The path by which Viagra became a staple in our culture may not be as simple a process as finding a pharmacological solution for a clear medical problem. Angus McLaren, in The New Scientist (28 April 2007), reviews the course of impotence across history and makes an interesting argument that our definitions of impotence reflect much about our cultural values. By evaluating attitudes toward impotence we can better understand what is considered healthy for men, their relationships and society.

Impotence has been a preoccupation with most western cultures since ancient Greece. Impotence was originally equated with sterility during times when reproduction was the primary role for men. In late 17th and early 18th-century Europe patriarchal power required men to produce heirs. Much was at stake, in effect dynastic stability demanded successful sexual intercourse. Thus the rumors of Louis XVI’s impotence can legitimately be argued to have played a role in fomenting the public unrest that led to the French revolution.

McLaren further points out that the 19th century was marked by concern for familial privacy thus historians find little evidence of public discourse about impotence during this time. However, during this time doctors advanced rather bizarre theories of impotence, such as a man’s impotence resulted from a misspent youth.

Which brings us to the 20th century injunction aptly characterized as “use it or lose it.” During the 1970’s impotence was associated with over-worked, highly stressed, older men who had grown bored with their middle-aged partners. However, the impotence now targeted by Viagra is one also purportedly experienced by younger men. Interestingly, the makers of Viagra, and other phosphodiesterase-5 inhibitors, have never marketed it as a means of enhancing fertility; this doesn’t seem to be a major factor in our cultural desire for Viagra. Nor is Viagra primarily a means by which older men suffering a dysfunction can correct that dysfunction. Rather, the impotence that Viagra addresses seems to reflect a seemingly superhuman notion of what sexual health should be.

There are several possibilities that arise from this new definition of impotence that raise concern. First, in expanding self-improvement to include outcomes that exceed typical physical functioning it doesn’t seem to be a huge leap in logic to start viewing illness and disability as related to poor choices by individuals, perhaps even as moral failures. Second, in creating such superhuman expectations we seem to be setting people up for unnecessary anxiety and ultimately an inevitable sense of failure. Do we really want to have a generation of 30-something year old men anxiously calling their friends before a date to try and find some “date insurance?”

Viagra can clearly help men maintain an active and enjoyable sex life for longer periods of life. But as its “off label” use expands to include a role as a “jump start” for men who clearly have no medical dysfunction we can no longer argue that we are talking about using a medication to treat a medical problem. We are creating a new definition of sexual health that exceeds the typical performance of our bodies. Some will argue that this simply represents progress and we should get aboard. I argue that we need to consider not only what this reflects about our current cultural values but we need to carefully consider the long-term consequences on our relationships, our health and our personal values.