This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.
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Rehashing Viagra: Just How “Revolutionary” is the Treatment of Male Sexual Dysfunction? by Adam Everson
Let’s face it: there is a lot of pressure for a man, when the time comes, to do what men are supposed to do in the bedroom. When a man can’t “do the deed” as he should for his partner, it tends to lead to a lot of problems for the relationship. It’s pretty common for a man with erectile disorder to have low self-esteem, low self-confidence, and a decreased sense of masculinity (American Psychiatric Association, 2013). While it may not seem like much for men without the problem, a man who does experience or has experienced erectile problems understands that there is a lot of pride in being able to do a man’s duty. And to make matters worse, a man’s partner can develop similar feelings, wondering if he/she is unattractive and unable to please his/her man in that type of way. These feelings, for both parties, are accompanied by decreased sexual satisfaction and a reduce desire to engage in sexual activities. All of this is then further amplified by a man’s usual avoidance of future sexual encounters.
Obviously, no man wants to experience this. And frankly, no man has wanted to experience this….ever. Like, ever in recorded history. Even Roman poets wrote about the troubles of not being able to perform:
And it’s not that she wasn’t seductive, just think of those marvellous
Kisses she wasted on me, the tricks she tried!
…
But still my member lay there, an embarrassing case of
Premature death, and limper than yesterday’s rose.
(Ovid, The Amores, 3:7, p. 151)
But while times change and cultures vary, there exists an unwavering importance for treating men’s sexual dysfunction across history. Religious leaders, witch doctors, alchemists, physicians, intellectuals, and traveling swindlers alike all attempted to develop cures that ensured a man’s sexual competence. While each trade was directed by distinct cultural and religious influences and scientific advancement of the time, all seemed to be searching for that one thing – that one insect, that one herb, that one cocktail of chemicals – that would fix a member “limper than yesterday’s rose.”
Okay, but we live in the 21st century. Our scientific advancements are practically light-years ahead of the Spanish fly and mandrake root previously given to men to treat their sexual dysfunction; modern medicine has revolutionized how we treat this, so we clearly know what we’re doing now…right?
But has modern medicine really revolutionized sexual dysfunction treatment? Granted, the medieval alchemist did not have the biological and chemical knowledge the modern physician has in his arsenal (so we have that going for us), but that doesn’t mean we are any more effective at treating problems with men’s sexual performance. If anything, we just know to market it better. Don’t believe me? Well then, let’s take a quick look at how sexual problems have been treated historically and see how that compares to modern methods.
Up through the medieval era, the causes of sexual performance problems were framed around physical or metaphysical terms. If performance problems were not attributed to such things as physical exhaustion, disease and age, they were attributed to spiritual causes manifesting through sexual functions. Depending on whether the problem (or fear of developing a problem) was a physical or metaphysical one, treatment would vary. The Greeks (and later the early Romans) would smear a mixture of pepper, olive oil, and honey on the penis or tie a collection of herbs that were soaked in wine to the thigh with the hopes of enlarging the penis (McKeown, 2013). Men would also wear a stone talisman in the hopes of making an appeal to the gods to relieve the dysfunction if they believed it was due to a god-given curse (McLaren, 2007). Despite the widespread presence of the Christian church, magic was also the preferred choice of European men of the Middle Ages when herbology proved ineffective in treating their sexual dysfunction (Berry, 2013).
Though the Enlightenment brought about a slight acknowledgment of the psychological causes of sexual dysfunction, biology and advancements in organic medicine dominated treatment. This biomedical approach was only intensified by physicians and charlatans (and eventually pharmaceutical companies) hoping for financial gain by selling aphrodisiacs and sexual enhancement tonics. But by the better part of the 20th century and following the psychoanalytic revolution, sex therapy became primarily psychological in orientation, underemphasizing the importance of biology in exchange for these “revolutionary” ideas that the mind was the culprit for any sort of problem.
So how does this short trip through history speak to our lack of revolution in treating sexual dysfunctions? Though the routes of treatment did change, there is a common theme throughout history: those providing treatment figured a cure could be reach by treating one aspect of a man’s life. Whether that aspect was working with small equipment, troubles in a romantic relationship, or a curse from the gods, clinicians thought making a cure for one part would solve the whole problem.
The truth, however, is that sexual dysfunctions are often the result of many factors. No one “thing” – talisman, psychological exercise, tonic, or a pill – is usually sufficient for fixing a man’s problem performing. Granted there is always the possibility it is just one thing, but this is usually not the case. The most successful forms of modern sex therapy are those centered around the biopsychosocial model, a model which emphasizes that sexual dysfunction is a multi-dimensional problem that needs psychological, social and biological treatment strategies (McCarthy & McDonald, 2009). A lack of blood flow to the genitals can be but one of the many things preventing a man from doing his duty; depression, chronic stress, cancer, religious background, the influence of the media on expectations of sex and many, many other factors have all been identified as candidates for causing problems in the bedroom.
So, Viagra isn’t anything new. Sure, the chemical construction of it is, but the search for a single “magic bullet” to help a man do what he does in bed isn’t. No matter what form it comes, no matter what time period it comes from, and no matter how attractive the couple in the latest commercial is, one thing really can’t fix something that is so complex. There are lots of routes by which a sexual problem can be created, so there needs to be a lot of routes by which to treat it effectively.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Berry, M.D.(2013). Historical revolutions in sex therapy: a critical examination of men’s sexual dysfunction and their treatment. Journal of Sex & Marital Therapy, 39, 21-39.
McCarthy, B.W. & McDonald, D.O. (2009). Psychobiosocial versus biomedical models of treatment: Semantics or substance. Sexual and Relationship Therapy, 24, 30-37.
McKeown, J. C. (2013). A cabinet of Greek curiosities: Strange tales and surprising facts from the cradle of western civilization. Oxford University Press.
McLaren, A. (2007). Impotence: A cultural history. Chicago, IL: The University of Chicago Press.
Ovid. (1982). The erotic poems (P. Green, Trans.). New York, NY: Penguin.
