If Alfred Kinsey's report on human sexuality encouraged the 50's generation to think and talk about their sex lives, then Masters and Johnson, who concluded that half of all marriages were sexually dysfunctional, made it possible for people to admit their sexual problems. Men, embarrassed by what is clinically called "male erectile disorder," and woman, frustrated with faking organisms because of "anorgasmia," could turn for help to a new breed of professional, the sex therapist.

In consulting rooms across the country, couples met with therapists to describe and discuss their sexual difficulties. And, whatever their problems were, the treatment plan was nearly always the same: Something called "sensate focusing" - a new name for the age-old  advice to "slow down and take it easy." Couples were exhorted to resist any urge for intercourse, and spend time, often weeks, just touching each other, first non-sexually, then gradually expanding into sexual caresses.

Only then could they proceed to cautious masturbation and finally, to the piece de resistance, intercourse.

Although most sex therapists now put more emphasis on couples talking to each other about their feelings, nothing much has changed in the past 50 years and sensate focusing remains the central technique of sex therapy. Recent studies suggest, however, that the outcome of this treatment does not come close to the dramatic results initially claimed. It seems that up to one- third of the couples usually drop out before finishing treatment and that, of those who do stick it out, about 60% show some improvement. The erotic fireworks of fantasy are not, by any means, the usual outcome.

Although the actual results aren't outstanding, sex therapy is still thriving as a business. But maybe not for much longer. In April, as only people who have been on Mars don’t know, Pfizer Pharmaceuticals released Viagra in the U.S. , a new drug to help men overcome impotence and "erectile dysfunction." Some have compared it to Prozac, the drug which, almost overnight, became the preferred treatment for depression. In fact, early numbers suggest that this new wonder drug might even outsell Prozac, which would be quite a feat considering that in
the U.S., Prozac sales amounted to $1.2 billion in 1993, its first year on the market, and the annual sales of Prozac, Zoloft and Paxil combined are now in the $5.5 billion range. In the first weeks of its being on the
market, doctors were writing a reported 40,000 Viagra prescriptions each day, which compares very favourably to Prozac, with its new prescriptions and renewals of about 70,000 each day. Current reports are that in its first two months, Viagra sold $182 million worth of pills, outshining any other drugs in history.

While Viagra may be a blessing both to the drug industry and to the estimated 30 million American and three million Canadian men who suffer from erectile dysfunction , it is a threat to the sex-therapy industry. To quote Leslie Schover, a Cleveland therapist who noted that Viagra seems to work best for the milder forms of the problems: "Viagra is a threat to sex therapy precisely because it is a drug designed to take our 'best customer.'" For decades, sex therapists have been stating that most sexual difficulties are psychologically based, and that,
since only a small minority could be attributed to physiological causes, the treatment of choice was obviously
psychological. But no more. Now there's a pill and it works.

Realizing that they are confronting a formidable foe, psychologists have begun to retrench. Some are attempting to define themselves as “partners” with medicine, suggesting that psychological “screening” must be done to rule out anxiety or depression as the cause of dysfunction. How they propose to do this is a mystery, given that most men seeking this treatment would naturally be anxious for help or depressed about their past experiences.

Other psychologists insist that these men will still need treatment for the shame and embarrassment that comes with these difficulties, seemingly oblivious to the way in which Viagra will eliminate these feelings.

Some sex therapists, instead of struggling to find such dubious secondary roles for themselves, are expressing concern that some men may use Viagra to enhance sexual performance when no diagnosable disorder exists. This is amusing. Ever since psychologist Miriam Polster declared that "therapy is too good to be limited to the sick," psychologists have been catering to "the worried well."

The famous "Dr. Ruth" Westheimer has warned of the problems to be expected if Viagra is not coupled with education and "sexual literacy." A case in point is that of the 70-year old man who downed Viagra, engaged in long overdue red-hot sex with his partner and then took off in search of younger women, destroying their 10-year relationship. His partner blames the lust drug. In fact, sex researchers now warn that older women may be unable or unwilling to match their partners heightened interest in sex.

Even if Viagra lives up to expectations, sex therapists may not be out of work: They can counsel the abandoned female partners of these Viagra males; the women who are the real victims of Viagra.