TORONTO - What with the ubiquitous TV ads featuring people smug with sexual satisfaction and the spam that jams your email account, it seems impossible to believe erectile dysfunction or ED drugs haven't been with us for decades.
And yet, Viagra is only 10 years old.
Actually, the little blue pill is 11, having launched in the U.S. market in March of 1998. But ... dare we say it? ... Canada was a bit slower to achieve liftoff. This month marks the 10th anniversary of the Pfizer drug's surge into the Canadian market.
Milestone birthdays provide an excellent opportunity for reflection. In the case of Viagra and the competitors that quickly muscled their way into the multimillion-dollar market, it's worth asking whether they've proved to be the miracle meds people thought they would be.
Have the PDE5 -- short for phosphodiesterase type 5 -- inhibitors revolutionized sex for the senior set? The not-so-senior set? If you ask the experts, the answer is a qualified Yes.
Dr. Gerald Brock, a urologist at St. Joseph's Health Care in London, Ont., says the availability of easy-to-use oral ED drugs has been "transformative" in the care of men experiencing trouble having and holding an erection.
Prior to their introduction, the only tools available were pretty unappealing -- penile implants or drugs that have to be injected into the penis. Both were "a difficult sell," says Brock, who is also a professor in the University of Western Ontario's medical school.
The advent of Viagra -- followed in 2003 by Eli Lilly's Cialis and Bayer's Levitra in 2004 -- meant there were painless and easy options.
"And because of that, we've had huge numbers of men who have come forward to talk to physicians, to deal with their issues -- many of whom don't end up using medication at all," said Brock, who owns stocks in, and receives consulting and speaking fees from the variety of companies that market ED drugs.
Bob Dole, the one-time Republican presidential candidate, was an early spokesperson for Viagra -- a task taken up in Canada by hockey legend Guy Lafleur. Suddenly powerful men were speaking publicly -- on TV! -- about a problem sufferers had previously coped with in silence.
Many men had even been too bashful to seek help from a doctor. Then came a breakout TV commercial featuring James McGowan -- now star of CBC-TV's "The Border" -- awkwardly asking a doctor about a problem he was having.
"(The drugs) opened up the door for the conversation. That's a very important thing," says Michael Adams, a professor of pharmacology and toxicology at Queen's University in Kingston and co-inventor of Uprima, a competitor drug that sold for a time in Europe and Africa but is no longer on the market.
The impact of the drugs on women has been a mixed picture, experts suggest -- solving problems for some, creating problems for others.
But still, the fact that people are talking about the physical hurdles that can impede sex in mid-life and beyond is important, suggests Dr. Stacey Tessler Lindau, a gynecologist at the University of Chicago.
"What we know about women's sexuality has lagged behind what we know about men's sexuality. And we owe it in large part to the invention and introduction of the erectile dysfunction drugs that we're learning more about both women and men's sexuality, particularly in later life," says Tessler Lindau, who does research into sexuality and seniors.
"I would see that as a positive."
In the years since the drugs have hit the market, millions of prescriptions have been dispensed in this country. In 2008, $170 million worth of the drugs were sold in Canada, up from $125 million in 2005. Viagra is the market leader, with sales of nearly $85 million last year. But Cialis has been making steady gains, last year selling nearly $70 million worth of pills.
The pills aren't cheap, ranging -- before dispensing fees -- from about $11.15 for the lowest dose of Viagra (25 milligrams) to $13.45 for Levitra (20 mg) to $13.83 for longer-acting Cialis (20 mg).
And they have side-effects. Most are mild -- facial flushing, indigestion, mild headaches. There have been reports, however, of sudden hearing loss and sudden vision loss associated with their use. The drugs cannot be used in combination with certain medications -- remember Jack Nicholson in "As Good As It Gets"? -- and they don't work for everyone with erectile problems.
Still, millions of people who couldn't have intercourse now can, thanks to these drugs. And that may actually be causing unanticipated problems.
Rates of sexually transmitted infections, especially HIV-AIDS, are on the rise among older adults, a group that may forgo condoms because they equate them with contraception.
"So it is a double-edged sword," said Jay Olshansky, an expert in aging and longevity in the school of public health at University of Illinois at Chicago. "But overall, it actually has been very helpful for older people. And I would imagine would continue to be so."
However, when a sexual relationship stalls -- whether in a marriage or outside it -- there generally isn't one single problem or one single solution. Setting up people to believe that swallowing a blue or pink or polka-dotted pill is going to make everything all better was never a realistic scenario.
"Treating a man with a pill may give him better erections, but it doesn't necessarily improve the overall relationship or the quality of the sex for the female partner," Tessler Lindau says.
Sex researcher Julia Heiman says the success of the drugs depends on the context in which they are used.
"I think for some couples, it's really helpful and appreciated," says Heiman, director of the famed Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University.
"And even if sex stopped for awhile because of lack of erections or poor erections, the fact that a male makes an effort in that direction -- if the woman has enjoyed sex in the past -- is a tremendous boon. It's a statement in itself that he's making the effort. So a lot gets better."
Other times the lack of physical intimacy has driven a chasm between sexual partners. Using a pill to bridge it can actually create a great deal of tension, Heiman says. "And it doesn't get better easily. So it really depends a little bit how they adapted to the lack of sex as to what the pathway might be to reintroducing sex."
Couples can find that just because sex is physically possible doesn't mean they know how to reach out to each other anymore, she says, a situation that requires sensitivity and patience.
"It really depends on the couple," Heiman says. "What they've been through. How they feel about each other. What their current struggles are. What their health issues are."
But the pills aren't always dispensed with that level of advice or taken with that level of insight.
"When we prescribe these medications to men, we need to educate them and ideally them with their partner as a couple about how to resume a comfortable, pleasurable sex life for both partners," Tessler Lindau says.
"In my view, that piece has been sorely neglected."
Adams thinks something else has been neglected as well.
In most cases, erectile dysfunction is an early signs of cardiovascular disease. Doctors ought to be viewing a consultation for an ED drug as an opportunity to start a discussion about heart health, he says, and should even discuss the issue with middle-aged men who haven't asked for one of the medications.
"Physicians need to be proactive in asking the question. `I know this sounds a bit off the wall, but are your erections what they used to be? Are you happy? Are you satisfied with the way your sex life is and how your erections are?"'
