Viagra Commercial 0:08
Going out for date night with your man is nice. Driving out on the open road together is great. Watching football together is great. But I think all women agree: getting home to cuddle up with their men is nice too. It's kind of nice too. Is nice too. Viagra helps guys with ED get and keep an erection, and you only take it when you need it. Ask your doctor if your heart is healthy enough for sex. Do not take Viagra if you take nitrates for chest pain, it may cause an unsafe drop in blood pressure. Side effects include headache flushing, upset stomach...
Anita Rao 0:39
25 years ago, what we now call the 'little blue pill' became the fastest selling drug in history.
Nightline ABC News 0:47
It has been described as the new fountain of youth. I have an erection like I was 25 again. It is a pill called Viagra. It seems to offer a real cure for impotence.
Anita Rao 1:05
That was the introduction for Nightline on ABC News on April 27, 1998. The demand for Viagra when it hit the market was huge, because up until that point, treatment options for erectile dysfunction were pretty limited.
Pfizer, the pharma company behind Viagra, chose the late Senator Bob Dole for their first ever television commercial, in which he admitted that while he was a little embarrassed to talk about his experiences with ED, he knew how important it was to millions of men and their partners. But what was missing from that message, and much of the public discourse since, is that Viagra is not a cure-all for erectile dysfunction. And framing the conversation that way can lead people to feeling even more alone in their experiences.
Ven Virah 1:51
I knew it wasn't normal, and started growing a lot of shame, a lot of guilt. It's something that I didn't want to speak about with family or friends or a medical professional. I was just dealing with my curved penis and, and the shame that came with it.
Anita Rao 2:06
That's Ven Virah. He's a public speaker and global healthcare staffing professional based in Vancouver. For Ven and so many others, erectile dysfunction is at once something that challenges your physical body, your sexuality, and perhaps most importantly, your relationship with yourself. This is Embodied. I'm Anita Rao. Erectile dysfunction, by definition, is the inability to develop or maintain an erection for satisfactory sexual activity.
ED can be caused both by physical and psychological factors. And while it's more likely to occur with age, it's not exclusive to older folks. Ven started noticing a physical curvature in his penis when he was in his late teens. Something he attributes to years playing soccer goalie, sans jockstrap.
Ven Virah 2:57
Did I have erections? Yes? Did it hurt? Yes. It was hard for me to to assess how were my erections versus other men at the time, because I was really not talking about it. And that became the reality I was living in, in my head for 10 years of my life.
Anita Rao 3:12
The curvature and the physical, emotional and mental aches that came along with it made sex and intimacy a real challenge. And some of the comments Ven heard left their own scars.
Ven Virah 3:24
Once initially, somebody did find out, she wasn't mean or anything. But she was pretty much telling me that, well, it's not going to go in, it's not going to work. So we can't have sex, we can't have penetration. And that stuck with me. And it was really hard for me to experience. From that point on, I was just very much subconsciously just breaking every relationship I was with when it got a bit more intimate.
Anita Rao 3:51
So you mentioned that there was this really long period, 10 years, where you didn't talk to anyone. And there are so many resources online about erectile dysfunction, that stress no matter the discomfort you're feeling, talk to your doctor. But I know that for so many people, that first step of actually being able to say something out loud is so, so challenging. It took you 10 years, what was it that pushed you to finally be able to open up to a medical professional?
Ven Virah 4:17
What led to me making a decision and moving forward was I did this personal transformation course. And a lot of things that were in my subconscious came to the surface, and it was like, Oh, my God, I do have a problem. I'm thinking that God's going to take care of it. It's going to heal on its own. But the reality is, I have the tools and the responsibility to deal with what I'm facing, and I need to do something about it.
Anita Rao 4:47
Ven worked alongside his doctor for months experimenting with a range of ED treatment options. The physician was actually so interested in his condition that he offered to fold Ven into some of his research, which allowed him access to treatments that wouldn't have been covered by insurance. But after a lot of trial and error, his doctor said the only option left was surgery to straighten out the curvature in his penis. This was back in 2011, when Ven was 28. Ultimately, it was the prospect of surgery that inspired him to finally open up to friends and family.
Ven Virah 5:28
So essentially, what happened was, I was going for my surgery. And I remember at that time, they were going to be putting me to sleep as part of the surgery. And I remember, a few years back, I had lost my cousin who passed away because of being put to sleep for a an easy surgery. And I was like, Oh my God, this could be the last time I'm alive by going through this surgery. And nobody knows what I'm going through.
And I remember that morning, I wrote on Facebook, as if this would be my last post, my last status. I'm like, My life is my message. And I left it to that. And my mom replied, she's like, No, your life is my message. And that just lifted my heart and I'm like, Oh, my God, my mom doesn't even know. But to my luck that morning, the hospital called me and they told me that the doctor that had to do my surgery, had an emergency procedure and couldn't take me for my surgery that morning. But that we will reschedule in that two months.
And in that two months timeframe, I took courage to tell my sisters, my mom, my dad, my closest friends. And every time I would share the story, I would cry so much. And I wasn't one to cry. But I really had like the floodgates open and I cried and then I shared, it was so great to see how everybody was so supportive. And just were wondering why it took so long to tell them. And then I went into that surgery with the closest people in my life, two months later, knowing what I was going through.
Anita Rao 6:56
You come from a South Asian family, as do I. And we've talked before, I've talked to my parents on this show. And there's been a lot of acknowledgment that it's not a culture known for talking really openly about personal struggles about things that are considered really private. I'm curious about any cultural pressure you felt to kind of protect your family's reputation or fears about, you know, what was gonna happen if you opened up.
Ven Virah 7:22
So that's a big thing. Because in the South Asian community there is there's a saying saying: What will people think, "log kya kahenge." And essentially, it's always, always like, what is the community going to think? What are they going to say? You know, you don't want to sound weak, you don't want to air our dirty laundry to people. So uh, yeah, I was trying to protect my family. I felt that asking for help felt weak. Many of us were actually conditioned to keep our hidden shame hidden.
Anita Rao 7:50
So you told each of your family members separately in individual conversations, and I'd love to know in particular about your conversation with your dad, and how that went, and what came up in that conversation for you.
Ven Virah 8:03
So I took my dad separately out for a walk, and then I just, I told him, and what I really appreciated about my dad is he kind of created a very light environment where he was making it sound like it's not a big deal, this is something people can go through, and that we're here as a family to help you. It felt a lot of relief, Anita, like to be able to tell my dad, like the male figure in my household, about what I was going through as a young man, felt like so much weight lifted off my shoulder.
Anita Rao 8:41
While medical interventions for erectile dysfunction like Viagra or curvature straightening surgery are a relatively new phenomenon, the existence of so called cures for ED or impotence or not. If you were a penis owner with erectile challenges in ancient Rome and Greece, you might have walked around wearing rooster and goat genitalia as talismans under the assumption that doing so would promote sexual function. If you lived in the 13th century, you might have been instructed to indulge in some roasted wolf penis to promote potency.
In the 19th century, French neurologist Dr. Charles-Édouard Brown-Séquard opted for a more invasive approach. He injected himself with extracts acquired from dog and guinea pig testicles. So yeah, we have made some progress.
One of our more modern inventions is the Vacurect. It's a vacuum erection device that's been in use since 1999. When Australian poet Steve Jones started experiencing ED post-prostate cancer surgery, he turned to the Vacurect to support him in his recovery. And he wrote a poem about that experience. It's Dr. Seuss-like in its rhymes, but serious in its subject matter.
Steve Jones 9:59
My trusty old friend. Still only a half, still only a quarter. Go on, stick it in, that plastic transporter. Now grease it up good, silicone ring on the end. Pretty soon he'll be there, my trusty old friend. Oh just for one night I'd like to be normal. No pump or no needles, roll over informal. Alas, it is not. I'm so sad it's not so. I hope for one day, I'll be all systems go. Your partner's right with you, though out of their league, they try to understand all the care you'll need. So needle it, pump it, stretch it and bend. I'll soon have it back, my trusty old friend. With patience, perseverance, love messages sent. I hope I see you some day, my trusty old friend.
Anita Rao 10:57
For many people experiencing ED, patience and perseverance are critical components of a journey without quick fixes or surefire cures. And moving beyond a diagnosis can be just as much a psychological matter as a physical one. That's where therapy can come into play, to help folks unravel the stories they've told themselves about erectile dysfunction.
Dr. Reece Malone 11:20
I often start with talking about language and the power of language. We have this language called dysfunction. And right there, that word can be incredibly destabilizing and stigmatizing for a person, and especially if he uses that term as a synonym for failure. And so before we even get to the root causes, I encourage the individual to start thinking more broadly. And perhaps that this isn't a failure. And perhaps we need to listen, and what is your penis trying to tell us?
Anita Rao 11:56
That's Dr. Reece Malone. He's a Winnipeg-based sexologist and sex therapist with a doctorate in human sexuality. And he often works with clients experiencing ED, many of whom come to his office after trying Viagra or Cialis, and after wading through the Wild West of internet guides to biohack your way to an erection.
Dr. Reece Malone 12:18
Well, we also know that there is big money to be made from someone's personal vulnerable experiences. And I, you know, prefer to move into these discussions of the impact, really, of those messages. And the messages that he takes on that impacts his sense of masculinity, that impacts his sense of what it means to be a man, you know, virile and available and sexy. What or how he senses value in himself and his sexuality.
Anita Rao 12:50
These messages of what it means to be a man are pretty inescapable. And for many folks experiencing ED, they can further contribute to a cycle of stress, shame and stigma. That's something that Ven encountered after his surgery.
Ven Virah 13:06
So when I was told by my doctor that I could go out there and meet someone and getting intimate, and that everything should be fine, I met someone, we tried to have sex once, it didn't work. We tried again, another time it didn't work. And the third time we tried and it didn't work. I got very, very, I guess frustrated or sad, and I was just feeling a lot of shame because I went through such an ordeal. So I went to the doctor and told him my situation. And that's when he replied, he's like, Well, physically, you're, you're healed. But you still have 10 years of trauma that you need to address. And he referred me to a psychologist. And then that took me on a nine month journey of talking about what it meant to be a man.
Anita Rao 13:50
Reece, there are so many kind of meta narratives around sexuality and at the core of a lot of concerns that people present with. This is something that sex educator Emily Nagoski always talks about is people want to know that they're normal. And it's hard to know if what you're experiencing is normal, when it's something that you don't really talk to people about. What are some of the recurring ideas that you hear from folks about what they expect to be normal in terms of sexual function in terms of erections?
Dr. Reece Malone 14:19
Yeah, you know, those messages, those cultural messages about what is a normal man, and that all penises should be able to quote unquote, perform on demand, that you can will an erection. And that when you have an erection that it's meant to be 100% hard or hard as if no other factors like aging, medication, injury — all those messages.
And so parts of the work is unraveling those messages, and that oftentimes, men would feel incredibly low about themselves, low self esteem, feeling that no one will love them. No one will be attracted to them, that their dating life is over, who will marry someone like me. And especially then, if I can't get this treated or cured, there's questions about, Can I have a family, am I desirable?
And so we've really put in a lot of meaning behind what it means to be hard, and not hard. But this also points to how important it is to have comprehensive sexuality education, to teach people and to bring awareness that these are how bodies operate, and bodies are not meant to operate 100% of the time. And that's normal.
Anita Rao 14:34
You bring up an interesting point about the dynamics within a relationship when erectile dysfunction is present. And Ven, I want to ask you a little bit about this. You went to therapy, you tried online dating, you matched with someone that you ended up marrying. And I'm curious about how you all talked about and navigated your history of ED in the context of your sexual relationship as a married couple.
Ven Virah 16:03
What I did initially was, she didn't even know that — I started dating her, she didn't know I was dealing with erectile dysfunction — but eventually, a few months into us dating, we actually had sex for the first time. And she thought I knew what I was doing. But in my head, I'm like, is this going to work? Is this going to be okay? Is this what it's supposed to feel like? And I went ahead and it worked. And everything was great. And I understood what it was supposed to feel like.
So on my last day of my therapy session, my therapist asked me, she was like, Is there any final wishes that you have? And I told her yes, I would like to invite my girlfriend to come to our therapy session. So we can explain to her the whole journey and the work that we've done. And then she can leave, and you and I, as a therapist and I, can have more closure.
And then after that I met with my girlfriend at the time, and we spoke about it. And I was like, So what do you think? And she's like, Ven, I'm actually so happy you told me and just know that it doesn't change how I think about you, that I'm here to help and support you, and I'm happy you told me and that this was your journey, and that this is what you had to go through. I actually feel it got us closer to each other. So that was a very healing journey for me to be able to experience that with a partner. And it actually led us to have a healthy sexual relationship and to be able to move forward on that path.
Anita Rao 17:29
Ven I'm curious about how your communication around ED evolved. You mentioned that moment of clarity and connection with your wife. You all have since gotten divorced. And you are back in the dating world. How do you talk about ED now and how does it show up in your sexual relationships?
Ven Virah 17:51
I've felt that the more I spoke about it, the more authentic I got in my conversations in general, the more I've been able to be more in my heartspace than my headspace with people, which I feel people really appreciate. And the one thing is, when I speak about such topics, I feel that I'm also giving permission to people to open up.
I remember a friend telling me, like 20 years later, he was like, Wow, if I knew you were going through this in university, I would have had so much I could have shared with you about my own personal experience. But now I feel that I want to be more real about my life stories, my life experiences, and to not feel that shame or guilt, to really empower myself and empower other people to know what it feels like to be human and that they're okay and whatever you're dealing with, I can help them or other people can help them, but there are people and resources out there to help them and it's okay.
Dr. Reece Malone 18:47
I do encourage people to give themselves permission to reach out to people that you trust. And those conversations can be difficult, and the more that we can lean into that vulnerability, the better position that we all are in a culturally and societally to talk about with dignity and respect different aspects of our sexuality, and destigmatize talking about sexuality, the better position that we will all be in individually, relationally, as well as culturally.
Anita Rao 19:29
Having erectile dysfunction is actually pretty normal. In fact, it's statistically common. Half of all people with penises aged 40 to 70 experience ED to some degree. And while it can be a source of shame and stigma, it doesn't have to be.
Will N Richards 19:48
The first time I had ED, I was 18 years old, and I was trying to have sex for the first time. And it didn't work. I wasn't able to get it up. It was like having an out of body experience, it was very unnerving, very destabilizing. And it was very much like I wasn't in charge of my own body.
Shannon Munford 20:14
At 47, I was diagnosed with prostate cancer. As an African American male, it's a common diagnosis. As a result of surgery, I was told that I could have erectile dysfunction, ED, and after, you know, waiting a few months to see if my functioning would come back, it never did. It was pretty devastating. I just wasn't ready for that part of my life to be over. But after time, I realized that it wasn't over.
Will N Richards 20:44
And so I did a lot of writing, a lot of thinking about it, worked with a therapist. And the result of that I would say is that I have a much better understanding of my sexuality, and I was sort of view almost ED, its ultimate result in my life as quite positive.
Shannon Munford 20:59
Our sex life expanded, we found that we could slow down and begin to enjoy one another in different ways that we may have bypassed. We're learning, we're growing this new way of connecting with each other and ED is not the end of it.
Anita Rao 21:16
That was Will Richards and Shannon Munford. Will is a writer and author from Montreal, whose inaugural novel "Mother" features a main character who struggles with erectile dysfunction. And Shannon runs a Facebook support group for couples exploring sexual intimacy after prostate cancer treatment.
With penetrative sex off the table, many folks experiencing ED are forced to grapple with their own definitions of sexual connection. That was the case for George Marx, a 72-year-old blogger and social activist who started experiencing erectile dysfunction in his 40s. George wrote about his experience in a 2013 article for Voice Male magazine, titled "Living and loving with erectile dysfunction." In that essay, he admits that while he was intellectually able to accept his new reality, emotionally, it was a different story.
George Marx 22:16
While I understood it was a quote, normal part of being, it still was difficult and I was transparent with my sexual partners. It wasn't like I hid things. But it still was challenging to have a disconnect from my own body. And it felt like it happened overnight. Although it, in a way it didn't. I could have the same experience of being with my partner, and feel wow, I'm really turned on. And think that my penis was engorged and was enlarged. And it was soft as can be. And there were other times when, it was back 20 years ago, was somewhat hard. And I thought it was soft. And it was very disconcerting to feel a disconnect sort of like, like a paralysis, almost.
Anita Rao 23:07
George's first experiences of erectile dysfunction were in the 90s and early 2000s. Well before anonymous internet forum started to bloom. And his efforts to find support and community were mixed.
George Marx 23:20
I looked for other people's writing, and all I found were ads for Viagra, or pills or things like that. And the only discussion I found was in a, I think it was a Yahoo group that I connected with. And even there, it was almost all women. And there was one man who was, who was deeply involved in it. It was isolating. And, I mean, fortunately, it wasn't all of my life. And I never thought it was all of my life. And I wasn't ashamed of myself for it. But I still felt it bothered me.
Anita Rao 23:54
So you experienced these repeated challenges getting and sustaining an erection you approached your family practice physician, who then referred you to a urologist who gave you samples of a variety of oral medications to try and you found that Viagra worked the best with the least side effects. Talk to me about your experience with Viagra. What was that like? How did it affect your experiences of sexual intimacy?
George Marx 24:19
From the beginning when I used Viagra, it was a mixed blessing at best. And some of that was the instructions, and I hadn't followed the instructions. But I discovered I had to do it on an empty stomach. I had to test myself about 30 to 50 minutes after I'd taken the Viagra and see if my penis was getting harder. And then if it was hard, then it was like, we got to have intercourse right now which was totally disconcerting because I was used to trying to please my partner trying to stimulate her sexually and I was not into this rush, rush, rush, rush rush kind of thing. And I didn't use sex as just intercourse. But in the, in these moments and in using Viagra, it was like, it was like I was a machine almost.
Anita Rao 25:07
Well, I'm curious about that. I mean, you you mentioned kind of the word machine did Viagra induced erections feel different compared to how they had been before?
George Marx 25:17
Yes. And it was hard to understand how they felt. It felt artificial in a way, it felt it felt sort of like seeing a phallic image as opposed to being my own body in a way. I felt disconnected even when I had an erection. And also, the other thing was that it didn't always work and, and it started to stop working at all. And all of these things made me feel, Is it worth it even using the Viagra? And I want to stress that this is a personal thing. It's it's it's how it felt with me. I'm sure other men might feel differently. And maybe in similar circumstances, I don't know, because we don't really talk about it that much. If at all.
Anita Rao 26:00
Of course, yeah, it's a very personalized process for each person, in your circumstances. How did the conversations with your partner go around using Viagra? What was that like? And are there any kind of memorable ones that stand out to you?
George Marx 26:16
Well, my partner tried to be supportive of me. And she accepted that I couldn't have an erection. But she would have loved to just be able to have sexual intercourse quickly and go to sleep and just be done. And I couldn't do that. It's not very romantic or very comfortable to plan exactly when you're going to have sex or sexual intercourse, and then just have it right then in the moment.
Anita Rao 26:44
So you mentioned that you all decided to take penetrative sex off the table. And I'm curious about how you then approached pleasure and sexual intimacy. It wasn't new to you to not focus on penetrative sex. And we talk a lot about kind of redefining sex beyond penetration. But what were the specific things that you started to experiment with and try in that moment, once you both had kind of embraced this new reality?
George Marx 27:10
Well, I always, I always love touch with a partner. And for me, I love it from just light kisses, hand holding to rubbing bodies and touching in ways that can be totally non-sexual, they can be sensual, and then they can move into being sexual. And for me, the focus on orgasm and the focus on penetrative sex was never the the goal per se, sex was two things.
And for me, a lot of the value of sex with my partner was trying to please her and help her have an orgasm. The only areas that I found really difficult with that were some of the things with strap-on kind of things. I was fine with doing those things. But I went it was painful for me when it was uncomfortable, but not in a sexual way but just physically, then I found that really, next to impossible, yeah.
But in general, in general, to me, there's a whole variety of touch they can have. And I also realized what I get pleasure of that sex is a lot in the head. It's not always in the body itself. It's how it affects my brain. And I feel very lucky in so many ways, because I don't feel like some of the masculine men messaging I didn't really get.
Anita Rao 28:33
And we've been talking a lot about erectile dysfunction in the context of intercourse and partnered sexual relationships. But it also shows up in your your relationship with self pleasure. How has erectile dysfunction shaped your relationship with self pleasure and masturbation?
George Marx 28:52
In that way, I think it's really changed it for the better. And it's helped me cope with the fact that it's getting harder and harder, or more difficult and more difficult, I should say, to orgasm and to get semi-erect and other things like that. But it's, well, some of this has nothing to do with erectile dysfunction with me, but I've been really trying to move out of my head and into my body.
And I think as a man, it's really important that we listen to our bodies. And as the therapist earlier said, erectile dysfunction can come from physiological things, it can be a warning sign to our body that we have something. And for me, it may have been cholesterol or blood pressure, that it may have been warning me, you've got to take care of these issues. And we need to listen to our bodies. And I think a lot of the times I as a young man learned to overcome my body, to force my body. to push my body.
And now I realize I don't want to die from not getting to the doctor in time to be treated and in order to do that, I have to listen to my body and my sexuality and my penis is part of my body, just like my arms and legs are, and my heart and other parts of my body.
Anita Rao 30:06
Folks like George who are willing to open up about erectile dysfunction are part of how the conversation around the condition can and will change. As scholar Angus McLaren puts it in his book, "Impotence: A Cultural History": "Western culture has simultaneously regarded impotence as life's greatest tragedy and life's greatest joke." And George would agree that it is time to rewrite that story.
George Marx 30:33
I think we need to heal ourselves and heal our traumas. And we need to really change what masculinity is in general, and I don't think it should be what it has been. I hope that we'll find more in the future as individually and as people, and I think part of this is the dialogue, and I would love to hear from other men.
Anita Rao 30:56
You're looking for community and connection.
George Marx 30:58
Community and connection and allyship and supporting other people in our similarities and our differences.
Anita Rao 31:35
Embodied is a production of North Carolina Public Radio WUNC, a listener supported station. If you want to lend your support to this podcast, consider a contribution at wunc.org now.
You can find more about all of the guests you heard from today in the show notes of this episode.
This episode was produced by Gabriela Glueck and edited by Kaia Findlay. Paige Miranda also produces for our show. Skylar Chadwick as our intern, Jenni Lawson is our sound engineer. Amanda Magnus is a regular editor and Quilla wrote our theme music.
Thank you for listening to Embodied and happy 2024. If you missed last week's episode about self help, it's a great New Year's listen. And as we kick off this year, we would love to hear from you if there's anything that you want to hear us talk about in the coming months. Find the link to leave us a voicemail in the show notes or write us a note, we're at embodied@wunc.org.
And if you liked the show, please spread the word in your own networks. Text this episode to a friend, share about it on social media...Word of mouth recommendations are the best way to support this podcast. Until next time, I'm Anita Rao, taking on the taboo with you.