By Elin Wilson

If you have seen Matrix, the groundbreaking dystopian film made by the Wachowski sisters in 1999, you may remember a scene where rebel captain Morpheus offers main character Neo a difficult choice. In one hand he holds a red pill and in the other a blue one. As Neo is forced to make a choice he is informed that the red pill will show him reality while the blue one will allow him to return to an existence of illusions. Neo eventually opts for the red pill and a difficult reality, forgoing the blue pills promise of a life in comfortable ignorance. While real life may not be quite as dystopian as portrayed in the film and most of us are not faced with choosing between reality and illusions one thing is still very real – that blue pill of delusion. If you’re a man, chances are you’ve thought about or even taken that pill. If you’re not a man, chances are you’ve seen men around you purchase or use it.

That little blue pill is Viagra, the world’s most famous drug for treating erectile dysfunction.
Widely recognized in popular culture, Viagra has gained quite a large following and is the punchline of countless jokes. While the brand name is recognisable to many, the medication behind the name is maybe not as familiar. It is called Sildenafil and has been on the market since 1990. It is most commonly sold as a cure for male impotence but can also be used to treat increased blood pressure within the arteries of the lungs. The effects Sildenafil has on erectile function were discovered in 1989 as pharmaceutical giant Pfizer was in the process of developing a new medication for heart-related chest pains. The medication was named Viagra, which is derived from the hindi word for tiger – Vyāghraḥ, and rolled out in pharmacies worldwide. While there have been some trials on the effects Sildenafil has on blood vessels in other parts of the human body the real moneymaker has been its use in treating erectile dysfunction, a medical condition mainly present in men over the age of 50.

It used to be quite difficult to attain the medication. A patient would need to consult with a medical professional to rule out any psychological reasons for erectile problems in order to get a prescription. Even then, Viagra was quite expensive and not covered by many health insurance providers, something that made it a last ditch effort for men trying to revive their sex life. Taking all this into account, Pfizer still made around 1.2 billion GBP in yearly revenue from the medication. Over the years Pfizers patent has expired in many countries, creating a market for counterfeit or non-brand alternatives. At the same time, the company has pushed for Viagra to be reclassified as an over-the-counter medication, something that has become reality in the UK. As the drug has become increasingly easier to come by, the number of users has risen dramatically. Even though there are no official statistics, revenue flows indicate that sales are surging and many studies show that most of the buyers are younger men. And while some would argue that this increase is due to a previously unreported rate of erectile dysfunction in men, most scientists believe it is due instead to a culturally constructed expectation on male sexuality causing young men to feel inadequate.

So what then is it about our expectations on male sexuality that makes young, healthy men take medication they do not need? Many have argued that the sudden surge in Sildenafil sales is the result of dysfunctional and crippling expectations on male sexuality. Surveys indicate that many men feel that they are constantly expected to be able to perform and that their sexual partners, be it male or female, are likely to react badly to any erectile problems.While some feel that they would be considered less of a man and others voice concerns about their partner feeling sexually unattractive they all share a genuine fear of not being able to get and maintain an erection.  As many steroids used by gym goers can cause difficulties in achieving and maintaining an erection Sildenafil pills are increasingly popular within this demographic. Erectile problems are also a common side effect of many popular stimulants such as MDMA, Ecstasy and even alcohol – making the blue pill a given part of many a young man’s night out. 

While the treatment of erectile dysfunction can surely have a positive impact on many lives the recreational use of the drug has been linked to some serious issues and scientists have labelled the trend an epidemic. What then are these negative effects and why should you be worried? While some of the side effects of Sildenafil are those of a regular hangover, such as nausea, headaches and general fatigue, others are much more serious. Reports have been made of young men suffering from strokes, heart complications or even priapisms – a painful condition in which an erection lasts for hours or even days, restricting blood flow and resulting in permanent damage of penile tissue. One less researched but often reported side effect is a psychological one, in which men feel unable to get an erection without popping the pill. 

Despite the negative side effects, pharmaceutical companies have not been slow to capitalize on this apparent insecurity and have done little to stifle recreational use of Sildenafil. Popular myths about the drug being linked to a permanent increase in penis size or providing protection against STIs have, while being scientifically proven untrue, been met by silence from the companies selling it. Savvy marketing executives have even likened the invention of Sildenafil to that of birth control pills, claiming that men now have the sexual freedom that women have already attained. 

Erectile issues are not an uncommon occurrence and something that will happen to most men at some point in life. In fact, they are so common that the medical criteria for diagnosing erectile dysfunction requires not having had an erection for a period of three months, effectively ruling out many of those younger users of Sildenafil.  So while the blue pill can surely be tempting, maybe we should all opt for the red one and face the very real implications of these culturally constructed ideas around male sexuality. Life is surely hard enough without them.

Illustration: Lisa Wilson

Elin Wilson

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