Sexual dysfunction generates concern, anxiety, shame, and even terror in those it affects. Historically, men in particular have equated their self-worth with sexual performance. Impotence, or erectile dysfunction, is said to affect some 30 million men, which leaves this large portion of the population feeling hopeless, helpless and inept.

In March, 1998, the problem of impotence saw new hope. The Food and Drug Administration approved a little blue pill that was to change the sexual capability of a large number of people. The controversial Viagra (manufactured by Pfizer) would increase blood flow to the penis where previous solutions such as vacuum pumps and injectable medications had been too painful or difficult to use. Even the Vatican got on the bandwagon by approving the use of the pill for Catholic couples on grounds that it would strengthen the family.

Now, with the onslaught of requests for hundreds of thousands of prescriptions for Viagra each week, pharmacies have begun to beckon prospective customers with signs advertising they stock the pill. While the insurance industry, taken by storm, continues to argue whether they will pay for "pleasure" drugs, women are looking toward an equal opportunity orgasm pill to increase their chances of gratification as well. Pfizer, Zonagen and Abbott Laboratories are targeting such a pill to be available within the next two years.

Since its public release, the Viagra buzz has become so overwhelming one may think that sex is the only thing we have on our minds. Viagra knockoffs and substitutes have begun to flood the market. The prescription drug Vasomax, traditionally used via penile injection, is now available orally--although it's purported to be less effective in this form. A non-prescription, "Vaegra," named similarly to the prescription drug, has been accused of being an herbal "scam" offering false hope for men with real problems-- especially at a time when baby boomers are beginning to feel the effect of age on their bodies. For them, remedies for impotence could not have come soon enough.

Despite high hopes, Viagra cannot perform miracles. It is not an aphrodisiac and does not directly cause penile erections. It merely affects a man's response to sexual stimulation. If a man mistakenly thinks it will induce desire with an undesirable partner, all he will raise are his levels of frustration and disappointment.

This brings us to the question of what the purpose of sex really is. Is its aim to extinguish a sexual yearning regardless of who the partner is or what the circumstances are? Or is the goal to express feelings two people share which go beyond words alone? Of course, the answer depends on those involved. Some people use sexual gratification as a tool to reduce stress, confirm desirability, release tension, and/or just have fun. If both parties mutually agree to its purpose, no harm is done.

Viagra has raised expectations for an entire segment of the population-- expectations that can potentially damage a relationship. It has changed the balance of power for many couples. Men whose virility has been revived have already reported straying from their spouses. In addition, unbridled passion can lead to compromises in the practice of safe sex. Some couples also experience sexual stress as they unrealistically expect their usual dull routine to improve. Finally, one woman confided that just when she was beginning to enjoy her husband's sexual apathy, allowing her to be left alone to read and watch TV, he got a Viagra prescription filled. Now she complains about not being able to have a solid night's sleep.

Recently, the first Viagra lawsuit hit the news. A 70-year-old man from New York, hearing aids in both his ears, made headlines when he swallowed the love drug. For the first time in years, he had sex with his live-in lover of a decade and then proceeded to leave her only four days later, bottle in hand. His departing note read, "Sorry, I'm leaving. It's time for me to be a stud again." With his reinvigorated outlook, he moved in with another woman and is said to be living sexually ever after. Meanwhile, his ex-lover who claims she endured their sexless relationship for years, is suing him $2 million in palimony plus damages. Since they are unmarried and there is no such thing as common law marriage in New York, her lawyers will establish the true nature of their relationship under the law at their second residence in South Carolina. It will take some time to muddle through the legal aspects, but it is suspected this kind of lawsuit is only the beginning of many more to come.

The pursuit of sexual enhancements is nothing new. It was not long ago people sought greater passion through the use of Spanish fly, a powder of ground beetle wings from Spain and the southwest United States. The powder is meant to irritate the outer mucous membranes of the vagina and the penis thus giving the impression of arousal. Women may experience lubrication as a response to its irritating itch, but intercourse may be painful. Spanish fly is also poisonous and, therefore, illegal in the United States.

As we've become more sexually sophisticated, we've also seen an increased fascination with food and clothing as they relate to sex. Alleged "rude food" items include oysters, chocolate body paint, whipped cream, honey, exotic jellies and jams, flavored condoms and edible undies. Some clothing fetishists dramatically drape garments made of leather, latex, rubber, silk, or feathers across specific body parts. And, of course, the notion of underwear that's fun to wear has put Victoria's Secret and Frederick's of Hollywood on the map.

But there are some drawbacks to this concentration on sexual gratification with the exclusion of the thing it is supposed to express: the relationship. The overriding lesson we've learned from the Viagra craze is that if a man thinks he'll go from dud to stud with just anyone, he's terribly mistaken. Overall, the need for positive communication and attraction remains. Even if a man begins taking Viagra, he must still consider whether his problem is based in sex or in the relationship. While Viagra has made it possible to fix many physical sexual ailments, the relationship issue requires introspection.

Despite misleading promises, an erection won't occur if a man is affected by alienation or indifference. In fact, the expectation that a body will cooperate in a negative environment might become a passion assassin. In addition, Viagra won't improve a man's technique or his ability to care. Women will still crave erotic foreplay as much as the post-orgasmic caress. Despite Viagra's claims, a man must be willing to have sex with his partner, not just with his erection. Viagra or no, lovemaking is not about putting Flap A into Slot B. It should be about mutual feelings and emotions which may or may not lead to intercourse. To make the most of one's sexual expression, emotions should build naturally over time. Herein lies the difference between casual sex and committed sex, and no pharmaceutical quick fix can substitute one for the other.

Successful relationships are based on trust. Trust is based on honest communication. No matter how old a couple is and how many years they've been together, they must openly discuss their sexual feelings and fears. They must be sympathetic listeners when their partner's possibly bruised ego needs a bandage. They must optimize their intimacy by touching base, and perhaps seek counseling if they reach an impasse. With or without the latest discoveries in pharmaceutical sex, the overriding rule of thumb is and always will be: "good communication is the best lubrication."

Reprinted from American Fitness