20 years of Viagra: The little blue pill that changed the world

Or quite such a problem.

March 28 is the 20th anniversary of the American Food and Drug Administration greenlighting the sale of an accidental invention, sildenafil citrate, which rescued the sexual lives of men around the world — and their partners.

Within months of its initial launch it was on the cover of Time magazine (the “Potency Pill”) and had the footballer Pele travelling the world promoting it.

It’s now been two decades since its invention, and has been used by 66 million men worldwide, selling about 40 tons annually. This spring, Viagra goes on sale over the counter in the UK.

Pfizer, Viagra’s manufacturer, meanwhile says it regards regard media stories about “fumes” from the factory in Ringsakiddy, Co Cork having a stirring effect on local men as anything other than an “amusing” myth, despite anecdotal comments from villagers, reported in Fortune magazine, that “one whiff makes you stiff”.

What started out as a failed treatment for high blood pressure and angina, the initial drug trial known as UK92480 turned out to have an unexpected side effect — it gave men long lasting erections. So much so that some of the participants did not want to give the drug back once the trials had ended. Yet Viagra — as sildenafil became branded — almost didn’t happen.

The doctors in charge of the trial were told to shut it down, so unsatisfactory were the results in addressing high blood pressure — until a group of participating Welsh miners recounted, after being asked if there was anything else to report from the drug trial, how it had resulted in unexpected and very positive effects in the trouser department. A second trial, which cost just £150,000, focused not on blood pressure, but erections.

Boom. Viagra was born, impotence became less taboo, and stalled sex lives all around the world were reignited by the little blue diamond shaped pill. Suddenly it was okay to talk openly about floppy penises and how to fix them.

The US politician Bob Dole, a Viagra pioneer in the 1990s, advertised the drug on American television, praising its restorative properties after prostate cancer had halted his sex life.

Osama bin Laden, holed up in polyamorous domesticity in Abbotabad, Pakistan, kept a herbal version of the drug in his bedside cabinet, and Michael Douglas, on turning 65, famously spoke of its positive impact on his marriage to Catherine Zeta Jones, 25 years his junior. He called Viagra a “wonderful enhancement” that “can make us all feel younger”.

Viagra is something of a genie, in that it grants three fundamental human wishes — eternal youth, sexual prowess, and an instant easy fix. No wonder the drug’s initial salespeople reported feeling “like rock stars” as they began distributing it around doctors’ surgeries in the US; one salesman remembers getting a standing ovation from a waiting room full of men who prior to its invention would most likely have had difficulty making eye contact with one another, given the embarrassment factor of ED. And here they were clapping and cheering.

“Viagra has radically transformed the treatment and management of ED,” says consultant urologist Richard Power of the Royal College of Surgeons Ireland.

It has facilitated men coming forward and opened discussion channels — 50% of men over 50 have a degree of ED, but it was never spoken about. However, Viagra does not work if there is low libido or lack of desire.

The secondary health effects of Viagra are equally positive. Men who may not have presented at the doctor could now access a pill that would address — within an hour of taking it — their ED. Previously, it was thought that ED was psychological — stress, lack of desire — or caused by fatigue or too much booze.

By presenting with ED, men were often found to have related physical conditions like diabetes, prostate cancer, hyper cholesterol, endocrinological or cardio vascular problems, which would not have come to light had men not been seeking out Viagra.

Viagra is another significant step forward in sexual health for men and their partners, and can be plotted on the human sexual health evolution timeline that follows Freud, Masters & Johnson, Kinsey, the Pill, the Hite Report etc. It works by relaxing the muscles in blood vessel walls, but unlike its predecessors, it only works when the man is already aroused — it there is no sexual stimulation, Viagra does not work.

“Viagra has empowered people to acknowledge difficulty,” says consultant psychologist Fergal Rooney.

Physically it’s very effective, and psychologically we have seen what is called the ‘Back Pocket Phenomenon’— where a repeat prescription for Viagra is not needed because people have overcome an emotional barrier, had their confidence restored, and regained their psychosexual mojo.

Dr Rooney reports how some younger men present with ED and think they need Viagra, but the problem lies instead with sexual arousal patterns being affected by porn use, so that real time emotional encounters become problematic.

In these instances, a therapeutic process is needed rather than a pill.

However, for those with physical ED, Viagra has greatly enhanced relationships that had run into sexual difficulty.

“It’s not very spontaneous,” says M, whose partner suffers from medication-related ED.

“There’s no such thing as a quickie. But given how it rescued our sex life from the doldrums, we would rather accept a bit of forward planning than not being able to have sex at all. In that respect, Viagra has saved our private life from what had essentially been bed death.”

Prior to Viagra, a drug called phentolamine was used to treat ED, but its drawback was immediate, uncontrolled erection, regardless of sexual arousal.

This was dramatically highlighted at a 1983 American Urological Association convention in Las Vegas, when urologist Dr Giles Brindley injected himself with phentolamine, then went on stage and removed his clothing to display one of the first drug induced erections to his audience of fellow urologists.

Undoubtedly a memorable moment, and one that refuted the long held belief that ED was all in the mind.

Before Viagra – treatments for erectile dysfunction

First mentioned in Egyptianpapyrus scrolls around 2000BC, impotence was treated by natural plant remedies in ancient times. Ginger, truffles and herbs were all used to little effect.

So were ground up bits of animal — rooster testicles, vulture lungs, goose tongues, tiger penises and rhino horns. The latter were so popular that tigers and rhinos have been hunted almost to extinction, for a ED ‘cure’ that has zero medicalimpact.

Chinese and Indian medicineadvocated drinking one’s own urine, as male urine contains tiny quantities of testosterone andandrogen. It had no effect onimpotence.

Mechanical penis pumps became popular in the 19th century, and remained popular late into the 20th century. Although ‘popular’ is probably the wrong word.

After the discovery of radium in 1898, radium suppositories were thought to be a good idea for the treatment of impotence. Another device, the Radi-Endocrinator, was a radium filled mesh worn in a pouch alongside the genitalia. It didn’t work.

Also in the 19th and 20th century, electrical devices were inserted in the rectum and urethra in the hope of shocking the penis back to life. External electrical belts were also used, but neither internal nor external electric shocks proved effective in the treatment of ED.

Doctors prescribed strychnine in the early 20th century, but instead of fixing ED, prolonged use meant it killedpatients rather than cured them.

Phentomaline, trialled in the late 20th century, caused immediate erection, whether the patient was sexually aroused or not.

The development of Viagra, therefore, came as a great relief to all.