
Steven and Katherine, who spoke on the condition that their last name
not be used, found that their marriage was in trouble after Steven began
using penile injections. Testicular cancer left him impotent in 1990, and he
and Katherine were married shortly after.
"When we would go to the urologist," Katherine said, "they would come
up with this or that and address really only my husband and his physical
problems." This or that turned out to be injections that produced erections
but terrible sex. The injections themselves were disturbing enough, she
said, but the underlying problem was her unacknowledged feelings about
having married a man who was impotent. Ultimately, she said, she
worked through the problem in sex therapy at Tulane. "Part of what
therapy did was help me face the grief that I had never faced being
married to a man who was impotent."
Steven agreed that he had not thought through the emotional issues
related to their sexual problems. "I thought my primary problem was
plumbing," he said.
"One thing that amazed me when we finally opened the lines of
communication was that my sexual performance was not satisfactory for
her. I thought things were fine. But because she loved me anyway, she
made a conscious decision to forgo a good sexual life to have a good
marriage."
In the end, they have decided to forgo Viagra and explore other avenues
of sexual intimacy.
Many therapists and urologists say that most men are loath to discuss
their sexual problems with anyone, especially a therapist. Those men see
the pill as an easy way out.
Pepper Schwartz, a professor of sociology at the University of
Washington in Seattle and author of several books about American sexual
habits, cited two things about Viagra that appeal to men: "They don't have
to talk about impotence and they have a high assurance of potential good
in using it."
"The issues that have been shrugged off are the psychological and social
aspects of it," Dr. Schwartz said. "And I do believe that any drug that
alters the core way a couple relates to each other requires discussions of
expectations and pressures."
But most men seem reluctant to talk even to their partners, let alone an
outsider, about their sexual problems. A 74-year-old man from Long
Island who has had erectile dysfunction since his 20's, particularly in
relationships that lasted for a while, could never quite talk to his wife of
25 years about the problem. "I would tend to kind of brush the problem
under the rug," he said. "It isn't an easy topic to deal with. It goes to the
heart of your masculinity."
After a divorce, he became involved with a much younger woman. "Let's
be candid," he said. "Obviously, that is a stimulating situation for a male."
But his problem recurred. "I do think that had we had a more active sex
life, perhaps my marriage could have been saved," he said. "And I am
quite certain that in the 20-year live-in relationship that followed, had the
sexual part been better, that would have gone on."
He is convinced that Viagra is the answer to his lifelong sexual problem
and that no amount of therapy would help.
"When you're dealing with circulatory problem, all the talking in the world
doesn't make any difference," he said.
The woman from Queens went into therapy alone and kept her emotional
journey to herself. "Therapy was helpful to me," she said. "I felt like it
made me understand that this was just one more thing to deal with, not
the end of the world."
Yet in a review of dozens of E-mail sites, including an impotence support
group site and Viagra chat rooms, almost all the postings were limited to
questions about where to obtain the drug, its possible side effects or
concerns that seem almost akin to choosing a new dry cleaner: "Since the
100-mg strength and the 50-mg cost about the same," read an E-mail
message from Carl, "it seems that getting 100's and splitting them would
be beneficial financially."
Or the messages brag about the new sexual prowess afforded to Viagra
users: "Took 100 mgs last night and had great five hours of fun," wrote
someone identified as Bump. "Did have a bit of a headache, but went
away with some ibuprofen after about an hour. Of course being up till 3
A.M. didn't help ... grin." A few women voiced concern that sex
offenders would have a new weapon.
But next to none of the E-mail messages seem concerned about the
emotions surrounding sexual problems and the effects they had on
relationships. Dr. David L. Casey, a urologist in Denton, Tex., spends a
lot of time answering questions about Viagra in Internet chat rooms as a
public service.
But when asked about emotional complications that using Viagra may
introduce to a couple's relationship, he replied: "I really have no comment
on such a question. I try to stick with answering technical questions, and
really have little time for the sociologic discussions." |
