Sexual revolution? HARDLY

WASHINGTON - When Viagra came on the market nine years ago, Time magazine worried that it signaled “the end of sex as we know it.” Playboy predicted a sexual revolution “as monumental as the birth control pill.” Adweek forecast demand for Viagra so massive that “not one dollar need ever be spent advertising it.”

It hasn’t worked out that way.

Prescriptions for erectile dysfunction drugs, which sparked a veritable gold rush to doctors’ offices initially, have been steady worldwide for three years despite massive promotional campaigns. Revenues for Viagra were once forecast at $5 billion a year. In 2006, revenues totaled just $3 billion for Viagra and rivals Levitra and Cialis combined.

“The market’s about as big as it’s going to get,” said Jason Napodano, a biotech stock analyst at Zacks Equity Research in Chicago.

Sexologists say Viagra and its cousins merely advanced substantially a long-underway trend toward enhanced and open sensuality.

The drugs made erection problems widely discussable for the first time. They made chemically assisted sex acceptable among law-abiding people. They enhanced the potential for sex among older Americans. For younger ones, the drugs reportedly made dating life more ardent, stressful and sex-centered.

For promiscuous gay men, the drugs probably made pleasure riskier: Surveys show that users have more sex and sexually transmitted diseases. For women, sex therapists say, the drugs made intimacy more intercourse-centered and more time-regimented.

NOT JUST A MEDICINE

The makers of erectile dysfunction drugs won’t address most changes in sexual lifestyle, although clinicians say they see them all the time.

“Our approach is to focus on ED as a serious medical condition,” said Rob Perry, a spokesman for GlaxoSmith-Kline, which along with Bayer promotes Levitra in the United States.

But believing that people take erectile dysfunction drugs only for medical reasons is like believing they drink wine only to help their hearts, according to Edward Shorter, a University of Toronto medical historian. He thinks that the strictly medical argument hides the drugs’ real utility: “For at least the last half-century, people have been intent on turning sex into a really sensual experience, and this helps that.”

Whether that’s the whole truth or just part of it, the drugs indisputably helped millions of men by making their erection problems mentionable.

“That was a very big deal,” said Dr. Judy Kuriansky, a longtime sex counselor on radio, based in New York.

MIXED RESULTS WITH USE

Yet for every man with erectile dysfunction who’s sought treatment, several more never have, surveys determined, and that more than anything suppressed the market for the drugs and the ballyhooed revolution.

And those who did try the drugs had mixed results. Here’s what happened.

First, consider men with erection problems. ED drug makers say there are 30 million of them in the United States, 52 percent of men ages 40 to 70. Those numbers, however, rely on a survey that counted every man who said he wasn’t “always able to get and keep an erection good enough for sexual intercourse.”

The best estimate is that a fifth or sixth of men with erectile dysfunction now take the drugs, which usually work.

In an AARP sexuality survey of men and women 45 and older, men treated for erectile dysfunction reported that they had more and better sex. The increased sexual satisfaction extends to their partners, according to a recent study sponsored by Pfizer Inc., the maker of Viagra.

For a second large group — younger men who take the drug simply to enhance performance — results are more mixed. Their number is unknown, but clinicians say they’re seeing more of them.

Dr. Abraham Morgentaler, a Boston urologist who teaches Harvard Medical School students, thinks that many are responding to pressure from sexually ardent women.

“They feel as entitled to sexual satisfaction as men, and they’re as knowledgeable about it and aggressive about it,” he said.

“I think guys feel pressure to perform that they never felt before. It’s not unusual to have a guy in his 20s or 30s come in, who’s by all accounts functionally normal, and say, ‘It’s crazy out there, Doc. I need help.’”

NOT AN APHRODISIAC

A third very large group consists of men who tried the drugs but only briefly. About half of men for whom erectile dysfunction drugs are prescribed don’t renew their prescriptions, surveys indicate.

One popular explanation for nonrenewals is the dumb lovers theory. By that scenario, the husband takes his Viagra, sits down to watch TV and his wife tells him to come upstairs when he’s aroused.

That won’t happen without foreplay or fantasizing, experts know, because the drugs aren’t aphrodisiacs; they simply make penises stay hard once inspired.

The drugs produce erections about four out of five times when the problem is psychological, according to their makers, two out of three when it’s organic. Alcohol or a heavy dinner can add to the failure rate, however. And side effects, such as headaches and nausea, can be discouraging.

But larger proportions of people keep taking other drugs that work less well, have worse side effects and make less dramatic cases for themselves.

So what’s really going on?

Therapists say failure is likeliest with the first pill, when the pressure is greatest. That’s especially true for couples who haven’t had sex for a long time or aren’t drawn to their partners, said Dr. William Petok, a psychologist and sex therapist who practices in the Baltimore area.

In short, erectile dysfunction isn’t the whole issue when it comes to intimacy problems. It’s simply the piece of the problem that medicine has learned how to fix.