Why Study the Relationship Between Women and Viagra?
At first glance, it makes little sense to examine the relationship between women and Viagra. After all, this drug was developed to treat impotence in men and nearly all prescriptions written for Viagra are for this purpose. However, Viagra has done much more than merely treat male sexual dysfunction--it has excited the media and captivated the attention of the American public as a whole. Not since Prozac has America become so fervent over a drug and the potential it has to change the way we live. This excitement extends far beyond the male segment of our society: Viagra has the potential to drastically change the sex lives of women as well.
For too long, sexual disorders in women have been ignored by the American medical establishment. Ironically, Viagra, a drug intended for use in men, has had the effect of bringing female sexual dysfunction to the forefront of discussion in the medical community. As doctors begin to explore the potential use of Viagra in women, investigators are re-examining what constitutes female sexual dysfunction. In so doing, myriad issues relating to gender bias in the way we perceive sex have begun to surface. Since there is virtually no academic literature which discusses the effects Viagra has and will have on women, this report is meant to bring together many of the ideas which have begun to surface in popular media circles. When examined as a collective, perceptions of this drug and its use in women speak volumes about larger social issues in America.
What Is Viagra and What Does It Do?
Viagra is the common name for the molecule sildenafil citrate, a powerful phosphodiesterase inhibitor. This molecule works by preventing a specific phosphodiesterase (PDE5) from breaking down cyclic GMP in a complex cascade of chemical reactions.1 The net effect of Viagra is to cause certain blood vessels to dilate and surrounding muscle to relax, which leads to increased blood flow in specific tissues (i.e. penile tissue). Although the effects of Viagra are mostly localized to the genitals, other parts of the body can be affected, leading to side effects such as blue-tinted vision and nausea.
Interestingly, sildenafil citrate was first developed as a potential treatment for patients suffering from cardiac ailments. However, while Pfizer, the company which developed the drug, was conducting clinical trials, many male patients noticed that their ability to achieve erection greatly increased.2 Subsequently, the course of Viagra research shifted drastically, and today Viagra has become one of the principal options available to physicians in the treatment of erectile dysfunction in men.
It is well documented that Viagra works well in most men unable to achieve erection, but no one really knows what effects, if any, Viagra might have in women. It is theorized that because the vasculature and tissues of the clitoris are similar to those of the penis, sildenafil citrate could increase blood flow to the female genitals in the same way it does in males.3 It is important to note that this is merely a hypothesis some investigators hold, to this point in time, no definitive research has been done to show that this is actually the case.
Regardless of whether or not Viagra increases blood flow to the clitoris, the idea that it could be used in this manner opens a pandora's box of social issues regarding sex. First and foremost is the question of whether sex is primarily for pleasure or reproduction. A woman does not need to have an orgasm for fertilization to occur (although it is possible that the involuntary contractions of the uterus during orgasm may assist the movement of sperm into the oviduct).4 Still, American culture perceives sex first as a pleasurable experience and then as a means of procreation. People often want to have sex but don't want to have a child--as evidenced by the widespread use of contraception. Under this paradigm of sexual enjoyment, there is no reason why women should not have the same opportunity to experience the pleasures associated with sex as men.
There are several reasons why more and more researchers are contemplating the use of Viagra in women. First of all, there is societal pressure from both men and women who hope that Viagra might be just the thing to improve their sex lives. Physicians are members of the population as well--they see the magazine articles, television news reports, and newspaper columns which are all part of America's Viagra craze. Thus, our societal obsession with Viagra has undoubtedly affected the thinking of these researchers and caused them to wonder what might happen if women could were to be treated with this drug.
Another principal reason why investigators are curious about the use of Viagra in women stems from a fundamental shift in perceptions of female sexual dysfunction. It used to be that if a woman could not achieve orgasm, her dysfunction was blamed on psychological problems. Recently, however, there has been movement away from psychology towards physiology in the perception of female sexual dysfunction.5 Accompanying this shift is a change in treatment strategy--from psychological therapy to drug treatment. However, there are no drugs specifically designed to treat sexual dysfunction in women, and thus, many researchers see Viagra as the best option for treatment.
There are also certain economic factors which have spurred interest in the use of Viagra in women. Currently, Viagra is the hottest selling prescription drug on the market--and the vast majority of these prescriptions are written for men. Thus, if the market for Viagra were to expand to encompass women, then Pfizer (and other pharmaceutical companies which are working on drugs similar to Viagra) would stand to nearly double their profits.6
Although Viagra has been tested thoroughly in men, no one really knows what this drug will do in women. Thus, most physicians agree that similar studies to those previously conducted in men must be performed on women to determine the efficacy and safety of the drug. One of the main problems with such a study is determining how the effects of Viagra in women can be gauged. In men, the ability to achieve erection was a relatively straightforward method of determining Viagra's efficacy, however, such a measure is not so readily available in women. Researchers argue that there may be several effects of this drug in women which must somehow be measured (amount of lubrication, blood flow, overall sexual sensation, etc.) which complicates these studies.
In Europe, Pfizer is currently conducting clinical trials of Viagra in women.7 The methods Pfizer has adopted to measure the effects of this drug in women are similar to those the company used in men--patients are given detailed questionnaires concerning several aspects of sexual arousal/performance, and the results of these surveys used to determine efficacy. The results of this study, however, are not yet available, causing some U.S. doctors to take matters into their own hands.
Although Viagra only has the approval of the Food and Drug Administration (FDA) for use in men, doctors are legally allowed to write prescriptions for Viagra for any person, regardless of sex. Thus, many physicians, not willing to wait for the results of clinical studies, have begun performing "proof-of-concept" studies on female patients. These studies, although often well-intended, have several problems associated with them. First, the sample size of these trials are often too small to accurately determine whether there are any significant effects caused by Viagra in women. Furthermore, these studies use different methods (doses of Viagra, method of measuring response, etc.) from one another making it impossible to examine the results of these studies as a whole. Also, because these studies tend to be conducted out of a physician's desire to help his or her patient, they tend to be performed without proper control groups--a necessary treatment in any scientific study.
The dangers associated with administering a drug that might have unknown deleterious side-effects to patients have led many in the medical community to disapprove of these "proof-of-concept" studies. Some argue that the women who participate in these studies are little more than human guinea pigs--a means to satisfy the curiosity of rogue investigators. However, these women participate in these studies, no matter how unethical they may be, because they want to--they have the right to wait for the results of more accepted clinical trials.
Some women have gone a step further and begun testing Viagra in themselves without the supervision of a physician. The results of such anecdotal studies can be found on the pages of popular magazines such as Cosmopolitan and Harper's Bazaar, as well throughout the world-wide-web. Many women who take Viagra illegally may be doing so for a number of reasons. Journalists may be cashing in on the wide-spread cultural interest in Viagra to increase their readership; others may be simply be interested in trying Viagra as a recreational drug--much like marijuana or cocaine. Regardless of motive, these anecdotal studies are dangerous. The specific effects of Viagra in women are unknown, and there is the definite possibility that Viagra can be dangerous in women who have certain heart conditions, just as in men.
Interestingly, the internet plays a part in these anecdotal studies besides merely posting the experiences of these women. Certain web-sites are designed such that individuals have access to Viagra without ever seeing a doctor (http://www.medicalcenter.net/viagrawaiver.htm). They allow individuals to merely describe their "symptoms" to a physician (who is obviously willing to sacrifice his or her medical integrity) electronically and receive prescriptions for the drug. The individual can then purchase Viagra from another related site (http://www.thepillbox.com/buyviagra.htm) and have the drug delivered directly to their home. Thus, the impersonality of the internet allows women (through either lying about her gender/symptoms or getting a male to fill out the form for her) relatively easy access to Viagra.8
Technological Addiction in America
As we move closer to the widespread use of Viagra in women, the ways we perceive sex and technology as a society become increasingly lucid. It is disturbing to many that individuals look to Viagra as some type of sexual salvation--Viagra is not a drug which has any direct effect on sexual desires, it merely treats the physiological aspects of sexual dysfunction. Our societal obsession with Viagra leads many to ask, "are we looking for science to take the place of good, old-fashioned romance?"
Although the answer to such a question is not a simple yes or no, the proliferation of Viagra in American culture is clearly related to the "Tech-Fix"--the idea that any problem can somehow be solved through technology. In the case of Viagra, there are many potential benefits for women: not only might Viagra help cure the sexual dysfunction of an estimated 30-40% of American women, but merely the idea of treating such dysfunction with drugs rather than psychoanalysis has helped bring the sexual lives of women to the forefront of discussion. However, we tread on thin ice with Viagra--the potential exists for this drug to be abused when people believe that it will somehow heighten their sexual experience.
Return
to Women's Studies Homepage
Send message to Swarthmore College Women's Studies
E-mail Comments to: David Plante
Last Modified 12/10/98
webmaster