Pharmacological treatments of sexual dysfunction have opened a new and exciting area for clinical sexology and sex therapy. Used correctly they can help people to overcome fears of and actual sexual dysfunction. Used incorrectly, they can wreak havoc in the relationship or with the individual. The recent pharmaceutical debut of sildenafil citrate (Viagra™), and the ensuing stampede by male consumers to obtain it, is a significant historical moment in our collective sexual history. The advent of a medication that reduces the vulnerability of erections to some psychological and even medical causes of impairment provides many men with a “bionic” insurance policy against shame regarding their sexual performance.
Undoubtedly, many men and their partners are well-served by sildenafil citrate. Such couples are unequivocally delighted at the remission of erectile problems, enjoying their regained ability to lose themselves in the sexual encounter without worrying about erections. For other couples, sildenafil citrate uncovers relational dilemmas, revealing the inadequacy of the medicalized construction of sexuality. The impact of any new medical innovation that makes it easier for men to have erections and thus to have penetrative sex must be understood within the relational and social context.
Fueled by the media and the anonymity and accessibility of the Internet, millions of patients are requesting pharmacological solutions for erectile dysfunction. Clearly, not all individuals who would benefit from sildenafil citrate are availing themselves of it; conversely, many inappropriate prescriptions have been written. Our clients and the public in general will not be well-served if sildenafil citrate is used indiscriminately. Any intervention, including psychotherapy, can be misused or abused. Pharmacotherapy is no different. Sildenafil citrate is just the first in a series of drugs that will treat various sexual concerns. Sex therapists should familiarize themselves with the uses, abuses, and misuses of these drugs. Some patients will seek out a nonphysical to avoid confronting a physical defect or problem. The opposite is also true—patients who want to deny a psychogenic etiology of their dysfunction will present to a physician. The solution to this dilemma involves helping both sex therapists and physicians to incorporate these new medications in social and relational context.