The Culture of Impotence
Penile injections are the
most frequently prescribed antidote for male impotence. According to the
medical literature, the FDA-approved medication works like this:
The
impotent excuses himself from foreplay with his partner and enters the
bathroom. Here, he fills a syringe with the muscle-relaxant prostaglandin and
swabs a spot near the base of his penis with rubbing alcohol. Next, clasping
the head of his penis with one hand, the impotent inserts the needle about two
centimeters into the shaft. The needle must penetrate to the corpora
cavernosa--the rods of spongy tissue in the penis core. The user plunges the
syringe and almost immediately the prostaglandin loosens the muscles that
control circulation to the penis. The sting passes quickly and blood rushes
in--even a penis that has been limp for decades will spring to erection. To
prevent the puncture from turning black and blue, the impotent applies pressure
to the spot for the next 30 seconds.
Finally, after five minutes or so, the impotent emerges
from the bathroom sporting a dandy hard-on, not to mention the confidence that
his coach won't turn into a pumpkin for half an hour, regardless of how many
times he orgasms.
Thanks to prostaglandin, an
economy, even a culture, of impotence now flourishes in America. Extrapolating
from local studies, urologists estimate that more than 200,000 men injected the
drug into their sex organ last year (at about $20 a pop), and a total of
650,000 men sought treatments for impotence, up 43 percent from 1994.
According
to Business Week , U.S. men spent an estimated $665 million in pursuit of
erection last year. Clinics that diagnose impotence and teach the afflicted how
to inject themselves have set up shop in most major American cities. Doing
business under academic-sounding names like "Integrated Medical Resources,"
these clinics advertise their services on all-sports radio stations, cable TV
channels, and mass transit. (The bus ads give impotence treatment a friendly
face, usually depicting a balding, pocket-protector-wearing doctor.) Impotence
doctors have also helped found 55 chapters of Impotents Anonymous, and dozens
of telephone hot lines, to help the unarousable cope and steer them to medical
treatment. Plus, pharmaceutical companies are racing to develop simpler ways to
deliver the drug than injections. A tiny tablet cooked up by Pfizer, awaiting
FDA approval, allows men to stuff a drug similar to prostaglandin straight into
their urethra.
When urologists pitch impotence cures,
investment bankers and venture capitalists swoon--and for good reason. Between
10 and 30 million American men suffer from impotence, most of them around the
age of 60. Not only do most of these men have the time to fret over their
fading virility, most have the disposable income to indulge their anxieties.
And the demographic is burgeoning, giving a new meaning to the phrase "baby
boom."
But the culture of impotence
cannot be reduced to money-grubbing doctors and Wall Street shysters exploiting
the worst fears of the graying guys on the golf course. The conventional wisdom
about impotence has changed: What was once considered a normal part of the
aging process is now considered a treatable medical condition. "If a man has a
penis he can get an erection," says Irwin Goldstein, author of The Potent
Male and a urologist at Boston University. "[Prostaglandin] is literally a
magic potion that powerfully restores--safely, without any side effects--what
was once lost," says the Web site of Uri Peles, a Los Angeles urologist. New
York urologist Edward Moses employs the same overheated rhetoric on his Web
site: "For many men, life without sex can be likened to a watercolor painting
that should possess all of the vibrant colors of life, but which has been
reduced to sterile black and white."
Attribute
some of the doctors' enthusiasm to the novelty of their powers. A decade
ago--before penile injections--doctors thought of impotence as a psychological
problem or an unavoidable consequence of aging. (As the circulatory system
goes, so goes the reliability of erections. According to a National Institutes
of Health report, 70 percent of impotence cases among older men can be traced
to cardiovascular problems.) With the advent of the new medication, the doctors
now had a cure in their bag, allowing them to shelve the psychological
explanations trumpeted by venerable sex gurus like Masters and Johnson and
Alfred Kinsey, as well as the ancient belief that growing old means growing
soft. Goldstein epitomizes the new conventional wisdom: "[I]mpotence is
basically a plumbing problem," he says. To fix it, a doctor needs to get under
the sink with drugs, not into the head with talk.
Yet, in their haste and fervor to cure, urologists may have
debunked too many old assumptions about impotence and invested too much faith
in their new power to make men hard.
Indeed, many impotents do
suffer from an exclusively medical problem. Diabetes, cardiovascular problems,
and penile injuries (more than 100,000 whacked in bike accidents have been
permanently deflated, according to the medical literature) all prevent men from
mustering a swelling. No amount of chat will ever restore their virility. A
stiff dose of prostaglandin for them, please.
Still, the prostaglandin is
an inadequate fix for almost half of its users. Caverject, the prostaglandin
injection sold by Upjohn, gets a rouse in nine men out of 10, but 40 percent of
those who use it abandon the drug within months of beginning their therapy.
According to Upjohn, the leading explanation offered by the quitters is that
the drug doesn't restore the sexual desire or the pleasure they once derived
from sex. In fact, some impotence researchers assert that the success rates of
prostaglandin may not be much better than the success rates of placebos.
What this indicates is that
erections--satisfying erections--don't reside solely in the groin. Natural
erections are elicited by the neural signaling of nitric acid, which in turn is
triggered by some desire, or thought, or external stimuli. You can
short-circuit the biology of erection, but that doesn't "fix" the nonbiological
problems that exacerbate and sometimes even trigger impotence.
The marginal efficacy of
prostaglandin isn't likely to keep the baby boomers from buying the urological
spin. After all, their cult of youth has successfully preached that aging can
be staved off by medical intervention: hair implants, skin peels, and
liposuction. And by drugs, which have been their remedy for every psychological
malady: LSD to shatter hang-ups; cocaine to alleviate chronic boredom; Prozac
to lift depression. Look for prostaglandin to become a sacrament that allows
boomers to rut until death. The generation that still listens to rock 'n' roll
will consider it their right to keep getting their rocks off.
