Erectile dysfunction

Posted on February 26, 2018 by Jesse Oler

Glossary term: Erectile dysfunction

Jesse Oler

Definition of Term and Background

Erectile dysfunction is a complex, multifaceted public health issue that draws controversy because of its sexual nature. According to John M. Last’s “A Dictionary of Public Health,”erectile dysfunction is the “inability to achieve or maintain an erection of sufficient strength and duration to perform sexual intercourse. The causes may be psychogenic, neurological, endocrine, or vascular” (Last 137). This definition assumes a legitimate physical causation for a man’s inability to sexually perform. However, this was not always the case throughout human history. In fact, erectile dysfunction has only been a widely utilized term since 1992 (Shah 433). Previously known as impotence, this health issue has largely been blamed on a male’s lack of masculinity or sexuality. However, since erectile dysfunction has been rebranded as a legitimate medical condition and pharmacotherapy has been developed to treat it, individuals with erectile dysfunction are able to lead happier and healthier lives (Shah 439).

A background of erectile dysfunction would be incomplete without discussing the pharmacological treatments that have been developed to combat it. While there are a variety of drugs used to treat erectile dysfunction, none are as well known as Viagra. Viagra, the trade name for sildenafil citrate, was a drug originally developed to treat high blood pressure and angina (Wilson). During clinical trials, it quickly became clear that the drug was more effective in opening up blood vessels in the penis, leading to larger and longer lasting erections than it was in treating high blood pressure and angina (Wilson). In 1998, when the drug hit the market, it drew a firestorm of attention and demand. Major publications and TV shows began to publicize the revolutionary new treatment (Wilson). In the early 2000’s, the FDA would approve other erectile dysfunction drugs including Levitra and Cialis, but Viagra still dominates the industry with over 45% of the sexual dysfunction market share (Wilson).

 

Historical Context

To understand erectile dysfunction, which is now understood as a medical condition, one must be familiar with the history of male impotence throughout the world. The first known allusion to impotence occurred in India in the eighth century BC, and hypotheses regarding the cause arose including various diseases of the genital organs or a lack of desire to engage in sexual activity (Shah 433).  Many primitive treatments were experimented with, including eating “the testes of a goat” or preparing butter that “should be boiled with eggs or testes of alligators, mice, frogs and sparrows. By lubricating the sole of the feet with this, a man would be able to visit a woman with undiminished vigor,” (Shah 433). This is notable because based on modern science, we now understand that these crude treatments would not alleviate the ailment. In Ancient Grecian and Egyptian societies, both physical and supernatural causes were suggested to explain male impotence (Shah 434). By the Middle Ages, the prevalent opinion was that impotence was the result of witchcraft or sorcery. (Shah 434). According to Haller, this opinion predominated popular thought in the West until the 19th century, when Victorian officials expressed their belief that male impotence was caused by excessive masturbation and a deficit of self-control. (Haller 1010). Theories such as these were widely accepted until the late 20th century, when various medical treatments were introduced that gradually led many people to believe that erectile dysfunction stemmed from a medical cause. During the 1950’s, experimental penile prosthetics were introduced, and this treatment is still used today in extreme cases of erectile dysfunction which are not treatable with drug therapy (Shah 438). However, pharmacotherapy designed to treat erectile dysfunction was eventually developed, and the anti-impotence drug alprostadil, delivered by injection or as an intraurethral pellet, hit the market in 1995. (Shah 438). Just a few years later, in 1998, Viagra hit the market and became the most popular treatment for erectile dysfunction. (Wilson). Today, erectile dysfunction is widely recognized as a medical condition that is treatable, and blame is being absolved from males who suffer from this ailment.

 

Perspectives

The treatment of erectile dysfunction has become a massively lucrative industry that incites controversy. Large pharmaceutical companies that produce erectile dysfunction drugs profit immensely from these medications. Wilson writes, “There were 8 million Viagra prescriptions written in 2012 with total sales of about $2 billion” (Wilson). Pfitzer, the pharmaceutical company which produces Viagra, is relatively unrivaled in this market. While Bayer and Lily USA produce Levitra and Cialis respectively, Viagra holds a near majority of the market share (Wilson). Additionally, a federal judge has extended the United States patent for Viagra until 2019, meaning that other competitors and generic brands attempting to enter the market will be prevented from doing so (Loftus). In the world of healthcare, consumers and advocacy groups are often concerned with the strong grip major pharmaceutical companies with near monopolies hold over the treatment of certain ailments. Because of the dominant position Bayer and Pfizer hold in the market share of erectile dysfunction, they have been able to gradually rise the prices of the medication over the years without much consequence (Lief). According to Erik Lief of the American Council on Science and Health, a reputable non-profit research and education organization, the price of a single Viagra has risen nearly sevenfold since the medication was approved by the FDA (Lief). In a recent CBS article, sexual dysfunction specialist Dr. Elizabeth Kavaler is quoted as saying, “Once you get to a certain price point, sex becomes a financial decision. It takes a lot of the joy out of this” (Kavaler). This relates the treatment of erectile dysfunction to a much larger debate in healthcare about the right of consumers to make their own choices about their sexual behavior. Unfortunately for many Americans, finances are a barrier to being able to lead the sex life they would hope to have. While this issue is often cited in debates about access to birth control or abortions, erectile dysfunction is another issue that prevents low-income individuals from being able to enjoy the sexual lifestyle of their choice. In the chart below, the striking rising cost of erectile dysfunction is displayed.

Figure 1: Chart displaying rising prices of ED medications (Wall Street Journal)

The major corporations that produce erectile dysfunction medications are known for their frequent television advertisement campaigns. These commercials feature themes of masculinity and male sexuality and seem to imply that the medications will improve those attributes in the patients who take them. This commercial illustrates the typical advertising techniques utilized by Pfizer, Bayer and Lily USA in marketing their product: https://www.youtube.com/watch?v=HMSv0GtzCDk However, these commercials are often a subject of mockery, as people feel that they display a false outcome from these products. While male impotency was historically seen as a lack of masculinity (Shah 433), it is now a common belief that erectile dysfunction stems from a strictly medical cause. Ironically, while these advertisements market medications that treat these medical issues and dilate penile blood vessels, they also have implications that are archaic in terms of their portrayal of erectile dysfunction. The image below displays a typical erectile dysfunction medication advertisement, with a handsome, physically fit middle aged man shown flirting or engaging in conversation with a beautiful woman. These advertisements often create a false belief that taking these medications is somehow correlated with an enhanced ability to attract women (Elliott).

Figure 2: Print advertisement from Cialis (Lily USA)

 

Relation to Politics of Health

The complex, multifaceted issues surrounding erectile dysfunction relate greatly to the curriculum of the Politics of Health course. Pharmaceuticalization, a term coined by sociologist Simon Williams and his colleagues, is exemplified by what has occurred with the treatment of erectile dysfunction. Defined by Williams as “the translation or transformation of human conditions, capabilities and capacities into opportunities for pharmaceutical intervention” (Williams 20), male impotence became an opportunity in the mid 1990’s for pharmaceutical companies to create new drug treatments and profit from a condition that had never been treated with medication. Since the pharmaceuticalization of erectile dysfunction began, drug treatments have become the most popular treatment for the ailment. Additionally, this process could be seen as a use of biopower by these strong corporate institutions. Biopower is a concept theorized by philosopher Michel Foucault to describe the dynamic in which individuals and their bodies become targets of interventions from powerful institutions for their gain (Foucault 279). In this instance, major drug corporations are using their position of power to gain profit through the production, marketing, and sale of erectile dysfunction medication. Through the pharmaceuticalization of male impotence, drug companies have influenced consumers to purchase medication in order to make money. Additionally in our discussion of inequities in healthcare delivery, we have often discussed socioeconomic barriers as being preventative from low-income individuals receiving access to healthcare services and products. Because of the rising costs of erectile dysfunction drugs (Lief), impoverished Americans who suffer from erectile dysfunction are being priced out of access to medications that would enable them to engage in sexual intercourse. This relates back to Farmer’s concept of structural violence, in that by preventing poor Americans from having access to erectile dysfunction medication by drastically raising prices, drug companies are preventing them from enjoying a basic human activity that many would consider a right or even a need (Farmer). Evidently, erectile dysfunction is an important and complex public health issue that is greatly impacted by the influence of major pharmaceutical companies and the structure of the American healthcare system.

 

Works Cited

 

“Can’t Buy Love? Sex Drug Prices Put Medicines out of Reach for Some.” CBS News, CBS Interactive, 5 Dec. 2016, www.cbsnews.com/news/sex-erectile-dysfunction-drugs-viagra-cialis-addyi-medicines-cost/.

Elliott, Stuart. “Viagra and the Battle of the Awkward Ads.” The New York Times, The New York Times, 25 Apr. 2004, www.nytimes.com/2004/04/25/business/viagra-and-the-battle-of-the-awkward-ads.html.

“Erectile Dysfunction Disorder.” A Dictionary of Public Health, by John M. Last, Oxford University Press, 2007.

Haller, John S. “Spermatic Economy.” Southern Medical Journal, vol. 82, no. 8, 1989, pp. 1010–1016., doi:10.1097/00007611-198908000-00020.

Lief, Erik. “Viagra & Cialis Make Prices Rise, Too, Defying Market Forces.” Viagra & Cialis Make Prices Rise, Too, Defying Market Forces | American Council on Science and Health, 5 Dec. 2016,

Loftus, Peter. “Pfizer Viagra Patent Upheld.” The Wall Street Journal, Dow Jones & Company, 16 Aug. 2011,

Rylko-Bauer, Barbara, and Paul Farmer. “Structural Violence, Poverty, and Social Suffering.” Oxford Handbooks Online, 2017, doi:10.1093/oxfordhb/9780199914050.013.4.

“The Pharmaceuticalisation of Society? A Framework for Analysis.” The Pharmaceutical Studies Reader, by Sergio Sismondo et al., John Wiley & Sons Inc., 2015.

Shah, J. “Erectile Dysfunction through the Ages.” BJU International, vol. 90, 2002, doi:10.1111/bju.2002.90.issue-s4.

Stavrianakis, Anthony. 2013. Foucault, Michel. In Theory in Social and Cultural Anthropology : An Encyclopedia. Eds. Warms, Richard L., and R. Jon McGee. Thousand Oaks, California: SAGE Publications, Inc. Pages: 277 – 280.

Wilson, Jacque. “Viagra: The Little Blue Pill That Could.” CNN, Cable News Network, 27 Mar. 2013, www.cnn.com/2013/03/27/health/viagra-anniversary-timeline/index.html

 

Additional Resources

 

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