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
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 dont
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
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.