With the introduction of Viagra in the late 90’s, many men who could not otherwise sexually perform were granted a new lease on their sex lives. Since then Cialis and Levitra have joined Viagra as options men may turn to when their penises don’t respond as they or their partners wish.  The opportunity for impotent men to once again celebrate potency unsettled a delicate balance many couples had emotionally-engineered to cope with sex and sexual needs.  Floating in on the tide of new-found sexual performance is the complexity created in a sphere of human interaction that benefits from simplicity. 

     Pro-erection medicines offer great help, but do so in a part of our lives that is shrouded in misinformation and secrecy.  The result is that these medicines are frequently used incorrectly, with unrealistic expectations and disappointing results.  Different than the widespread erroneous beliefs, Viagra and the others do not alter low sexual desire, strengthen ejaculatory control, fix relationship disconnection or solve emotional problems which hamper good sexual performance.  Yet for some men, the pill’s placebo effect can temporarily seem to suggest otherwise.  Despite the medicine’s narrow purpose, men and their doctors continue to prescribe them without sensitivity to the actual cause of erection problems, which is often broadly emotional and relationship-based.

     In addition to being mis-applied, many hold tightly to unrealistic expectations that these medications are guaranteed to be effective.  While very helpful when properly used, uncomfortable side effects may outweigh the benefits for many men, the most common of which are headaches. They eliminate the pleasure of a successful sexual encounter by swapping one problem with another.  And what of those erections that last more than four hours?  The men who have difficulty performing due to strong anxiety or other negative emotions may obtain little relief from using medication.  Very powerful emotions can easily override the medicine’s help. As a group, men have practiced for a lifetime to avoid their emotions.  When facing an emotionally-based problem, men routinely opt for an action which makes them feel more in control rather than facing their irrational feelings.  When learning that the true source of their erection loss is emotionally-based, many men perceive this as the worst-case scenario. Most men would prefer the problem to be concrete and physical…something they could get their hands around with a simple and direct fix, such as a pill.

     Ideally, sex is a simple and natural act. Viagra and its siblings inject complexity into the natural rhythm that couples develop.  Even if reassured multiple times, female partners tend to fear that the real cause for her male partner’s failed erection is his lack of attraction for her.  Aging women are even more likely to hold this insecure assumption. Knowing and fearing this, many men obtain the erection prescription secretly.

     Because men are acutely uncomfortable talking about their sexual failures so often pro-erection pills are obtained covertly, especially in those relationships most in need of greater openness. Messy situations develop when a female partner unexpectedly discovers that a pill is responsible for her partner’s arousal. She will ask, “For how long have you been doing this?” Wondering how many of their historical encounters were truly motivated by his love and attraction for her, and for how many he needed help because in her mind, “she isn’t enough”? And if he hid this from her, she will ask, “How many other things has he lied about?” Deceit and the insult to trust is a hard-to-heal, nasty wound.  Should he take the pill guessing that they will be sexual while risking the waste of an expensive pill?  If he asks her, the spontaneity is lost and he has reminded her of his embarrassing dysfunction. But what if she learns that he has taken the pill?  Will she be insulted that he expected a sexual experience without considering her choice? Pro-erection medications upset the natural order and instead of easy and spontaneous, sexual situations become artificial and complex.

     There is no simple fix; yet emotionally-based problems call for emotionally-based solutions.  If used properly Viagra, Cialis and Levitra can be of great help. Their placebo effect may help a man escape from the thorny cycle of performance anxiety. Yet it is best that a sexual problem be a couples’ problem and not an individual problem. Being open about difficulties and solutions, while inviting dialogue offers an opportunity for partners to get even closer while facing the adversity of dysfunction. If treated this way the highest and best values may guide partners to good, loving solutions. Andrew Aaron, LICSW