Hillary Stout

It isn?t often that an article in AARP?s magazine gets the attention of People, the London tabloids, The Huffington Post and the celebrity blogosphere. But so it was last year when Michael Douglas, upon turning 65, sat down for an interview with the mass-circulation periodical for the over-50 set, and in the process uttered a word heard round the world: ?Viagra.?

?Michael Douglas Takes Viagra? announced headlines in The New York Daily News and other sites.

For the record, the exact quote was subtler, spoken during musings about his life with Catherine Zeta-Jones: ?God bless her that she likes older guys. And some wonderful enhancements have happened in the last few years?Viagra, Cialis?that can make us all feel younger.?

With media images abounding these days of virile older men?Hugh Hefner, 85, and Crystal Harris, 25, announcing their engagement; 80-year-old Rupert Murdoch with his elementary-school-aged daughters; the 74-year-old Italian prime minister, Silvio Berlusconi, and that 18-year-old party girl?one has to wonder if Viagra has again worked its magic.

And now we have evidence that 54-year-old Osama bin Laden had what has been referred to as an ?herbal version of Viagra? in his medicine chest at the compound where he was hiding out with multiple wives.

All of this raises the question of just what the far-reaching implications of Viagra (and similar drugs) are, beyond the specific medical achievement of providing a treatment, in the form of increased blood flow, for millions of men with erectile dysfunction.

More than any pill ever to be dispensed, Viagra has played to the yearnings of American culture: eternal youth, sexual prowess, not to mention the longing for an easy fix.

From the first announcement of the drug?s existence, fantasies went into overdrive; with the popping of a pill, lackluster marriages would be repaired. Or a generation of newly virile men would be on the make, hooking up with younger partners, maybe even getting a chance at righting any wrongs they had committed as fathers of young children years earlier. At the very least, everyone would be having great sex well into their twilight years.

It hasn?t worked out quite that way. Thirteen years after Viagra hit the market, we have not turned into a Viagra Nation. Pfizer, the maker of Viagra, said that it has been prescribed to more than 35 million men worldwide.

But recently the market for Viagra-type drugs has stalled in the US. Last year the total number of prescriptions for so-called ED drugs declined by 5% in the US after growing just 1% annually the previous four years, according to IMS Health, a heath-care data and consulting firm.

There could be many reasons for the dip: effectiveness or insurance payments, to name a few.

But another number is perhaps more telling: doctors widely observe that 40 to 50% of men who are given a first prescription do not end up refilling it.

Abraham Morgentaler, the director of Men?s Health Boston and author of the book The Viagra Myth, said he was startled by the expectations that people initially poured into one little pill. It became, at least subconsciously, a panacea for all that was missing. ?Men look to these types of pills as a saviour for other aspects of their lives where things are not going well,? he said.

The real effect of Viagra seems to be subtler. A 62-year-old man, who asked that his name not be disclosed, described in an interview how his experience helped change his attitudes about ageing. The man, a widower who has been in a long-term relationship since 2004, said he initially looked to ED drugs as a saviour. ?This is going to give me back everything,? he said.

But that wasn?t the case. The man said he has ended up using the drugs on and off for the last 10 years. But he no longer believes they are necessary. ?In some ways it?s a nice addition, but not so important that I need to have it every time,? he said. ?We?ve sort of made an adjustment.?

Therapists and others who counsel people on relationships say that the very existence of pills like Viagra have heaped expectations on an age group that may have more concerns than just whether they can still have sex.