Viagra and the Essence of Male Sexuality
By John S. Tamerin, M.D. – December 1998
Everyone is talking about Viagra (sildenafil citrate). Although the banter may be frivolous, the discussion ought to be serious. Impotence is no joking matter for the estimated 30 million U.S. males who suffer this dreaded malady. Finally, there appears to be a relatively painless solution to their agonizing problem. Since Viagra received U.S. Food and Drug Administration approval last March, over five million prescriptions have been written. Undoubtedly, millions more will follow. Pfizer has broken pharmaceutical sales records and appears to have discovered the pharmaceutical equivalent of McDonald’s Big Mac. Better yet, they may have finally fulfilled the mission of Ponce de Leon and discovered the fountain of youth!
For many men, Viagra will provide a much-needed opportunity to reinitiate sexual contact. Men who were previously humiliated by their impotence and often reacted by physically withdrawing from their partners will now be able to reconnect in this fundamental aspect of an intimate relationship. In these situations, Viagra has been profoundly beneficial. There is no question that Viagra will enable men to recapture the pleasure, joy, potency, and excitement they once associated with a sexual relationship.
However, many people, myself included, are troubled because we feel that the majority of men are not looking beyond this biological remedy. The true meaning and, indeed, the deep pleasure associated with sexuality cannot be found in a pill. Sadly, many men may be cheating themselves and their mates. Exploring the deeper aspects of sexuality is an opportunity and a challenge.
It is unfortunate that in many instances Viagra is not being used as the first step in reinitiating intimacy but has become the first and the last step in treatment. For some couples, this may be sufficient. For many more, it is not. Instead, what is needed is a deeper, shared exploration of the meaning of sexuality within the life of the couple. Without this much-needed step, the “Viagra Solution” may become merely a flash in the pan. Furthermore, if we as a society do not utilize this opportunity to examine what constitutes the essence of a man’s sense of identity, and the deeper meaning of a sexual relationship, we will have missed a unique societal moment to enhance our awareness and wisdom in these crucial aspects of life.
The purpose of this piece, then, is not to examine the physiologic mechanism by which Viagra enables formerly impotent men to obtain and sustain an erection. Instead, I would like to focus on two more fundamental questions. What is the essence of a man? And what makes a sexual relationship meaningful? If the Viagra phenomenon invites men and women to begin to ask and attempt to answer these questions, at least for themselves, then its value will be far greater than the physical value of an erection.
The Machismo Factor
There are many different views of what constitutes the essence of a man. The majority of these involve a demonstration of strength and power. Sometimes this strength relates to the domination of others, as in the conquering hero. This definition of manliness usually places a heavy emphasis on instinctual expression and the visible demonstration of power. In the United States, this is epitomized by the two-fisted man of the frontier memorialized in endless Westerns – a man who was never afraid to fight. This type of man was also expected to exercise his sexual prowess and, indeed, his manliness was measured by his sexual success with women. South of the border, this is referred to as machismo and a man who manifests these characteristics is a macho man.
Perhaps James Bond, albeit fictionalized, is the best contemporary exemplar of such a man, entirely comfortable and always successful in a fight with a man or in a sexual encounter with a beautiful woman. In our culture, a man is often perceived to be weak when he cannot or will not fight or when he is unable to perform sexually. Indeed, an impotent James Bond is an oxymoron. Could we even imagine the legendary 007 not being able to raise his gun?
True Strength
There exists another definition of a man in which the emphasis is placed not on the expression of power but on the restraint of it, and strength is defined by the man's capacity to control himself. Two thousand years ago, sages said that a strong man was “not the man who could conquer a city, but the man who could conquer himself.”
Two types of strength are described in the Bible. In Hebrew these are “koach,” sheer physical strength, and “gevurah,” the strength of restraint and self-control. Gevurah was most valued because the power to restrain oneself reflected self-mastery, a manifestation of one's free will. Indeed, the ability to exercise free will to improve his character was what made a man human, “a little less than angel" and a good deal more than an ape with an opposable thumb.
When the primary goal of life is character improvement, not the demonstration of strength or power, the emphasis is on the use of the cerebral cortex, the center of thought, planning, empathy, and compassion. Basic aggression and sexuality, in contrast, may not involve the higher centers of the brain and, instead, may be merely involuntary responses of the “lower” brain to external stimuli.
Depending on whether the stimulus arouses aggressive or sexual impulses, the lower brain sends blood to either the skeletal muscles or to the penis. With this physiologic image in mind, how sad it is for so many men that the magnitude of blood supply to their penis should be so fundamentally related to their definition of themselves as men!
Yet, the extraordinary emotional and financial investment men are willing to make in Viagra says volumes about how they define themselves. Furthermore, this thrust is coming primarily from men, not from their wives’ unhappiness. The majority of wives with whom I have discussed this matter seem far more concerned with whether their husbands love them and are able to express this love in acts of verbal and physical affection than with the size and strength of their husbands’ erections.
In other times, men were willing to die for a principle – for God or for Country. Now, men are literally willing to risk their lives for an erection. So far, 69 men known to be taking Viagra have died. There will undoubtedly be more.
Apparently, for these men and others like them, a life without an erection is barely worth living. Indeed, having an erection may be a central aspect of their sense of masculine identity. Regardless of their rationalizations, this is far more than a matter of pleasure. It is a matter of self-definition and self-esteem. What Viagra apparently provides is a sense of feeling and being whole and complete again – free at least from the unbearable bondage of impotence.
Defining Male Sexuality
The extraordinary success of Viagra suggests many men may be trapped by a definition of manliness that is both limited and adolescent. This is a serious matter. Until men feel free to measure themselves by the quality of their character and relationships rather than by the size of their erections, they may never realize a complete and loving sexual relationship, with or without an erection.
Meaningful and fulfilling sexuality must focus on the relationship – not only on the self. The inner experience of a man who sees the relationship as the essence of his sexuality is vastly different from the narcissistic experience of the man obsessed with himself and his performance. Sex for the narcissist is hardly a shared experience: it is his “show.” He is the star and the woman's primary role is that of a supporting actress.
The contemporary language of sexuality so often describes what one person is doing to another. This harkens back to ancient societies where sex was traditionally used for domination and power. Sex was an act of aggression between the penetrator and the penetrated.
For many men, this is precisely what makes sexuality exciting – the sense of battle and conquest. The excitement for these men lies in the pursuit of victory. A rewarding sexual experience for them is, in effect, a hostile takeover. None of this, of course, is possible without an erection. All of this may be highly pleasurable for both the man and his partner when it is part of mutually enjoyable lovemaking. However, if the sexual experience is exclusively focused on the pleasure of the penetrator, the relationship will undoubtedly lose in the process.
Perhaps the narcissistic emphasis on performance is merely a sexual manifestation of an attitude that pervades all aspects of our culture. We live in a society that constantly counts down, whether it is for New Year's Eve or the launching of a spaceship. Our only concern is whether or not the rocket is launched: the focus is on getting there. If you don’t get there, then you have failed and you are a loser. There is only one winner and results are all that count.
The sexual analogy to erection and ejaculation is obvious. This was even stated by the writer Gay Talese who reportedly said, “The astonishing success of Viagra testifies to how integral the erection is to the man’s self-worth. Indeed, it is man's most honest organ. Either it is up or down, and you can't lie about it.”
The Essence of Loving Sexuality
There is another philosophical view of man in which the emphasis is not on winning, but on connecting. Spiritually, this represents the desire to achieve union with a transcendent being and all of creation. In order to be meaningful, this highly abstract goal must be made tangible.
Nowhere can this goal be fulfilled more completely than in a relationship between two loving and committed individuals. Nowhere else in human experience is there a better opportunity to achieve this unity when a man and woman come together physically and spiritually in an act of loving sexuality. The essence of loving sexuality is more metaphysical than physical. Indeed, the essence of sexuality takes place in the brain, not in the genitals. Genital sexuality, however, is still the most profound and powerful means by which we can heighten and deepen the metaphysical aspect of the relationship.
Our purpose and meaning in the world is best defined by the quality of our connection to others. Indeed, this is the human characteristic most valued in the Judeo-Christian tradition and is universally known as the Golden Rule. In an intimate relationship, a man expresses this quality of connectedness through the act of making love. This is a very different view of sexuality than focusing on an erection as the center of a man's sexual experience. An erection may be a means to an end. It is tragic that for many men it has become an end in itself.
Sages have known for thousands of years that the key to lasting pleasure is responsibility. This is the ultimate irony, since so many men in our society seem to feel that pleasure can only occur when responsibility disappears. The truth is that only when we welcome responsibility do we give our lives meaning. In a relationship, meaning and pleasure emerge when two equals join together in an act of loving sexuality, each feeling responsible for the happiness of the other. Only when there exists a sense of mutual responsibility can there be mutual love. Only then can two souls unite to become one flesh. At that transcendent moment, the man experiences a unique sense of completion and wholeness – a sense of unity and union with his metaphysical and physical other half – his “soul mate.”
Many men have never reached this level of sexuality and, as a result, they remain spiritual nomads. Lacking deep roots, they spend their lives looking for shallow experiences. Inevitably, there will be an emotional emptiness in men who fear a deep and honest confrontation, not only with a committed partner but with themselves. Sadly, these men view mature, responsible sexuality as dangerous and even terrifying. They fear that they will lose themselves in the very act of joining with another human being! Their defense is hyper-masculinity, and the essence of masculinity for these men is an erection. This brings us back to where we started and may help to explain the unparalleled success of Viagra.
Until the final word on Viagra has been written, I will reserve judgment as to its true benefit for our society. In the meantime, however, I wish that its manufacturer would include a package insert warning: “Viagra is not a cure for sexual dysfunction. When used alone without an exploration of the needs and feelings of each participant, and without full understanding of the deeper meaning of the sexual relationship, it is unlikely that it will have the desired long-term benefit.”
Dr. Tamerin is a consulting psychiatrist at Greenwich Hospital, in Greenwich. Connecticut, a clinical associate professor at Cornell University School of Medicine and has served on the faculty of Yad Vashem in Jerusalem.