The Culture of Impotence

The dubious merits of drug-induced virility.

Penile injections are the most frequently prescribed antidote for male impotence. According to the medical literature, the FDA-approved medication works like this:

The impotent excuses himself from foreplay with his partner and enters the bathroom. Here, he fills a syringe with the muscle-relaxant prostaglandin and swabs a spot near the base of his penis with rubbing alcohol. Next, clasping the head of his penis with one hand, the impotent inserts the needle about two centimeters into the shaft. The needle must penetrate to the corpora cavernosa–the rods of spongy tissue in the penis core. The user plunges the syringe and almost immediately the prostaglandin loosens the muscles that control circulation to the penis. The sting passes quickly and blood rushes in–even a penis that has been limp for decades will spring to erection. To prevent the puncture from turning black and blue, the impotent applies pressure to the spot for the next 30 seconds.

Finally, after five minutes or so, the impotent emerges from the bathroom sporting a dandy hard-on, not to mention the confidence that his coach won’t turn into a pumpkin for half an hour, regardless of how many times he orgasms.

Thanks to prostaglandin, an economy, even a culture, of impotence now flourishes in America. Extrapolating from local studies, urologists estimate that more than 200,000 men injected the drug into their sex organ last year (at about $20 a pop), and a total of 650,000 men sought treatments for impotence, up 43 percent from 1994.

According to Business Week, U.S. men spent an estimated $665 million in pursuit of erection last year. Clinics that diagnose impotence and teach the afflicted how to inject themselves have set up shop in most major American cities. Doing business under academic-sounding names like “Integrated Medical Resources,” these clinics advertise their services on all-sports radio stations, cable TV channels, and mass transit. (The bus ads give impotence treatment a friendly face, usually depicting a balding, pocket-protector-wearing doctor.) Impotence doctors have also helped found 55 chapters of Impotents Anonymous, and dozens of telephone hot lines, to help the unarousable cope and steer them to medical treatment. Plus, pharmaceutical companies are racing to develop simpler ways to deliver the drug than injections. A tiny tablet cooked up by Pfizer, awaiting FDA approval, allows men to stuff a drug similar to prostaglandin straight into their urethra.

When urologists pitch impotence cures, investment bankers and venture capitalists swoon–and for good reason. Between 10 and 30 million American men suffer from impotence, most of them around the age of 60. Not only do most of these men have the time to fret over their fading virility, most have the disposable income to indulge their anxieties. And the demographic is burgeoning, giving a new meaning to the phrase “baby boom.”

But the culture of impotence cannot be reduced to money-grubbing doctors and Wall Street shysters exploiting the worst fears of the graying guys on the golf course. The conventional wisdom about impotence has changed: What was once considered a normal part of the aging process is now considered a treatable medical condition. “If a man has a penis he can get an erection,” says Irwin Goldstein, author of The Potent Male and a urologist at Boston University. “[Prostaglandin] is literally a magic potion that powerfully restores–safely, without any side effects–what was once lost,” says the Web site of Uri Peles, a Los Angeles urologist. New York urologist Edward Moses employs the same overheated rhetoric on his Web site: “For many men, life without sex can be likened to a watercolor painting that should possess all of the vibrant colors of life, but which has been reduced to sterile black and white.”

Attribute some of the doctors’ enthusiasm to the novelty of their powers. A decade ago–before penile injections–doctors thought of impotence as a psychological problem or an unavoidable consequence of aging. (As the circulatory system goes, so goes the reliability of erections. According to a National Institutes of Health report, 70 percent of impotence cases among older men can be traced to cardiovascular problems.) With the advent of the new medication, the doctors now had a cure in their bag, allowing them to shelve the psychological explanations trumpeted by venerable sex gurus like Masters and Johnson and Alfred Kinsey, as well as the ancient belief that growing old means growing soft. Goldstein epitomizes the new conventional wisdom: “[I]mpotence is basically a plumbing problem,” he says. To fix it, a doctor needs to get under the sink with drugs, not into the head with talk.

Yet, in their haste and fervor to cure, urologists may have debunked too many old assumptions about impotence and invested too much faith in their new power to make men hard.

Indeed, many impotents do suffer from an exclusively medical problem. Diabetes, cardiovascular problems, and penile injuries (more than 100,000 whacked in bike accidents have been permanently deflated, according to the medical literature) all prevent men from mustering a swelling. No amount of chat will ever restore their virility. A stiff dose of prostaglandin for them, please.

Still, the prostaglandin is an inadequate fix for almost half of its users. Caverject, the prostaglandin injection sold by Upjohn, gets a rouse in nine men out of 10, but 40 percent of those who use it abandon the drug within months of beginning their therapy. According to Upjohn, the leading explanation offered by the quitters is that the drug doesn’t restore the sexual desire or the pleasure they once derived from sex. In fact, some impotence researchers assert that the success rates of prostaglandin may not be much better than the success rates of placebos.

What this indicates is that erections–satisfying erections–don’t reside solely in the groin. Natural erections are elicited by the neural signaling of nitric acid, which in turn is triggered by some desire, or thought, or external stimuli. You can short-circuit the biology of erection, but that doesn’t “fix” the nonbiological problems that exacerbate and sometimes even trigger impotence.

The marginal efficacy of prostaglandin isn’t likely to keep the baby boomers from buying the urological spin. After all, their cult of youth has successfully preached that aging can be staved off by medical intervention: hair implants, skin peels, and liposuction. And by drugs, which have been their remedy for every psychological malady: LSD to shatter hang-ups; cocaine to alleviate chronic boredom; Prozac to lift depression. Look for prostaglandin to become a sacrament that allows boomers to rut until death. The generation that still listens to rock ’n’ roll will consider it their right to keep getting their rocks off.