‘Sex for life’? Men's counter-stories on ‘erectile dysfunction’, male sexuality and ageing

Authors


Address for correspondence: Annie Potts, School of Culture, Literature and Society, University of Canterbury, Private Bag 4800, Christchurch, New Zealand e-mail: annie.potts@canterbury.ac.nz

Abstract

Discourse on male sexuality in mid-to-later life has exploded in recent years (Gullette 1998). Attention to this topic has been spurred by the advent of (highly profitable) sexuopharmaceutical ‘solutions’ to erectile changes affecting older men. ‘Success’ stories abound in the media and in medical literature related to the restoration of faulty erections and ailing sex lives through drugs such as Viagra (sildenafil citrate), Uprima (apomorphine) and Cialis (tadalafil). In this paper we explore some of the ways in which notions about ageing and male sexuality are changing in popular cultural and medical texts in response to the advent of Viagra and the increasing authority of biomedicine in this area. We also demonstrate how the recent biomedical endorsement of ‘sex for life’ (the imperative to maintain an active youthful masculine [hetero]sexuality – defined in terms of male orgasm through penetrative sex) may be challenged by the very accounts of older men who are, or have been, affected by erectile difficulties and have used drugs like Viagra themselves. We present the perspectives of mid-to-late life heterosexual men in New Zealand whose stories question the contemporary biomedical privileging of erections and intercourse ‘at any cost and at any age’. We argue that the current push to identify and treat so-called erectile dysfunction (and restore erections and penetrative sex to relationships) neglects some men's own experiences of alternative modes of relating sexually that they identify as ‘normal’, ‘healthy’, ‘enjoyable’ and ‘satisfying’ for them and their partners; and undermines their understanding of such changes as positive outcomes of ageing, experience and maturity.

Introduction

In 1998 Margaret Morganroth Gullette identified a ‘midlife decline narrative’ operating in Western cultures, in which changes associated with getting older are constructed in negative terms through tropes of ‘diminishment’ and ‘reduction’. The ‘decline narrative’, she proposed, is associated with nostalgia for youth; many men (and women) are influenced by this idea and it profoundly affects their relationships and lives in general. In relation to sex, as Gullette (1998: 28) points out, this discourse portrays male sexuality and pleasure as ‘waning’ with age: ‘Men who hold this view go by the numbers, as they were taught in their youth. Counting and contrasting, they note that they have sex less often or more slowly, and that this is awful and could not be felt or be understood otherwise’. Moreover, this authoritative discourse purports to ‘know’ best about the outcomes of ageing: ‘Taking “the truth about aging” as its domain, decline discourse relegates other assertions to the subordinate and defensive realm of counter-discourse’ (Gullette 1998: 7). It is, however, this counter-discourse that we focus on in this paper, particularly as it relates to male heterosexuality. The experience of ageing (and of erectile changes) may give some men opportunities to experiment with alternative sexual lifestyles. Men who take advantage of these opportunities often report that sex in mid-to-later life does not change in quality for the worse, and in fact they are ‘doing more of the kind of sex they want. They are more considerate to women; they are more competent at giving pleasure’ (Gullette 1998: 29, citing the Janus report). Men in this group tell what Gullette terms a ‘progress story’, rather than a ‘decline narrative’; youthful sex as they remember it (or imagine it) may still be their reference point when discussing sexuality, but they relay an account of sex improving with age and experience.

Gullette was writing before what Barbara Marshall (2002) has termed ‘the Viagra era’, and while these narratives of decline or progress are still evident in contemporary culture, we would argue that they are also being modified or revised as a result of the recent focus on the so-called ‘epidemic’ of male erectile disorder (shortened to MED in medical discourse), and the advent of treatments to correct this ‘disorder’. The corollary of constituting erectile changes for men in later life in terms of MED is the new imperative of ‘sex for life’ understood as erectile ‘function’ for penetration (Marshall and Katz 2002).

In this paper we explore the ways in which some men in mid-to-later life, who have themselves experienced erectile difficulties and used Viagra, are challenging this new imperative of ‘sex for life’, and how they are responding to the various ‘decline’ and ‘progress’ narratives. We analyse their ‘counter-rhetoric’ from the perspective of the sociological debates related to the role of resistant discourses within social processes of medicalisation and, more latterly, biomedicalisation.

Lupton (1997) argues that the ‘orthodox medicalisation critique’, as one of the most dominant perspectives in the sociology of health and illness in the 1970s, was concerned to expose and contest the power of the institutionalised force of medicine. ‘Medicalisation’ was understood as a political process whereby increasing aspects of the lives of individuals come to be understood through the discourses and practices of medicine. Individuals, within this orthodox critique, were generally conceptualised as disempowered, and subjected to the overwhelming power of medicine and its allied professions. Although, as Lupton notes writing in the late 1990s, this orthodox critique is still evident within the sociology of medicine, a Foucauldian influence since the early 1980s has challenged some of its central assumptions. With Foucault's emphasis on power as productive rather than solely repressive, understandings of resistance shift from attempts to wrest power from those assumed to ‘hold’ it, to identifying ways in which the relational and strategic microphysics of power operate.

While a Foucauldian analysis represents a considerable theoretical transformation, opening up possibilities for analysing forms of localised resistance and contestation, Lupton (1997) remains critical of the way the specifics of Foucault's interpretations can in fact lead again to a view of dominant discourses subjugating human agency and leaving ‘little scope for resistance or acknowledgement of the “lived experience” of the body’ (1997: 101). Lupton proposes a greater emphasis on more phenomenologically-influenced approaches as one response to this criticism, through advocating a focus on experiences of medical care to enable a greater understanding of the mutual dependencies of professionals and patients, and patterns of complicity and resistance operating in the medical encounter.

The current research does focus on the experiential narratives of men experiencing erectile difficulties. But because this research does not attend to the doctor-patient relationship but rather to that of the ‘consumer’ resistant to the knowledges embedded in a medically-marketed product, our theoretical framing of the question of modalities of resistance in the context of the medicalisation critique is brought into focus with greater salience through consideration of Clarke et al.'s notion of ‘biomedicalisation’ (2003).

Biomedicalisation is Clarke et al.'s term for ‘the increasingly complex, multisited, multidirectional processes of medicalization that today are being both extended and reconstituted through the emergent social forms and practices of a highly and increasingly technoscientific biomedicine’ (2003: 162). According to the biomedicalisation thesis, it is not only a matter of the orthodox theory of medicalisation changing, but the actual social formation of industrial complexes, knowledges redefined through the inseparable nature of technology and biomedical science, and the diversification of marketing practices constituting new forms of consumer bodies and identities. Clarke and colleagues argue that such transformation of the medicalising landscape is not one to be likened to a ‘technoscientific tsunami that will obliterate prior practices and cultures’ (2003: 184–5), but is rather one in which we see new forms of ‘agency, empowerment, confusion, resistance, responsibility, docility, subjugation, citizenship, subjectivity and morality’ (2003: 185). They call for case studies that attend to precisely the heterogeneities of biomedicalisation practices and effects in different lived situations.

Our focus here is on men's counter-rhetoric on erectile dysfunction, which we explore in the context of perspectives on male sexuality and ageing found in some popular self-help and medical texts over the past decade with a particular interest in the shifting employment of ‘progress’ or ‘decline’ narratives in pre- and post-Viagra era texts.

Changing perspectives on male sexuality and ageing

According to the ‘decline narrative’ men's sexuality diminishes with age; this is an inevitable ‘negative’ outcome of getting older, accompanied by a sense of loss for the youthful capacities and escapades of the past; Gullette (1998: 17) terms this ‘the invention of (sexual) nostalgia’. In the ‘progress narrative’, while men may still use ‘youth’ or adolescent sexuality as a reference point, male sexuality is viewed as changing in more positive ways with age; men adapt accordingly, and sexual experiences may expand, and take on new meanings and different modes. Both the ‘decline narrative’ and the ‘progress narrative’ are evident in various kinds of literature on male sexuality and ageing. One way of demonstrating the difference in ageing narratives pre- and post- the Viagra era is to compare representations of male sexuality and ageing in popular cultural and medical texts over the past 10 years.

Popular sexual and lifecourse self-help texts

Popular sexual self-help texts preceding the Viagra era may be seen to stress the ‘naturalness’ of changes in sexuality associated with ageing, and endorse such changes as positive and normal. This is typical in pre-Viagra texts on so-called ‘milestones’ in men's lives, such as the ‘male menopause’ (also referred to as the manopause, andropause and viropause). For example, in Male Menopause, Jed Diamond (1997: 5) contends that:

The greatest concern most men have as they enter the Menopause Passage is the loss of sexual functioning. Many men cling to memories of the rock-hard-fire-hose penis of their youth. They are unprepared for the normal changes associated with Second Adulthood . . . Male menopause forces men to confront their changing sexuality. Rather than being a time where sexuality drops off, it can be a time where sexuality expands and takes on new dimensions.

In the 1990s, Gail Sheehy's (1995, 1999) books on lifecourse psychology were extremely popular in the United States and other Western countries. In Understanding Men's Passages: Discovering the New Map of Men's Lives, Sheehy (1999) outlines her version of ‘the male sexual life cycle’. This cycle, not to be confused with Masters and Johnson's (1966, 1970) ‘male sexual response cycle’, consists of several stages: ‘Racing car sex’ (ages 15–30), which is characterised by narcissistic attitudes to sexual pleasure involving ‘instant gratification’; ‘Dutiful sex’ (30–40), when ‘sex becomes powerfully linked to procreation’; ‘Masters Tournament sex’ (40–55), defined as ‘the virtuoso peak of a man's sexual life cycle [when] his sexual responses slow enough for him to control, choreograph, prolong and savor each erotic encounter’; ‘Surfing sex’ (55–70), when erectile changes are most noticeable; and ‘Snuggling sex’ (ages 70 onwards) when touching and tenderness are important (Sheehy 1999: 181–4)1.

Sheehy (1999: 184) states: ‘It is normal for a man, after 50, occasionally to have a partial erection . . . A clever man will educate himself to graduate from adolescent “racing car sex” to “surfing sex”’. It is worth focusing some more on this stage she calls ‘surfing sex’ as most of the men we interviewed were in this age range. Sheehy elaborates:

The surfer won't exhaust all his sexual energy in a frenetic effort to reach full erection and orgasm . . . Instead he will ride the waves of erotic love, gliding up with the swells of pleasure [and] down with the ebbs of intensity, when stroking and intimacy can be enjoyed . . . He will learn the ways his partner likes to be pleasured, with hands or tongue, in between their couplings . . . He will enjoy receiving pleasure from his partner's touch . . . (1999: 184)

While the various stages of the male sexual life cycle speak of the advantages of sexual pleasures and practices diversifying with age, Sheehy (1999: 199) also reinforces Masters and Johnson's adage, ‘use it or lose it’, and thereby supports an imperative to maintain sexual activity for as long as possible or else risk losing the ability altogether.

These two sexual self-help texts, Male Menopause and Understanding Men's Passages, provide examples of pre-Viagra narratives associated with male sexuality and ageing. While male sexual capacity may be described according to negative tropes of degeneration (‘dropping off’) and deceleration (‘slowing down’), male sexual experience in mid-to-later life is considered to have the potential to ‘expand’ and ‘take on new dimensions’. The pleasures of mutuality in sexual relations become more significant; the importance of non-penetrative and even non-genital sexual pleasures is acknowledged; and men are encouraged to expect, accept and adapt to ‘natural’ changes in sexuality associated with growing older.

In contrast, some popular sexual self-help texts following the advent of Viagra (and here we have specifically selected those which focus on the use of Viagra as a sexual self-help measure) argue that erectile changes are not a normal feature of ageing:

Many people believe ED is a natural consequence of aging. This just isn't true! (Viagra and the Quest for Potency, Drew 1998: 12).

In the past, people assumed that as men grew older, their sexual function would automatically slow down and finally fail . . . We now know that the inability to function sexually has very little to do with age (Viagra: The Wonder Drug for Peak Performance, Whitehead and Malloy 1999: 10).

Post-Viagra self-help texts may ‘reinvent’ changes in erectile capacity in older men as adverse and abnormal (there is no ‘natural’ shift in ‘sexual function’ linked to ageing); they may advocate that any reduction in sexual ability can be countered; in any case, ‘decline’ is viewed as a pernicious force –‘the enemy’– which men must combat (with the help of biomedicine and ‘virility remedies’):

For the first time, it is possible to restore optimal sexual function to nearly every man who desires it. [Viagra] will put to rest the myth that ED is an irreversible function of aging. In a matter of minutes, the new oral medications can: allow a man to have firmer erections to ensure fulfilling sexual intercourse; renew and strengthen an existing – or even dormant – sex life; . . . offer joy in the sexual arena, where little or none had been felt for years . . . (The Virility Solution, Lamm and Couzens 1998: 11).

The post-Viagra self-help texts dismiss the inevitability of erectile difficulties associated with ageing. A modified version of the ‘decline narrative’ is employed within these texts – no longer is a man to accept bodily and erectile changes, whether they are associated with ageing or any other process, event or condition; changes in sexual capacity in mid-to-later life must be resisted and overcome, and ‘premorbid’ sexuality restored. They also relay a ‘revised progress narrative’, which espouses the revitalisation of ‘potency’, the ‘restoration’ of sexual relationships to prior states, or even the ‘strengthening’ of sex lives beyond the scope of previous sexual pleasure. ‘Progress’ is measured in terms of the ability to ‘turn back the clock’ and maintain ‘functional sex’ for as long as possible. Functional sex – and sexual performance – in these books generally equates with penetrative sex, which is viewed as essential to concepts of masculine identity and potency. These texts re-establish and reinforce the primacy of firm and enduring erections – capable of penetrative sex – in constructions of healthy male heterosexuality, and in all stages of life. They argue that there is no need to accept change with age; indeed, men can – and should – enjoy ‘sex for life’ (by which they clearly mean one particular version of ‘sex’ for life).

Medical texts on male sexuality, ageing and/or erectile difficulties

A ‘decline narrative’ is also evident in pre-Viagra scientific and biomedical articles on male sexuality and ageing. This may, however, be tempered by a positioning of any ‘deceleration’ as normal and non-pathological – something men are more likely to be encouraged to adjust to rather than view as a loss. For example, in the following pre-Viagra excerpts from medical literature, there is acceptance of the ‘normal’ sexual changes affecting men as a function of age (see also Adelman 1995, Schlesinger 1996):

Although ageing men do not usually experience the strong sexual interest characteristic of youth, most do report continued interest from a mild to moderate degree. Erectile responses and penile sensitivity decrease, and it takes longer for men to obtain an erection as they age. . . . Penile rigidity declines gradually, and by the early sixties, most men notice that their erections are not as stiff as they were when young (Shiavi and Rehman 1995: 711).

The next excerpt cautions against confusing normal sexuality changes associated with age with abnormal ones:

The medicalization of normal aging men, that is the treatment of a typical physiological process as pathological, with the consequent labelling and associated clinical management (treatment), present ethical and public health policy challenges (McKinlay, Longcope and Gray 1989, cited in Metz and Miner 1995: 302).

In contrast, papers published in biomedical journals following the advent of Viagra may emphasise the impact of growing older on male ‘sexual function’ (and instead attribute erectile changes to other forms of physical ‘pathology’); or reframe such changes which are associated with ageing as ‘dysfunctional’, while also endorsing the view that any such ‘adverse’ changes – due to age or other factors – can be reduced or corrected through medical means and new biotechnologies. In accordance with this millennial approach to erectile changes, the numbers of men suffering from ‘erectile disorder’ increased significantly following the debut of Viagra in 1998. And what might once have been considered a ‘natural’ component of ageing experience for men became a medical ‘disorder’, a condition requiring treatment:

ED is a common disorder among elderly men (Meuleman 2002: S22).

In the US, an estimated 17 per cent of men aged 40–70 years have minimal ED, 25 per cent have moderate ED and 10 per cent have complete ED (Olsson et al. 2000: 561).

[Erectile] disorder is age-associated, with estimated prevalence rates of 39 percent among men 40 years old and 67% among those 70 years old (Goldstein et al. 2002: 1197).

The second and third excerpts demonstrate the use of alarmist prevalence statistics relating to MED in the Viagra era.

The new sexual imperative: sex for life

Before the mid-1990s it was more common for erectile difficulties to be attributed to psychological aetiology (Potts 2002). The contemporary privileging of physical causes over psychological is a trend that has been enhanced through the discovery of drugs such as Viagra. It is indicative of the increasing influence of biomedical accounts of sexuality in Western societies – a move referred to as ‘the biological ousting of culture’ by Aleksandar Stulhofer (2000: 141) – and viewed as part of the process of ‘biomedicalisation’ by others (see Winton 2000, Bass 2001, Hart and Wellings 2002, Carpiano 2001, De Ras and Grace 1997, Tiefer 1995, Clarke et al. 2003).

Marshall and Katz (2002, 2003) identify the creation of a new imperative in Western societies to maintain ‘busy bodies’ in older age (see also Katz 2000). This is especially evident, they argue, in the realm of sexuality, where it is now assumed that the ability to remain vigorously active across the lifespan is a measure of overall health, fitness and productivity. Such a belief is consistent with late capitalism's privileging of youthfulness and quest for self-enhancement in all areas of life (Marshall and Katz 2002). Katz and Marshall (2003: 8) have analysed the contemporary drive to maintain active sexual bodies in older age, arguing that ‘the commercial successes of pharmaceutical and mechanical remedies for sexual dysfunction rest on a recent cultural-scientific conviction that lifelong sexual function is a primary component of achieving successful aging in general’. Furthermore, ‘lifelong sexual function’ is defined as the ability to maintain an erection for the purpose of completing male orgasm through penetrative sex (Marshall 2002, Marshall and Katz 2002, Katz and Marshall 2003). In accordance with this new imperative to ‘maintain busy bodies’– and in particular, sexually active bodies – into later life, many of the more recent biomedical papers endorse the need to remain sexually ‘fit’ and ‘healthy’ when older in order to ensure continued sexual capacity and satisfaction. For example:

The phrase ‘use it or lose it’ is particularly appropriate for the genitalia. This is a very important message that is not always welcomed by the aging population; the best way to prevent or to limit the signs of aging is to remain active (Meuleman 2002: S24).

Katz and Marshall argue that the imperative to remain ‘forever functional’ (2002: 43) is contingent on a new mode of conceptualising (and marketing) senior sexuality. Urologists now maintain, for instance, that ‘physical decline [is] no longer or necessarily the consequence of bodily aging or psychological problems’; instead, ‘sexual dysfunctions’ are viewed as ‘effects of “modifiable, para-aging phenomena”’ (Katz and Marshall 2003: 3).

There are also differences between pre- and post-Viagra era understandings of what constitutes sexual ‘success’. As can be seen in the earlier popular self-help and medical texts, changes in erections and sexuality are more likely to be viewed as part of a natural aging process which is, to a lesser or greater extent, inevitable, but which also has the potential to bring its own positive experiences. These are associated with, for example, the embracing of new sexual possibilities that are more relaxed, less competitive, ‘less driven’ (and feature intercourse as optional rather than compulsory). The more recent excerpts from Viagra self-help books and medical literature reiterate the importance of ‘functionality’, of restoring pre-morbid abilities, and the need to retain ‘sexual fitness’ and vigour (largely understood in terms of the capacity for penetration) across the lifespan. Tropes of ‘graceful decline’ and the celebration of different styles of intimacy and sexual relations (in the early 1990s) have been largely replaced by endorsements to retain or restore sexual ‘function’ and activity (almost always defined as intercourse): to ‘use it or lose it’.

The importance placed on ‘sex for life’ (and implicitly ‘penetration’ for life) is coupled with a renewed emphasis on the significance of ‘potency’ for men. ‘Male erectile disorder’ is generally defined in medical discourse as the ‘inability to attain or maintain penile erection sufficient for satisfactory sexual intercourse’ (Bivalacqua and Hellstrom 2001: 183, Fujisawa et al. 2002: 15, Seidman 2002, Steidle 2002, Goldstein et al. 2002, Olsson et al. 2000). There is increasing importance placed on the ability to achieve and maintain erections as a measure of healthy male sexuality; this ability often becomes an ‘obligation’ for men (Potts 2000).

In our reading of popular and medical texts from the Viagra era we have identified the emergence of two new narratives about ageing and male sexuality. The first, which we have termed the anti-decline narrative, with its emphasis on restoration and maintenance of ‘potent’ sexuality in older men, challenges both the prior decline narrative and progress narrative identified by Gullette. It disrupts previous understandings of male sexuality in later life through its resistance to viewing erectile changes occurring in later life as usual or acceptable (thereby disputing the natural or inevitable reduction of sexual capacity with age), and through its insistence that any changes in sexual capacity (at any age) require rectification and can be treated via biomedicine. The assumed negative qualities of decline and diminution are controlled by the promise of sex for life offered through the use of new biotechnologies such as Viagra. There is no need to grieve for lost youth, to be nostalgic over the firmer and more enduring erections of adolescence: these can be acquired again (and in some cases, enhanced) through sexuopharmaceuticals (Potts 2004a). The second new narrative we have identified, which we term the revised progress narrative, defines progress in terms of the capacity to perform sexually like a younger man again, or even better than ever before (Potts 2004b).

In the next sections of this paper we focus on the ways in which the stories of older men who have been affected by erectile difficulties (and used Viagra) may challenge the new directive to remain ‘forever functional’ that is embodied in the ‘anti-decline’ and ‘revised progress’ narratives. We present these ‘counter-stories’ to the biomedicalising narratives of the Viagra era in order to promote an acknowledgement of alternative accounts of sexual pleasure and satisfaction in mid-to-late life men that are not necessarily connected with penile performance, penetrative sex and normative ideas about ‘potent’ masculinity. We are particularly interested in how these stories relate to ideas about changes in male sexuality across the life-course, experiences of sexual relations as a feature of getting older, and the ways in which men utilise or disturb aspects of the decline, progress, anti-decline and revised progress narratives.

Method

The empirical material analysed derives from a broader investigation on the social impact of Viagra, in which we interviewed 33 New Zealand men (aged from 33 to 72) who responded to advertisements on radio and in local newspapers throughout the country2.

Interviews took place in different locations throughout New Zealand between April and September 2001. Participants chose to be interviewed in their homes or at the local university by a member of the research team; four participants were interviewed by phone. A third of the men were interviewed by a male interviewer3,4. Interviews lasted between one and two hours, and followed a semi-structured format, beginning with men being asked to relay their personal stories of erectile difficulties and Viagra use. Men were also asked about their viewpoints and experiences of sexuality over the lifecourse. Appropriate Ethics Committee approval was given for the research, and informed consent was obtained from men before participation. All interviews were audio-taped and transcribed in full.

Repeated close readings of the transcripts were conducted in order to identify key themes related to the experience of sexual difficulties within relationships, the use of Viagra or similar medical interventions, masculinity, sexuality and erections, and men's perspectives on sexuality and ageing. We noted a great diversity of responses and experiences among participants (see also Potts et al. 2004)5. The analysis presented in this paper is designed to illuminate a particular set of responses that we identified in a subset of interviews from the broader study. This subset involves 12 men, ages ranging from 54 to 70, whose stories reflected experiences and viewpoints that challenged the anti-decline or revised progress narratives associated with current biomedical discourse on sexuopharmaceuticals such as Viagra. We highlight these resistant accounts here for the reason that counter-discourse on male sexuality and ageing is neglected in so much of the mainstream discussion and promotion of the drug, and is especially absent in reports on the experiences and viewpoints of Viagra users themselves.

Changing sexual pleasures and practices over the lifecourse

Many of the 33 men in the study discussed how their perspectives and experiences of sexuality had changed, sometimes in quite marked ways, over the lifecourse. Here we present differences between early and mid-to-late life sexual experiences in relation to the following themes identified in the transcripts: shifting sexual priorities, goals, and practices; the increasing importance of mutual enjoyment and involvement of partners; and experimentation with alternative sexual practices and pleasures.

Early sex: ‘It was just empty out and move on’

One of the features of the decline narrative is a tendency – in the face of changes associated with ageing – to reminisce, reify and mourn the loss of the sexual capacities and exploits of ‘younger days’. And certainly some men in our study had used Viagra with the hope of revisiting the ‘firmness’ and ‘energy’ of adolescent erections (Potts et al. 2004, Potts 2004b).

But in many cases the perceived restorative effect of Viagra was not intended for use in an unqualified return to ‘adolescent’ sex. In fact, men often conveyed that their first experiences of sexual relations with women had been ‘selfish’, primarily focused on male orgasm through intercourse (colloquially referred to in New Zealand as ‘bonking’).

M24: Sex – certainly my earlier life, and I think in the case of a lot of blokes – is a very selfish act. They bonk because they want to get it off [age: 54].

This kind of testimony to selfishness in one's early sex life (associated with a desire to ‘score’ for oneself), and described by the next participant as ‘masturbating in [a] vagina’, was often compared in interviews with the importance in current relationships of prioritising partners’ pleasures, or ensuring mutually enjoyable sexual relations:

M28: Priority is the woman first . . . and then . . . well to fit it in together of course, but the main priority is to control yourself so that you’re looking after her . . . I realize when I was in my twenties, 22 I suppose. . . . I sort of worked it all out . . . Before that you’re in the sort of . . . fast lane [small laugh] . . . Young men treat women terrible, by and large . . . [Interviewer: Something changed for you, that changed?] . . . Yeah, just understanding . . . before that it was just empty out and move on [age: 58].

M28 indicates that the key to prioritising one's partner's sexual pleasure is to ‘control yourself’, to look after her6.

A similar story is told by M1, who contrasted his experiences of sex in younger life with sex in mid-life in terms of essential differences between male and female sexuality. M1 contended that male sexuality was basically penis-centred, and that men had to make an effort to shift the focus from penis to mind (control over the sexual experience for oneself and partner):

M1: It really comes down to . . . a relatively major mind-shift to take it away from that physical . . . sensual area to the mind, and saying there's somebody else involved in this partnership, mate, do something about that as well. . . . And when you come to terms with that. . . . there are ways in which you can overcome . . . your maleness and sort of put that aside. . . . and you can get as much pleasure if not more pleasure . . . pleasuring your partner . . . But it is a bit of a mind-shift and I mean, let's face it, when you’re younger and you go through . . . the hormonal drive, when the hormones start getting into the system as a 17-, 18-year-old, you know the whole thing is based around . . . the penis area really [age: 56].

For M1 the change from ‘selfish’ penis-focused sex (characteristic of hormonally-driven youth) to mindful partner-oriented sex is something that requires control over essential male sexual drives. M1 views male sexuality as fundamentally penis-oriented; this is framed as a ‘problem’ which men need to beat in order to look after partners during sex. Such control over ‘your maleness’ comes with experience and maturity.

Shifting focus, changing goals

While early experiences of sex may have concentrated on ‘emptying out and moving on’, many of the men in this study noted that the purpose of sexuality and sex had changed with age and experience. Here we explore the ways in which men felt sexuality had altered for them in positive ways over the course of their lives. They discussed, for example, how less emphasis was now placed on penetrative sex and ‘achieving orgasm’, and more importance given to non-penile pleasures (other bodily sensations and pleasures), mutually enjoyable sexual relations, and the pleasuring of partners. The accounts in this section draw, in different ways and to varying degrees, on a progress narrative which views sexuality in mid-to-later life as more ‘advanced’ and satisfying than sex in youth.

The place of male orgasm

M24: Sex in younger life – yes, the game was to climax and get it over and done with . . . well that just doesn't matter now . . . [age: 54].

Several men commented that the importance placed on ‘achieving orgasm’ had changed for them over the years. For example, M25 did not discount the value of orgasm for his own sexual experience, but reported that its significance had altered with time; it was now less important whether occurring during partner sex or solitary sex.

M25: For many years I guess all it was about was coming . . . without even really knowing anything about helping your partner to come – I would just be going in and out as rapidly as I – with the idea of coming inside the –[Interviewer: So that was your sort of goal would you say?] . . . The goal was to come, but then over time that changed. . . . with the passage of time just the pleasure of being together when you’re having sex with somebody, or with masturbating, just masturbating really quite slowly and feeling a sort of tingle spread over one's body, but then the climax is important too [age: 68].

Attention has been drawn to the operation of an ‘orgasm imperative’ in Western constructions of ‘normal’ heterosex (and sex in general), whereby the ability to ‘achieve’ orgasm, especially during coital sex, becomes the measure of ‘healthy’ sexual capacity and ‘sexual satisfaction’ (Bejin 1986, Nicolson 1993). Male orgasm, in particular, signals the ‘climax’ of sex by being positioned as both the central ‘goal’ and the end-point of sexual relations. As the accounts of these men indicate, however, the influence of the orgasm imperative may weaken and shift in relation to sexual experiences in different stages of the lifecourse for some individuals.

De-centering the penis

For some of these 12 men, the penis was the key source of sexual sensation and pleasure, and when asked about other bodily ‘erogenous’ zones, they were convinced the genital area was ‘where it's at’ for men:

M13: As far as I go, it's only just the genital area . . . [age: 69].

M1: I don't get turned on by nibbling of the ears or anything like that. . . . And stroking of the back and you know, other areas. . . . I mean I couldn't find them . . . sexually stimulating at all . . . no [age: 56].

Others, however, reported that the penis had never been central to their sexual enjoyment:

M19: Well I can't comment on the focus of my sexuality being on my genital area because it's not. It's neither here nor there for me . . . [age: 50].

Some men commented that bodily pleasures had expanded beyond a penile focus as a consequence of age, maturity, experience, and, in some cases, as a result of necessity (due to persistent erection changes):

M4: The mind doesn't focus on the penis at all really, it's on the whole body. . . . I like to be touched and rubbed all over sort of thing, it's not just the penis, no . . . It's focused all over really. . . . As a young fella that's the only thing that is on the mind is the penis, yeah, great to have her, whatever, that's where the mind is. . . . But no, I haven't thought along those lines for I don't know how many years [age: 57].

M10: I don't think that I was ever, since maturity anyway, particularly penis focused, but rather seeing sexuality as a more englobing sort of thing which sometimes I've seen ascribed to [a] female attitude towards sexuality [age: 61].

In the next extract, M28, who asked his partner what would happen if he became ‘penis-less’, comments that such a notion wouldn't mean the end of his relationship and sexual intimacy for him, although he struggles to convey this outside the penis-centred narrative of male heterosexuality (Potts 2001). He also questions the assumption that masculinity relies on an ability to achieve erections:

M28: [I asked her] what happens if my penis fell off? Stuff like this. . . . you know, what happens if when I get my hip replaced they cut the wrong leg off, the middle leg, and all this? She said I don't care. No . . . I think we would have stayed together. . . . I don't think that's what makes you a man, I'm sure it's not. And I've never thought that way. But it just would have been . . . not as . . . I was going to say not as good as it is now, but that's wrong . . . just . . . can't think of the word, there's a word they use . . . We would have been probably just as happy, but it would have been a different sort of happiness and fun . . . Is that putting it right? Dunno [age: 58].

The absolute centrality of the penis in normative constructions of pleasurable and satisfying male heterosex and masculinity is disrupted in these accounts. Such alternative experiences and preferences are rarely acknowledged in contemporary popular and medical literature as viable, let alone desirable, options for men.

‘Relaxed sex’: Slowing down as a positive experience

Contrary to the assumed negative responses affiliated with a decline narrative, several men expressed an acceptance of changes in sexual capacity as a function of ageing. These men were not driven by a desire to rejuvenate their sex lives and strengthen their virility; rather they acknowledged such changes as a normal component of ageing:

M22: I think you've got to recognise that . . . as you get older you've got less physical ability, you can't walk as far, as vigorously . . . and the same with sex, you've got to accept it . . . I don't treat it as negative because [I] just accept it as a fact. I think your drive diminishes as well, the need to have sex as frequently. In both of you [age: 67].

M23: I accept that life is slowly coming to an end, sort of the body itself is . . . noticeably less strong and I'm less active and . . . at my age you just have to accept that . . . and it's not unpleasant, you use your mind a lot more [and] in a much more peaceful fashion than I used to use it [age: 70].

While these accounts indicate a more or less neutral acceptance of sexuality changes associated with growing older, the next accounts suggest that such changes may be accompanied by a sense of some improvement in sexual relations. For example, one of the advantages of sex in older age identified by some men was the change from sex in younger years (often depicted as ‘urgent’, ‘driven’ or ‘aggressive’) to a more prolonged and relaxed intimate experience with partners. Here M29 is discussing his experience of sex improving as he got older. He attributes this to a mixture of having more time (since retiring) and knowing more now (with experience and age) about the pleasures of slower, longer sex.

M29: I suppose it's like a good wine, it improves with age. . . . More relaxed outlook on making love. . . . whereas perhaps years ago it might have been more aggressive and now it can be, you know, sort of probably more gentle and loving. . . . You think now how silly you were to adopt that attitude [laughs] because. . . . it's a pity that you've taken 40-odd years or something like that to learn that hey, it doesn't have to be rushed to get enjoyment from it. . . . All I can say is that, you know, you probably – it would have been sort of more urgent or aggressive, younger married years but you wish now that hey, you'd just slowed up a little bit [laughs] and you would have been having that same continued enjoyment for much longer. . . . I feel that probably our sex now is probably some of the best that we've ever experienced. . . . I can't really say it's because of our age, ah, it's because of closeness, perhaps, you know, taking time, not rushing things . . . what else could I . . . put it down to? It's just been more satisfying . . . [age: 66].

Similarly, when asked what has given the most pleasure sexually, M23 comments that he prefers the ‘relaxing’, ‘gentle’ sex he experiences now to the vigorous sex of his youth:

M23: I think sort of loving relationship with my partner . . . sort of stroking and bodily contact, skin contact . . . in a fairly relaxed fashion, nothing done in a great sort of hurry and oh, at times when there's a good communication mentally between you and . . . I know [previous partner]– we'd sometimes have a row and then go to bed and have very sort of vigorous sex for a couple of hours . . . It released something out of you but it's not to me as satisfying as the sort of gentle, to most people relatively non-exciting. . . . [In younger years] . . . driven far harder to it, and far more vigorously and also fantasised far more . . . I mean I still go a bit into the realms of fantasy and these days. . . . in a fairly relaxed fashion but it's not a drive any longer in that respect. I think . . . all males are basically sort of competitive against other males, and I think that's tied up in your sex drive, I think it's very hard to get over that and see things more clearly [age: 70].

M23 suggests that competitive masculinity is connected to the male sexual drive, and the influence of both these things for men changes in tandem over time. This participant endorsed the use of Viagra as a means of facilitating erections and coital sex as an optional component – rather than a central or compulsory aspect – of sexual relations. For example, he explains how the significance of penetrative sex is changing (‘fading’) in his relationship, and how sex is more ‘peaceful’ now:

M23: I think [intercourse] is still for both of us but I think that importance is fading away. . . . probably the penetration is not nearly as important now, we both get into bed in the nude. . . . and spend a long time stroking and she got a Chinese back scratcher that I scratch her back with, that she loves having that done. I quite like running my fingernails and fingertips and things all over her and as I say we waste a few hours sort of at times on that . . . [age: 70].

Rather than mourning the decreased occurrence and significance of coital sex in his relationship (and adhering to a decline narrative), M23 accentuates the pleasures of ‘more peaceful’ sex, of sexual pleasures focused on ‘stroking, feeling, skin contact’. Thus, later life experiences of satisfying and pleasurable sexual relations may challenge the current imperative to maintain ‘certain forms’ of sex for life – to remain ‘forever functional’. M23 rejects an anti-decline narrative associated with the Viagra era. He relays a progress narrative which has more in common with the pre-Viagra stories of ‘sexy progressivists’ identified by Gullette (1998: 29), rather than the revised progress narrative which endorses the benefits of maintaining or restoring youthful, vigorous, penetrative sexual practices.

Focusing on partners and mutual pleasures

A common shift noted by men between early and current sexual experiences involved a transformation from self-centred sex to partner-focused or ‘couple-focused’ sex. Several commented that youthful masculine sexuality revolves around personal pleasures, goal fulfilment (male orgasm) and penetration. Conversely, sexual relations for men in mid-to-late life may have taken on new ‘meanings’ and ‘goals’. Often this was the reason why men reported they had sought help for erectile difficulties: in order to ensure their partners continued to be satisfied during sex.

M24: To me sex is something that's the sort of culmination of something rather nice beforehand and if that culmination. . . . doesn't bring about sex, well fine. So yeah to me sex is not . . . the thing in itself, it's the caring for the other person and the being nice to the other person and this sort of stuff. Sex is just a bit on the top of that. . . . I think it's probably to do with a bit of experience and listening to the partner. . . . I've got this kind of theory that. . . . if you aim to please the partner. . . . you’ll get it back with interest. . . . Yeah, it's based on the theory that it's better to give than what it is to receive [age: 54].

M24 discusses sexual relations for him at age 54 as a transaction between partners. With ‘experience’ he has developed a kind of economic theory of ‘sexual reciprocity’: if you invest in a partner's experience and pleasure, you will be rewarded in turn – and with interest. During his interview, this participant repeatedly voiced concern that he was portraying himself as someone into ‘blokey sex’ (which he defined as ‘self-satisfaction’, ‘sex for themselves’, ‘selfish sex’, ‘sex to have it off’).

M24: But the focus is not just straight on to getting it in and climaxing. It's not on that, the focus is on giving pleasure and the closeness. . . . So that's something we both thoroughly enjoy so – is that very blokey?. . . I'm definitely not like that . . . Definitely more into the giving, the smooching [age: 54].

Other men discussed their concern about erectile changes in terms of their no longer being able to satisfy a partner. Several stated they were not worried about the continuation of their own sex lives, but were worried for the sake of their partners that sexual relations involving erections could still be possible:

M17: I'm not too worried about my sex life coming to an end, I mean it doesn't worry me that much. . . . I don't worry about the fact I can't have an erection, I'm more worried about the fact that, you know, that [my partner's] happy that I don't have an erection. . . . [age: 59].

M28: [Intercourse] is only important in the respect [that] she has a lot of fun and I get fun out of [her] having fun . . . As I said before, it's . . . on a sensation basis . . . it's the bottom end of the plateau and it's nice . . . but it's not a thing that. . . . if it disappeared tonight I would never bother. . . . Just wouldn't bother me [age: 58].

Not surprisingly then, perhaps, some men reported that the primary reason for taking a drug like Viagra was to be able to maintain a partner's pleasure.

Alternative sexual experiences: ‘adapting to suit the occasion’

Elsewhere we have argued that the biomedical perspective prioritises coital heterosex as the norm; it is the standard against which all other sexual activities and pleasures are measured (Potts et al. 2003, Vares et al. 2003, Potts et al. 2004, Grace et al. in press). This is evident, for example, in diagnostic surveys related to erectile dysfunction (e.g. International Index of Erectile Function [IIEF]), which concentrate questions around whether or not the penis is erect enough to complete penetrative sex (see Lewis et al. 2001, Lamm and Couzens 1998, Whitehead and Malloy 1999); successful ‘intromission’ is taken as the measure of whether or not a drug such as Viagra ‘works’ (Potts et al. 2004, Potts 2004b). There is less importance placed on other kinds of pleasurable sexual activities – the assumed goal of sexual relations (and drugs like Viagra) is penetrative sex. And while popular sexual or lifecourse self-help books, such as Understanding Men's Passages, which predate Viagra, discuss the benefits for older men of exploring different ways of relating sexually with their partners, the newer Viagra-focused self-help texts are more likely to emphasise the benefits of retaining erections firm enough to engage in coitus. However, as indicated in some of the men's accounts presented in this paper, actual experiences of sexuality in mid-to-later life can directly challenge the assumed default position of coitus, the penis and male orgasm in older men's sex lives.

Importantly, several men participated in our study in order to discuss their experiences of persistent erectile changes, and what such more or less permanent changes entailed in their sexual relationships (Viagra had not ‘worked’ for them). M13 had not experienced an erection since undergoing surgery for prostate cancer, and he and his partner were now adjusting their sex life to accommodate these new circumstances. He did not, however, report grief over the loss of erections; instead this situation precipitated ‘new’ and ‘improved’ sex (a perspective shared by his partner who was also present during the interview):

M13: Matter of fact. . . . our sex life has been – in a different way – better since. . . . It was a matter of adapting to suit the occasion rather than giving all away [but] we were determined not to, and it's worked out for – I wouldn't say for the better because I still miss. . . . penetrative sex, and I know she does – but then she gets to a climax anyway. . . . and she can get me to climax and that's rather interesting because. . . . she can get me to a climax and sort of keep me going, you know, far more than I used to before. More like a woman can, sort of surges, you know, and so in that way the sex is . . . different and arguably better than what it was before. [ . . . . Interviewer: Without there being any erection involved?] Mmm. . . . I wouldn't say that they’re mind blowing but very strong, and probably stronger than before [age: 69].

M13 describes his new experience of climax as different and more intense than previously (he likens it to a woman's experience of orgasm). Even though he would like to be able to engage in penetrative sex again, when asked whether he would replace his current sexual practices with penetrative sex if he regained erectile capacity now, he responded: ‘Well . . . I wouldn't prefer to do it the penetrative way’. This indicates that when faced with profound erectile changes, men (and women) can perhaps, through a kind of experimentation induced by an inability to ‘go back to’ (or return to) prior modes, expand their perspectives and practices and modify their preferences for sexual enjoyment (see also Potts 2004b, Gray et al. 2002, Fergus et al. 2002, Bokhour et al. 2001, Tepper 1999, Candib and Schmitt 1996, Gordon 1995 for similar accounts). In this excerpt, M13 rejects both the original decline narrative (identified by Gullette), and the newer anti-decline narrative (associated with the Viagra era); he indicates the existence of ‘progress’ stories based on transformation and expansion of sexual experiences not involving erections.

Conclusion

Discourses related to male sexuality and ageing have changed significantly over the past few years in response to the increasing biomedicalisation of sexuality and the advent of sexuopharmaceuticals like Viagra for the medical restoration of ‘failing erections’. While a decline narrative, in which male sexuality in older age is represented in negative terms associated with decreasing erectile capacity and flagging sexual performance, is still evident in Western constructions of mid-to-late life male sexuality, we have argued that there is also evidence of the emergence of a newer anti-decline narrative, which is associated with the restoration of youthful erections, and a new obligation to remain forever functional (to be capable of sex for life) – all features of the new Viagra era (Marshall and Katz 2002, Katz and Marshall 2003, Marshall 2002). Conventional Viagra success stories affiliated with the anti-decline narrative and its privileging of frequent coital sex are prolific on the internet, and in drug company promotions, popular media and medical literature on MED. Our study indicates that alternative success stories – accounts of changes in erections and sexual practices that are more readily accepted, and sometimes even welcomed by men and their partners (albeit in retrospect), are in circulation as well. Some of the men in our study relay a progress story associated with adapting to, enjoying, and even preferring, sexual experiences and practices that are quite different from their preferences when they were younger, and/or when they were able to readily experience erections; these alternative stories are not necessarily related to erections, male orgasm or coital sex. Such accounts disrupt the arguably common-sense notion that healthy meaningful sex for life for men (and their partners) requires the maintenance of ‘rock hard’ erections and frequent penetrative sex.

Returning to Clarke et al.'s call for case studies that examine the local specificities of the sociological processes of biomedicalisation, this research illustrates how a group of those positioned as consumers of a pharmaceutical product, in this instance male users of Viagra, challenge and counter the rhetorical ‘scientific’ knowledges embedded in its production and marketing. While none of the men quoted in this paper are coming from an initial position of radical resistance to prevalent contemporary medical understandings of the place of erections in male sexuality (that is, they were all willing to engage with a medical approach and try drugs like Viagra to facilitate erections), they are all nevertheless in various ways, and to different extents, challenging aspects of the dominant discourses surrounding the role of erections, male orgasm and the penis in constructions of masculine heterosexuality. The new imperative to remain coitally active in mid-to-later life in order to make the grade for ‘normal sex’ and be classified as ‘sexually healthy’ marginalises these alternative perspectives and different success stories, at the same time as it reifies youthful sex and discounts the positive changes associated with slowing down and relaxing more about sex. As Brooks (2001: 52) argues: ‘When we define sexual health and dysfunction only in terms of frequency and adequacy of sexual performance, we end up with an odd exemplar of sexual vigor – the adolescent male’. It also largely discounts the perspectives of women partners in mid-to-later life (see, for example, Potts et al. 2003, Vinick 2000, Mansfield and Koch 1998 for studies of women's preferences for non-coital sex, less frequent sexual relations and more focus in later life sexual relations on affection and non-genital touching).

Research on historically- and culturally-specific patterns of change in sexual pleasures and experiences over the life course reveals how these changes occur in response to partners, relationships, and individual and societal understandings about sex and sexuality. While a biomedical model of sexuality seeks to reduce all men's bodies and sexual experiences to a universal model of male (hetero)sexuality – one that, in the Viagra era, most closely resembles the classic picture of ‘adolescent male sexuality’ (see Holland et al. 1998) – we argue for placing greater research emphasis on the diversity of men's experiences of sexuality, individually and in the context of their relationships, and of exploring the changes that occur in sexual practices and pleasures with time and experience.

Instead of focusing on an assumed adverse effect of erectile changes in older age and thereby perpetuating a sense of inadequacy and abnormality, we might rather redefine such changes in terms of positive opportunities for increased sensuality, intimacy and experimentation (Fergus et al. 2001). In the Viagra era, emphasis is placed on the importance of restoring and maintaining erections and penetrative sex once these are compromised as a result of ageing or disease processes (e.g. diabetes, prostate cancer, cardiovascular disease), but the counter-stories of participants in this study demonstrate that some older men are already understanding, experiencing and validating their own sexualities in terms beyond the conventional (biomedical) model of sexuality.

Notes

  • 1

    Sheehy's (1999) book is considered a pre-Viagra text as it was written prior to the advent of Viagra (although its publication date crossed with Viagra's debut in 1998).

  • 2

    Interviews were conducted by Annie Potts, Nicola Gavey, Tiina Vares and Philip Armstrong. Evaluation forms, which were completed anonymously by participants following interviews (and sent back to the researchers by post), specifically asked men about their experiences of and responses to being interviewed about sexuality and Viagra use by either a female interviewer or male interviewer. Interestingly, we did not notice any major difference in reported experience due to sex of the interviewer.

  • 3

    During one interview, a man's partner was present at his request and she also contributed from time to time. While this ‘couple interview’ worked well in terms of eliciting interesting material related to their‘Viagra story’ we did not encourage interviews involving men and their partners during the research. This is, in part, because we were conducting several related sub-studies which relied on individual accounts: e.g. in one sub-study we were interested in the perspectives and experiences of women partners of men who used Viagra and we felt that the presence of male partners might have altered these participants’ ability to talk freely about detrimental, as well as positive, experiences.

  • 4

    A note regarding transcription conventions: When presenting extracts from interviews in this report, we have omitted word repetitions and all speech hesitations (i.e. all terms such as ‘um’ and ‘ah’). The presence of three consecutive dots [ . . . ] indicates a portion of speech has been cut. The abbreviation ‘M’ refers to ‘male participant’.

  • 5

    The analysis we present in this paper exists in relation to a broader investigation on the social impact of Viagra. For a more general overview of the findings of this research project, readers are referred to Potts et al. (2004) and Grace et al. (in press). For more in-depth analyses of other specific issues and topics arising from this research, see Vares et al. (2003), Potts et al. (2003), and Potts (2004a and b).

  • 6

    See also Grace et al. (in press) for a discussion of how an analysis of the male participants’ narratives on pleasing their partners suggests that this process also forms an important measure of their own sexual ‘success’.

Acknowledgements

This research was made possible by a Health Research Council of New Zealand project grant. We are immensely grateful to the men who volunteered to take part in this study. We also thank Philip Armstrong for helping with the interviews and for his valuable feedback on an earlier draft of this paper. Thanks too to the transcribers, Roxane Vosper and Sharon McFarlane.

Ancillary