The ubiquitous sports-themed advertisements for Viagra and Levitra and the romantic ads for the new Cialis are designed to de-stigmatize impotence for the estimated 30 million U.S. sufferers. But the campaigns, ostensibly targeting aging men with a medical problem, are tapping into healthy men's insecurities about their ability to sexually satisfy.
More men in their 20s to 40s are seeking the prescription pills as a kind of insurance that anxiety won't overpower desire. Even men who haven't doubted their sexual abilities hope the medications might "take them to some new higher level of sexual prowess," says Dr. Abraham Morgentaler, a urologic surgeon at Beth Israel Deaconess Medical Center in Boston.
The growing popularity and availability of the drugs also have changed the way doctors prescribe them. Impotence occurs on a spectrum, and doctors are increasingly writing prescriptions for men whose problems fall into a grayer area -- like the 50-year-old who functions sexually but complains that things "are not quite the same as they used to be," said Morgentaler, author of "The Viagra Myth."
The drugs have few side effects, but can have psychological consequences, especially for young men who might benefit more from therapy and education. Ultimately, reliance on the drugs could erode, rather than enhance, men's self-confidence, says Alvin Cooper, director of the San Jose Marital and Sexuality Centre. "The confidence [then] rests in the pill, not in the person," he says. "What I don't want is for somebody to start Viagra at 20 or 25 and take it for the next 40 years."
The drugs haven't been around for decades, so long-term safety studies aren't available. Some men suffer headaches, flushing, heartburn and blurred vision; a few complain of painful erections that won't subside. Also, combining the pills with nitrate-containing heart medications or alpha blockers can produce dangerous drops in blood pressure.
Such events could become more common as increasing numbers of men take the drugs, often purchased on the Internet without a doctor's oversight.
All three drugs improve blood flow to the penis, making erections stronger and more resilient. They work for men with a diagnosed inability to maintain an erection, often due to diseases such as diabetes, those with a psychologically induced decline in virility and those with an age-related decrease in firmness of their erections.
Pfizer's Viagra (sildenafil) was approved in 1998, GlaxoSmithKline's Levitra (vardenafil) in August 2003 and Cialis (tadalafil) in November. The effects of Viagra and Levitra last about four to six hours. Cialis lasts an average of 36 hours, giving rise to its French nickname "le weekend."
Ads for all three are flooding the airwaves, although none that ran during the two NFL playoff games Jan. 18 mentioned erectile dysfunction by name. The drug companies are expected to have bigger audiences during the Super Bowl on Sunday.
During the playoffs, an ad for Viagra -- the industry leader with 2003 U.S. sales of $1.1 billion last year -- showed NASCAR driver Mark Martin saying, "I know a little something about making good moves." Levitra used the symbolism of a middle-aged man missing as he tries tossing a football through a tire swing while a narrator says: "Sometimes you need a little help staying in the game."
Cialis' debut ad depicted a couple holding hands in adjacent bathtubs.
While the ads give hope to men whose sex lives may have died, it also "creates a social environment where just being who we are or even normal at age 45 or 50 is no longer adequate," cautions Morgentaler.
He's particularly worried about the 18- to 25-year-olds "going into the next 50 years of their lives thinking they need a medication to match up."