The Little-Blue-Pill Problem
My mother and I talk a lot about sex on a near-daily basis, which hasn’t always been the case. Growing up, the only “sex talk” I can remember came the summer before I left for boarding school, when I was packing up, and my mother suddenly asked about the sex-education classes I’d endured as an eighth-grader.
“Did they teach abstinence or safe sex?”
Because I didn’t know what abstinence was, I chose the latter.
“Well then,” she said, “you know about sex.”
I didn’t know about sex, but she sounded relieved, which in turn relieved me.
We first started talking openly about sex after our respective divorces, which happened within a year of one another. I was 39 and in Kentucky, in a freestanding house, living alone for the first time in my adult life. She decided to leave Virginia and buy a too-large house just down the street. Within just a few months of her relocation, I’d sold my house and moved in with her.
It was in between episodes of Prime Suspect — in which Helen Mirren must not only hunt violent criminals but also combat rampant sexism — that we began exchanging stories about our sex lives. I was surprised to learn that my then-68-year-old mother considered herself sexually enthusiastic and that she thought sex had become more rewarding with age. I was also surprised to learn that she, an intrepid internet dater, had hopes and intentions of remaining sexually active for the foreseeable future.
Now, though, just eight years later, our talks have gone from casual and funny to negative and remorseful, as she’s become increasingly weary of attempting intimacy with men her age.
My mother negotiated sex through three marriages with three very different men, for a cumulative 43 years, but never once reckoned with erectile dysfunction. “Maybe I was lucky,” she said. “Maybe not.” When ED “dropped its head” during her first post-divorce sexual encounter a couple of years ago, she was flummoxed. “My partner and I were both in our mid-60s, healthy, and fit. A flaccid penis was not part of my intimacy vocabulary.”
Neither was “the blue pill,” which could actually be any number of phosphodiesterase type 5 (PDE5) inhibitors in any number of colors — Viagra (sildenafil), Cialis (tadalafil), or Levitra (vardenafil), prescribed medications that improve dilation of the arteries in a penis, helping a man get and maintain an erection.
To the uninitiated, including myself and almost all of the friends I polled, 30- and 40- and even 50-somethings who haven’t yet had personal experience with it, sex on the blue pill is assumed to be just the same as sex without it. Maybe there would be a few extra lengthy erections, some discomfort on the guy’s end, but that would be it.
Large swaths of men and women describe Viagra as a game changer, a marriage-maker, a life saver. But there also exists a mostly unheard-from subset of heterosexual women who would disagree. In fact, my mother unequivocally views Viagra as the cause for her newfound aversion to sex.
The problem is that while a urologist can improve circulation pharmacologically and add testosterone, actual ejaculation isn’t guaranteed. But some men, perhaps out of a desire for the familiar satisfaction of completion, keep going, keep engaging in sex, regardless of whether or not their partner wants to or is still getting any pleasure from it.
One doctor I spoke with, Claiborne Whitworth, explains it this way: A functional erection does not equal the ability to achieve orgasm or, as my mother points out, even an erection capable of penetration. “Older male patients commonly report difficulty achieving orgasm,” Whitworth told me, “some failing to achieve it at all, with sexual encounters ending due to exhaustion and/or discomfort for the receiving partner.” The average time for a male to ejaculate (once the penis is in the vagina) is three-to-seven minutes. An older man with delayed ejaculation can take 25 to 30 minutes or even longer.
Now consider this: Vaginal lubrication is produced during arousal, and most water-based lubricants, which mimic natural lubrication, come with a suggested reapplication time of five to 15 minutes. According to a survey conducted by the Study of Women’s Health Across the Nation, which lasted over 17 years and included more than 2,400 participants, the “prevalence of vaginal dryness increased from 19.4% among all women at baseline (ages 42 to 53 years) to 34% at ages 57 to 69 years.” Menopause, anxiety, and being married were all linked to the development of vaginal dryness.
My mother’s most recent encounter with “the blue pill” was grueling. After a taxing day (stalled car, heavy traffic), my mother told the man she was seeing that he should not take it that night. She was exhausted; all she wanted was a good night’s sleep. He took the pill anyway and got into her bed with an erection. Too tired for an argument, she acquiesced. “You’re ministering to him,” she said of the experience, “trying every trick in the book, and it’s not working. But he’s like, I have an erection, I’m going to make this work, I’ve got this usable part, I’m just going to do it … I felt like I was the blow-up doll, as if I’d disappeared. I was so conscious of being utilized and totally objectified.”
Ultimately, the man did not ejaculate. But penetration didn’t end until my mother, who says she’d begun to disassociate from the moment, dug her fingers so deeply into his shoulders that he finally stopped to ask what was wrong. The next day, there was “no pain. No physical irritation. Tedium. Annoyance. Anger at self for putting up with it. Lots of the latter.”
In a 2003 study published in Sociology of Health, the sociologists Annie Potts, Nicola Gavey, Victoria Grace, and Tiina Vares discuss the dearth of documented experiences from the female sexual partners of men who use sexuopharmaceuticals. Talking to 27 women whose male partners used Viagra, the writers suggested that “while the publicity surrounding Viagra may potentially facilitate more positive attitudes to sexuality in older age, it may also produce a societal expectation that ‘healthy’ and ‘normal’ life for older people requires the continuation of ‘youthful’ (energetic) sex lives focused on penetrative intercourse.”
Of course erectile-dysfunction medications can create positive change for both the prescription holder and their partner. Peter, an 80-year-old in Ashville, North Carolina, can’t remember when he first started using Viagra, but he does remember it was when his ability to orgasm went from twice a day to once a day. “One day, there was less penis in my pants,” he told me. Somewhere in his late 60s, early 70s, however, the pill stopped working as effectively. He returned to his doctor. His problems were four-fold: “It won’t get up; it won’t stay up; it won’t stay up long enough for me to complete; it won’t stay up long enough to give her satisfaction.”
Peter’s doctor put him on a low daily dose of Viagra, instructing him to increase the dose to 100 milligrams before sexual activity. “It’s not as rigid as when I was a younger man, and it still presents some issues with penetration — I am working through those issues with the incredibly generous cooperation of my partner.” Today, he says, he’s having “the most satisfying sex I’ve ever had, albeit with challenges. I’m much more thankful and appreciative of what’s possible.”
Still, my mother was eager for me to write about her experiences with the blue pill, in part because she’s convinced, given her exploits, that the drug is quietly affecting the well-being and happiness of an untold number of women all over the world. Telling me about her recent and past encounters, she sometimes waxed quite funny (“I mean, their faces still look good, but their little wanker is not wanking”), but mostly she was mad: “The whole business of entitlement, sex, aggression, erections, and pills makes me angry. On the one hand, I felt that I was complicit in allowing him to continue,” she said, “but the reason I didn’t stop him is because of that stupid toe in the door of patriarchy: that a man’s penis is such a fragile subject that I didn’t want to humiliate him. It felt incumbent on me to make the problem go away. Which is just stupid. But I was, in a way, taking care of his bad behavior.”
In the case of many erectile-dysfunction advertisements, the perspective of female partners is either portrayed as entirely healthy and participatory (those bathtub commercials, for example) or entirely excluded. That 1998 ad featuring Bob Dole equated medicated sex with bravery, leaving out any consideration for the partner altogether with the tagline, “It may take a little courage to ask your doctor about erectile dysfunction. But everything worthwhile usually does.” An entire Pfizer campaign featured solo well-dressed men in confident, contemplative poses. One series of slogans highlighted by Weill Cornell Medicine’s History of Medical Advertisements collection — “You may be a man of few words, but you know how to make them count”; “Men don’t look for excuses. They get things done”; “This is the age of knowing what you’re made of” — reinforce that the drug is all about the man, all about his desires, all about helping him recapture what he’s previously been, and no one, nothing, else.
“Everybody was going on about how wonderful this thing was,” said one 60-year-old woman participating in the 2003 study, “and … [when I read about some other women’s experiences] I thought oh, thank God, I’m normal! — not everybody sees it as being … the most wonderful thing that ever happened this side of sliced bread!”
I asked a general practitioner if she ever had complaints from female patients about partners misusing or overusing Viagra prescriptions. She said, “Viagra can probably uncover deeper relationship struggles. We think that sex is going to fix things, it doesn’t necessarily …” Plus, aging affects women’s sexual health, too, she points out. “Female genital atrophy, for instance, is a common phenomenon among menopausal women that can reduce libido, reduce arousal, and increase difficulty in achieving orgasm,” she added. She told me about a couple in their 70s who she sees and treats together. The husband wanted the pill. The wife did not. The husband wanted their doctor to explain why his wife was wrong. She wouldn’t. “It was very aggressive,” she told me. “Very much But I’m the man sort of thing.”
I talked to Dan, a mid-50s CrossFit instructor who gave up Viagra about a year ago. Dan first started using the pill after going through a bad breakup in his late 40s. He didn’t need it, he says, but the fallout from the breakup was stressful. When he started dating someone he connected with, he got worried that his stress would be a distraction and that he wouldn’t be able to perform when the time came. He went to his doctor.
“Knowing what I know now,” he said, “if I was my doctor, I would have said, ‘Look, bro. I could prescribe this shit for you, and it will cause you to much more easily get an erection and keep said erection. It’ll spring to life and stay there for a while, no matter what’s on your mind. But in the medium to long term, you’d actually be better off, if you don’t actually have a physiological problem’ — which I didn’t and don’t have — ‘figuring out your fucking mind so that you don’t introduce this sort of dependency into the mix.’ Because that was the thing that happened.”
Other drawbacks for Dan included headaches, low blood pressure, and the issue of timing. He’d gauge the possibility of sex, take the drug so that he hoped the timing was about right, and then sometimes, if intercourse didn’t happen, he’d be stuck. “It just was not ideal.” A few times while using the pill, he tells me, he felt like he might actually “drop over dead” during some especially strenuous CrossFit classes. Ultimately, he weaned himself off what he referred to as his chemical dependency because the drug had begun to affect how he thought about sex. “Once you take it, you’re then stuck facing a headache and with this particular window where it does its thing. It inclines you to think, Okay, I just took this. I should probably use my penis.”
After talking with my mother, I started wondering about other women. I am guilty of acquiescing to sexual encounters with men when I wasn’t totally in the mood. I’m guilty of faking orgasms in the hopes of rushing a partner’s climax. I’m guilty of letting a partner continue his penetration long after it’s stopped being comfortable or pleasurable for me, a choice that left me feeling sore and achy well into the next day. Exactly how pervasive is women’s deference to men’s pleasure?
I texted a few friends, asking about their experiences. Mallory, who is in her early 50s, wrote back immediately: “My own experience with the blue pill was great,” she said, but she also told me about a woman who’s “a widow now but used to joke about the only foreplay was serving her husband a glass of water to take the blue pill.”
Lynne, a friend of a friend, is a 65-year-old retired medical interpreter who specialized in obstetrics and gynecology. Five years after her divorce — what Lynne refers to as “a length of time without intimacy” — she was thrilled to reconnect with her first love, who’d recently become single himself. “He was as opposite to my ex-husband as a man could be, in mostly wonderful ways, but also the not so great,” she said. “He was the prototypical sedentary American with terrible dietary habits on top of the smoking, and he needed Viagra to perform at all. But the sex was fantastic, and we had a blast making up for lost time.”
For Lynne, the drug, initially, was a revelation. But when she eventually asked him not to automatically take the pills when she noticed what she thought were side effects, as he would if there was even a possibility of intimacy, “it took a long time for him to control the habit of doing so, as if it were an obsession. And it is!” Eventually, her partner accepted Lynne’s feedback and now, eight years later, they’re still together.
On an intellectual level, Lynne understands that natural aging diminishes both the desire and abilities she took for granted in more youthful days; she told me that an active and fulfilling sex life has been an extremely positive part of her life. “That being said, the obsession with virility is creepy,” she says, “the assumption that it is what women want all the time is a turnoff.”
I found Ann, 53, through Instagram. She explained her marriage’s sex life as having its share of highs and lows before she and her husband turned to sildenafil. “We are very attracted to each other, have been from the very beginning in our 20s,” she told me. “It went up and down while raising kids. It got really good after the kids went to college.”
Ann described her experience with sildenafil as good, “for the most part.” She added, “It’s in his head now that he always needs it. I don’t like to always have to say, ‘Tonight, let’s do it.’ There’s something a little rote about sex now.”
Ann’s diminished craving doesn’t stop her from being grateful for the sexuopharmaceutical help her husband has received. She told me that the very best thing (for her) isn’t the sex; it’s the psychological side effect: “I couldn’t believe how down he could be if an erection did not happen.”
A woman in her late 60s named Pearl heard that I was working on this piece and offered to share her thoughts. “I’ve had to play along with my husband’s needs and wants for a while now,” Pearl told me. Before the blue pill, but since middle age, Pearl described sex as infrequent, quite casual, not unpleasant but also not earth shattering. “We both had to be quite ‘turned on’ for it to happen. And, yes, I often felt the need to hide my lack of interest and play along.” They hadn’t discussed Viagra until her husband brought a prescription home one day.
Pearl had lots of questions, including whether or not her husband had acquired a similar pill for her. He hadn’t. “How am I supposed to get in the mood, lube up, wait the half-hour, and act like this is great?” she said. “I do get asked sometimes ‘Should I take a pill?’ Hmmm … Am I in the mood? Will I be in a bit? Do I want to be in the mood? Or I get the ‘I took my pill awhile ago.’ Well, great, I’m about to fall asleep …”
When I told Dr. Bat Sheva Marcus, a sex therapist, over Zoom about my mother’s experiences that have inspired this story, she almost instantly teared up. “The fact that you’re talking to your mother about this is so powerful to me,” she said. But she was also quick to point out that she wasn’t crying for the reason I might think.
“It sounds to me to a certain degree that the thesis of this article is that the little blue pill has been really helpful for men but is putting a lot of pressure on women in a way it shouldn’t,” she said. “That’s probably true about a subset and I want to talk about what that subset is, but I also want you to know that phos-5 inhibitors in general have been a godsend to many, many people.”
Marcus then delivered a surprising statistic that she would go on to deliver a few more times over the next couple days: by 40, 40 percent of men need will need a PED5I to achieve an erection; by 50, 50 percent; by 60, 60 percent; by 70, 70 percent; and by 80, “well, you’re probably not gonna be able to have intercourse without Viagra.”
When I started this piece, I was filled with rage on my mother’s behalf. My working hypothesis was something along the lines of Fuck the blue pill, fuck the patriarchy, fuck masculine fragility. But after talking to Marcus, I understood that my initial stance conveniently eschewed nuance. “I think what you’re hitting on,” Marcus said, “is less the problem with the medication and more the problem with the communication and the expectations about sex in our society. If you can’t talk about it, you shouldn’t be doing it.”
Dan, the CrossFit instructor, told me, “My new relationship is so much deeper. We’ve gotten more comfortable. We’re pretty direct communicators now. Sex isn’t always going to lead to one or both of us having an orgasm. Sometimes it’s like the movies and awesome, and sometimes it’s nothing like that and still awesome. I just wish my doctor hadn’t been so ready to say, ‘Sure. Here. Try it.’ It’s much more complicated than that.”
My friend Anita, who is in her early 50s and lives in New York, met her husband, 15 years older, when she was 20. For several decades, they had a healthy and active sex life. When Anita was 45, her husband, after a year of debilitating symptoms, was diagnosed with a near-fatal heart infection.
“Our sex life had totally dried up,” she said, “because he was dying, and they didn’t know why.” Ultimately, he had two heart valves replaced, was in the hospital for a month, and put on IV antibiotics for six months after that. During that time, they had no sex. When they were ready to try again, they discovered he had erectile dysfunction, a common side effect for men after open-heart surgery.
His doctor suggested Viagra. “And, oh my God, it felt like I was being hammered by somebody who was never going to have an orgasm. It’s fine now, but it was terrible at first. Because his whole body — his whole body image — was fucked up from the surgery and almost dying.” Anita realized a conversation was in order. “But that was after I got to the point where I could be like, ‘It’s working, that’s great, but, you know, it’s not working in a way that is deeply satisfying for me.’ It took a long time — like four years — for me not to feel like I was just a receptacle.”
My boyfriend is nine years older than I am. Long before my mother and I started talking about erectile dysfunction, he and I had agreed that, if and when it was necessary, he’d get a prescription for Viagra, and that would be that. But he’s been privy to much of my research for this piece and, recently, our conversations around the topic have become more detailed and specific.
“Everything I knew about Viagra came from commercials I saw during football games,” he said. “You know: Talk to your doctor. Have better, more satisfying sex … I hadn’t thought much beyond the pleasurable smiles on the aging beautiful couples’ faces.”
“What if I don’t want to have sex into your 70s?” I asked.
“Ideally, we’ll find other forms of being intimate that work for us both,” he said. “The idea of hurting you is a total turnoff.”
“There are lots of ways to have sex,” I said.
“And if you don’t want to and I do, I’ll use my hand. But maybe it’ll be me who doesn’t want to have sex,” he said. We both laughed.
These new conversations aren’t sexy. Sometimes they’re playful, and sometimes they’re uncomfortable. But one thing that seems glaringly essential to any healthy and functioning sex life is communication. I’m grateful that my mother has provided me a reason to start thinking about and talking about what sex might look like as I move into my 50s and 60s.
Talking about sex is hard. It took my mother and me many decades, several divorces, a shared roof, a decent amount of wine, and Helen Mirren before we were able to start doing so honestly and without embarrassment. Now it feels as natural as pouring a cup of coffee first thing in the morning and as easy as tying a shoelace.
“Maturity and confidence contributed to my embrace of ‘geriatric’ sex and enthusiasm for it,” my mother told me. “We geriatrics passionately don’t want to grow old, and sex — good viable sex — offers the suggestion that we aren’t really old after all. But I now believe I’ve given up on that element in my life, which makes me sad. Joyous, frisky, passionate sex is just that: joyous, frisky, and passionate. I would happily forgo erections, penetration, and orgasms for the pleasure of being with a man who knows he’s still desirable in spite of impotence.”
My mother has scolded herself for sometimes still “having her toe in the door of the patriarchy.” But I see something admirable, even subversive in her new self-possession. I know a lot of women who fear the second half of their lives. But I’m beginning to think it’s the very act of becoming “women of a certain age” that inclines us toward autonomous and radical thinking — and demanding our pleasure be taken seriously.