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Keywords:

  • sexuality;
  • ageing;
  • biomedicalisation;
  • Viagra

Abstract

  1. Top of page
  2. Abstract
  3. Introduction: sexualising seniors
  4. Sexual medicine and the sex/age problematic
  5. Virility surveillance
  6. Sexual function and biomedicalisation: tales from the pharmaceutical imagination
  7. Sexy technogenarians?
  8. Conclusions
  9. Acknowledgements
  10. References

While historically sex has been seen primarily as the prerogative of the young, more recently, the emphasis has been on the maintenance of active sexuality as a marker of successful ageing. A new cultural consensus appears to have emerged which not only emphasises the importance of continued sexual activity across the lifespan, but links sexual function with overall health and encourages increased self-surveillance of, and medical attention to, late-life sexuality. Drawing on historical accounts, clinical research, popular science reporting and health promotion literatures, I explore several key shifts in models of sexual ageing, culminating in the contemporary model of gender, sexuality and ageing that has made ageing populations a key market for biotechnologies aimed at enhancing sexual function. Two central concepts frame my analysis: ‘virility surveillance’, where age-related changes in sexual function are taken as indicative of decline, and the ‘pharmaceutical imagination’, where sexual lifecourses are reconstructed as drug effects revise standards of sexual function. After consideration of how narratives emerging from qualitative research with older adults challenge the narrow depiction of sexual functionality promoted by pharmaculture, conclusions call for continued critical inquiry into the biomedical construction of sex and age.


Introduction: sexualising seniors

  1. Top of page
  2. Abstract
  3. Introduction: sexualising seniors
  4. Sexual medicine and the sex/age problematic
  5. Virility surveillance
  6. Sexual function and biomedicalisation: tales from the pharmaceutical imagination
  7. Sexy technogenarians?
  8. Conclusions
  9. Acknowledgements
  10. References

It is not so long ago that studies of sexuality excluded older people. For example, the National Health and Social Life survey, one of the most widely cited studies on the prevalence of sexual dysfunctions in the US, surveyed only those between 18 and 59 years of age (Laumann et al. 1999).1 The British National Survey of Sexual Attitudes and Lifestyles, data from which were published in 1994, also had a maximum age of 59 in the sample, with the rationale that ‘many of the topics for which data were collected are known not to affect older people greatly’ (Wellings et al. 1994: 23).2 Even the Massachusetts Male Aging Study (Feldman et al. 1994), widely considered to have established the relationship between ageing and erectile dysfunction, did not include men over the age of 70.

More recently, increased interest in the sexuality of older people has been apparent both by their inclusion in surveys, and by the extent to which scientific findings about their sex lives have been reported in the mainstream press. In 2007, a study out of the University of Chicago (Lindau et al. 2007), published in the New England Journal of Medicine, spurred media headlines like ‘Sexed up seniors do it more than you think’ (MSNBC 2007) and ‘Senior partners: still randy’ (Agrell 2007). In 2008, it was a Finnish study, published in the American Journal of Medicine (Koskimaki et al. 2008), that had the press urging older men to ‘have sex, and have sex often’ (ABC/Reuters 2008) if they wanted to maintain their sexual function. Also widely reported on in 2008 was a Dutch study, published in the journal Urology, which was aimed at determining whether or not some common complaints of ageing – namely urinary, bowel and erectile problems – were part of the normal ageing process. They concluded that while deterioration of urinary and bowel function were not, an ‘increasing prevalence of erectile dysfunction can be related to the “normal” aging process’. They go on to qualify this, however, by suggesting that ‘normal aging does not necessarily mean healthy aging…’ (Korfage et al. 2008: 5). Clearly, new agendas have emerged which have put the relationship between ageing and sexuality at centre stage for both scientific research and public health promotion.

There is now a substantial body of research documenting the development of, and subsequent impact of, Viagra and other erectile dysfunction drugs (e.g. Loe 2004a,Mamo and Fishman 2001,Marshall 2002,Potts and Tiefer 2006). While historically sexual decline in both men and women was assumed to be an inevitable consequence of growing older, this assumption has now been reversed. Changing sexual capacities once associated with ‘normal’ ageing are now pathologised as sexual dysfunctions that require treatment. As with other aspects of health in contemporary societies characterised by ‘healthism’ (Crawford 1980) and ‘surveillance medicine’ (Armstrong 1995), individuals are encouraged to continually monitor their sexual function, manage risk, and seek medical treatment where indicated. With age seen as the most universal risk factor for sexual dysfunction, the latter becomes re-framed as potentially progressive and as indicating ‘unhealthy’ ageing. As populations age, the prevalence of sexual dysfunction and the anticipated market for pharmaceutical solutions are predicted to increase dramatically. While currently a trend most notable in regions such as Europe, North America and Japan, the United Nations identifies population ageing as a global and accelerating trend, and notes that ‘the population of most countries of the world is aging’ (United Nations Department of Economic and Social Affairs, Population Division 2007: xxix). The pharmaceutical reconstruction of sexual lifecourses thus has the potential to become a global phenomenon, although local contexts will always shape the way that eldersex is discussed, sold and practised.

In this paper, I explore the new place of sexuality in conceptions of ‘healthy ageing’. First, I will briefly recount some key shifts in the sex/age problematic as it has been taken on by sexual science and sexual medicine. I will then turn to the emerging emphasis on ‘virility surveillance’ as sexual function is taken not only to be a marker of successful ageing in general, but as the ‘canary in the coal mine’3 with respect to health status. This will lead to a consideration of the place of sexual function in the biomedicalisation of ageing, and its relationship to what I call the ‘pharmaceutical imagination’. Finally, I consider the status of sexualised ageing bodies in a global biotech market.

Sexual medicine and the sex/age problematic

  1. Top of page
  2. Abstract
  3. Introduction: sexualising seniors
  4. Sexual medicine and the sex/age problematic
  5. Virility surveillance
  6. Sexual function and biomedicalisation: tales from the pharmaceutical imagination
  7. Sexy technogenarians?
  8. Conclusions
  9. Acknowledgements
  10. References

Genuine senile impotence can never be the subject of rational medical treatment, though one may sometimes pity an amorous old man (Vecki 1920: 409).

Few fields in medicine can match the rapid progress that has been made in our understanding of male erectile function….The current state of the art is a pre-eminent example of what is achievable by systematic and conscientious application of basic research and clinical observation (Morales 1998: xv).

The currently hegemonic version of sexual medicine likes to tell a Whiggish history of progressive enlightenment (e.g.Goldstein 2004). Once upon a time, the story goes, doctors dismissed peoples’ sexual problems as all in their heads, or, in the case of older people, as the result of natural decline that they should simply accept. Then, discoveries in the laboratory revealed the truth about how bodies worked, and drugs to fix their mechanical glitches were developed. Medicine finally shed its reticence to intervene in sexual disorders, and brought the arsenal of rational scientific treatment to an area of human life that was formerly shrouded in ignorance. The future looks bright, as the limitless horizons of pharmacological and gene therapy promise even greater treatment options. However, as studies of medicine from the social sciences and humanities have shown, medical histories are far more complex than this. The development of sexual medicine is no exception, with definitions of, and explanations for, sexual dysfunctions shifting in relation to both available treatments and cultural trends. Between the late 19th and the late 20th centuries, the aetiological pendulum for sexual dysfunctions swung from organic to psychological and back to organic causes.

The degree of medical importance accorded to age as a cause of sexual decline has varied historically. Common wisdom in the late 19th century often cited the age of 50 as that at which one should renounce physical love as one’s desires and powers waned. Desire and power were separated out here (what sexologists would today treat as libido and function). Desire naturally waned, and while sexual powers (presumably erectile function) could be husbanded carefully to last as long as desire did, sexual excesses could easily deplete them. As William Hammond noted in 1887, ‘No cause is…so destructive to the happiness of the average man as the loss of his virile power while his desire still exists not measurably impaired’ (1887: 93). But sex after 50 was often deemed to be exhausting and injurious to body and soul (e.g. Nichols 1873). It was nature’s plan, for both men and women, to link peak sexual desire and power to the reproductive years, and these, once past, signalled a new, sexless phase of life (e.g. Drake 1902,Stall 1901).

The association of sexual vitality with youth (and the corresponding association of ageing with desexualisation) has long been integral to the general promotion of anti-ageing therapies (e.g. Sengoopta 2006). Part of the problem for earlier reincarnations of anti-ageing medicine – and especially for that related to sexuality – was a continuing association with quackery and the less-reputable rejuvenation enterprises that were seen to prey on the sexually weak. The reticence of mainstream medicine to promote sexual rejuvenation could be seen, for example, in the downplaying of the potential sexual benefits of testosterone supplementation in treating the ‘male climacteric’ in its American incarnation in the 1940s (Marshall 2007,Watkins 2007, 2008). Despite this, as those such as Susan Squier (1999) and Elisabeth Watkins (2008) have pointed out, throughout the 20th century the idea of rejuvenation – including sexual rejuvenation – continued to find resonance in the popular imagination despite the pooh-poohing of the medical establishment. Not until the latter part of the 20th century did mainstream medicine embrace the enterprise of sexual rehabilitation, especially with respect to ageing persons.

The clinical and market success of Viagra – introduced to the American market in 1998, and subsequently a global blockbuster -- was pivotal in creating new institutional structures and health promotion discourses around sexual health and in constructing ageing bodies as sites of biomedical intervention. The enormous interest in sexual dysfunction by pharmaceutical companies and their eagerness to fund research, conferences, publications and ‘disease awareness’ has created for dysfunction-focused sexual medicine the same sorts of markers of disciplinary structure that other specialties have had for many years (textbooks, journals, institutional centres, CME programs). This interest has extended across the globe, as indicated by Viagra manufacturer Pfizer’s sponsorship of a massive study of older adults’ sexual experiences and attitudes in 29 countries (Nicolosi et al. 2004), and the establishment of global networks of researchers and organisations focused on sexual dysfunction, such as the International Society for Sexual Medicine.4 The concept of sexual health itself, once defined as reproductive health and absence of sexually transmitted disease, has become increasingly focused on sexual desire and performance (Giami 2002). While those other agendas are still evident with respect to younger persons, when seniors are the concern, sexual ‘health’ is largely equated with ‘sexual function’, and new ‘anti-decline’ narratives have emerged (Potts et al. 2006). No longer constrained by the limits of ‘normality’, eldersex is opened up to the discourse of functionality (Katz and Marshall 2004).

Virility surveillance

  1. Top of page
  2. Abstract
  3. Introduction: sexualising seniors
  4. Sexual medicine and the sex/age problematic
  5. Virility surveillance
  6. Sexual function and biomedicalisation: tales from the pharmaceutical imagination
  7. Sexy technogenarians?
  8. Conclusions
  9. Acknowledgements
  10. References

Problematisation of the normal is central to what David Armstrong (1995) has called ‘surveillance medicine’. In surveillance medicine, ‘health no longer exists in a strict binary relationship to illness’, and is characteristic of ‘a world in which everything is normal and at the same time precariously abnormal, and in which a future that can be transformed remains a constant possibility’ (1995: 400). As he describes it, ‘in Surveillance Medicine each illness is simply a nodal point in a network of health status monitoring. The problem is less illness per se but the semi-pathological pre-illness at-risk state’ (1995: 401). Signs of waning sexual function in ageing bodies act in precisely this manner.

In contemporary sexual medicine, ‘sexual health’ (particularly in ageing men) has been treated as a ‘canary in the coal mine’; that is, as an indicator of their general health in mid-to late life. If the canary stops singing, it should be taken as a warning sign of imminent danger to health. As the keynote speech at the 2006 World Congress on the Aging Male put it, ‘Sexual Health is the Portal to Men’s Health’ (Shabsigh 2006). An editorial in the Journal of Men’s Health and Gender similarly proclaimed that ‘…sexual health is one of the gates to men’s health in general!’ (Meryn 2006: 318). The press release for the 2007 North American Congress on the Aging Male was headlined ‘Failure to treat sexual dysfunction can pose serious risk for aging males’ and warned that ‘leading research scientists and clinicians from around the world are reaching the consensus that failure to treat decreased sexual function in aging males may actually put them at greater risk for heart disease and cancer’ (Canadian Society for the Study of the Aging Male 2007). A recent article in the journal The Aging Male goes so far as to call men with erectile dysfunction ‘lucky’, suggesting that as an early indicator of testosterone deficiency or metabolic syndrome, it might bring them in for treatment at an earlier stage (Corona 2008).

While definitions of virility are generally associated with masculinity and masculine potency, I use it here as a more expansive standard for performative, phallocentric sexuality which includes women’s sexual desire for, and response to, heterosexual intercourse in its purview. While women lack the external index of the erect penis to indicate their overall health, they are included in the project of virility surveillance by proxy, or with promissory claims that regular sex will boost their immune systems, their oestrogen levels, keep them young-looking, and prevent incontinence by exercising their Kegel muscles (BioSante Pharmaceuticals 2008,Ehrenfeld 2007). While not as dramatic as the warning messages regarding men, the promises to women still rest on a reinforcement of the benefits to general health (and in this case, beauty) of regular sexual activity (presumably intercourse) into late life, and suggest that women’s sexual function also needs to be continually monitored.

The widespread media coverage of supposedly epidemic rates of sexual dysfunction has fostered an atmosphere of amplified risk for both men and women, and has intensified the move towards self-surveillance, monitoring and diagnosis. Versions of scales and indices assessing sexual function, originally developed in the context of clinical pharmaceutical research, are reproduced across a range of media as self-diagnostic quizzes, inviting individuals to screen themselves and consult their doctors for appropriate treatment options. For example, the Androgen Deficiency in the Aging Male scale, which was developed for clinical research on testosterone deficiency (Morley et al. 2000), has appeared as a self-screening quiz in newspaper articles (Black 2001), websites (http://www.andropause.com) and ads in magazines such as Golf. If individuals are negligent in screening themselves, doctors are encouraged to engage in ‘pro-active questioning about a patient’s sexual relations during routine consultations’ (Kirby 2004: 256). They are told to monitor their patients for signs of sexual decline by conducting ‘proactive sexual health’ interviews (Nusbaum and Hamilton 2002) and by ‘routinely asking about libido, sexual function and stamina’ (MacIndoe 2003: 256). The lead author of the University of Chicago study mentioned earlier suggested in an interview that she would ‘like to see physicians begin asking patients if they are sexually active, how their sex lives are going, or if there is anything preventing them from having sex’ (Lindau, as cited in Agrell 2007). In short, ageing bodies have been reclassified as sexual bodies and targeted for rehabilitation.

This reclassification of ageing bodies is, however, far from a gender-neutral project. As Stephen Katz and I have argued elsewhere (Marshall and Katz 2006), the current pharmaceutical technologies of sexual enhancement are premised upon a re-sexing of ageing bodies. That is, ageing, which had traditionally been understood as weakening the conventional logic that the sexes were biological ‘opposites’, is now the basis on which sexual difference is re-instated. If the shifts in sexuality once associated with normal ageing were taken as signifying de-masculinisation and de-femininisation, then reversing the effects of ageing requires re-sexing bodies and identities to align them with culturally dominant notions of heterosexuality and the hegemony of penetrative sex.

Sexual function and biomedicalisation: tales from the pharmaceutical imagination

  1. Top of page
  2. Abstract
  3. Introduction: sexualising seniors
  4. Sexual medicine and the sex/age problematic
  5. Virility surveillance
  6. Sexual function and biomedicalisation: tales from the pharmaceutical imagination
  7. Sexy technogenarians?
  8. Conclusions
  9. Acknowledgements
  10. References

Carrol Estes and Elisabeth Binney (1989), in their prescient paper on the biomedicalisation of ageing, argued that ageing was increasingly becoming defined as a medical pathology requiring intervention, with widespread consequences for how ageing bodies were known, treated and experienced. Revisiting that thesis some years later, Kaufman and colleagues (2004) confirmed that biomedical advances continue to shape knowledge about ageing bodies, and crucially influence public opinion and personal expectations regarding ‘normal’ ageing and medical intervention in later life. As we have seen, ‘normal’, when it comes to ageing, and especially when it comes to ageing and sexuality, is not what it used to be.

Centrally implicated in the contemporary biomedicalisation of ageing and sexuality is the expansion of pharmaceutical culture, although not as a simple process of pharmaceutical imperialism. As Nikolas Rose (2006: 480) suggests, ‘it is too simple to see actual or potential patients as passive beings, acted upon by the marketing devices of Big Pharma who invent medical conditions and manipulate individuals into identifying with them’. I suggest that the concept of the ‘pharmaceutical imagination’ might capture the contemporary orientation of biomedical research into sexual function and dysfunction, and the manner in which it provides an important set of resources for understanding and managing sexuality (Marshall 2009). The pharmaceutical imagination frames a range of possible narratives whose common thread is the assumption of a linear model of scientific progress which proceeds towards physiological explanations and results in pharmacological solutions. In this framing, knowledge about drug effects (either already existing or anticipated) is incorporated into the production of knowledge about bodies (including sexual bodies). As applied to sexuality, the pharmaceutical imagination defines ‘sex’ in terms of the physiological capacity for intercourse, largely interpreted in terms of youthful bodily standards. As such, it trades in a rather narrow understanding of what counts as sex and sexual pleasure. The pharmaceutical imagination assumes that the biological body is a realm unto itself, neatly separable from its cultural materialisation or subjective experience. It circumscribes what is to be considered problematic, valorises particular kinds of solutions and accords significance to some agents over others in constructing explanatory narratives for the success or failure of those solutions. But bodies are, of course, never outside culture, and it is from this point that the pharmaceutical imagination draws its gendered (and ageist) character. Assumptions about ‘naturally’ (hetero)sexual bodies whose essential properties can be known and then restored obscure the hegemonic conceptions of gender and sexuality upon which they rest.

The pharmaceutical imagination also embodies a future-orientation: there is an optimism linking patients, practitioners, researchers and industry that, whatever the problem, a better chemical solution is on the horizon. It is this optimism that provides a key point of articulation between sexual medicine and anti-ageing medicine (see e.g. Mykytyn 2006). Articulating a similar point, Kaufman and her colleagues conclude that, ‘knowledge of aging and disease today, like knowledge of life itself, is intrinsically linked to interventions’ and ‘the coupling of hope with the normalization of life-extending interventions affects our understandings of a ‘normal’ and therefore desired old age’ (Kaufman et al. 2004: 735–6).

As Stephen Katz and I (2004) have argued, the binary of ‘functional and dysfunctional’ appears to be supplanting that of ‘normal and abnormal’. The pharmaceutical imagination underpins this binary as it links clinical scientists, medical practitioners and patients pursuing treatments to manage sexual dysfunction.

First, there is an important distinction to be made between ‘functional’ and ‘normal’. For example, it may be ‘normal’ for erectile function or testosterone levels to decline in ageing men, or for libido or lubrication to vary in women at different life stages (or even on different days of the week). However, because functionality does not have to correlate with normality, standards of sexual function can redefine what is statistically normal as dysfunctional, and hence treatable. Clearly, sexual function is more of a cultural ideal than a biological ‘norm’ or capacity. But, because treatments to produce functionality are premised on the biological effects of drugs, they link these fluid cultural ideals to perceived biological capacities. For example, the clinical success of drugs like Viagra in producing erections has been instrumental in reinforcing a notion of male sexual function as a strictly physiological capacity that can be manipulated and enhanced. That they can do this so effectively is related to the fact that conceptions of functionality are premised upon measurability and standardisation.

Thinking about ‘function’ in terms of measurability and standardisation is required by the logic of pharmaceutical testing. Functional states must be quantified and stabilised as endpoints for evaluating interventions. The measurement of functional states is directed at quantifying drug effects, and the effects that drugs produce become the endpoints against which their success as interventions is measured. For example, a drug aimed at treating erectile dysfunction is evaluated by how much it increases penile rigidity. However, the indices designed to measure drug effects, as components of clinical trials (which require standardised and measurable data to report to regulatory bodies), also then circulate as diagnostic tools. For example, the International Index of Erectile Function was a 15-item index developed to measure the efficacy of treatment for erectile dysfunction in clinical trials (Rosen et al. 1997). After demonstrating its ability to detect ‘real treatment effects’ in those clinical trials, it was shortened to five items to make it better suited for use as a self-administered screening tool for erectile dysfunction (Rosen 1999). The end result is that standards of function become inseparable from treatment effects. Therefore, if a drug effect is to produce increased penile rigidity in men or increased lubrication in women, these become the standards for evaluating sexual function, and those from which ‘dysfunctions’ are distinguished.

Once functional states are accepted as adaptable states, the transformation of previously normative experiences into dysfunctions or pathologies demands intervention. Thus, drugs and their effects become important points of articulation between cultural ideals and bodily capacities. Acknowledging the latter by exploring the manner in which particular narratives materialise them in no way means resurrecting a ‘natural body’ separated off from culture. Rather, it takes up the challenge articulated in recent science studies, to confront ‘how matter comes to matter’ (Barad 2003). This work suggests a more complex understanding of the biology/culture interface which recognises that biology is better understood as a source of variation and diversity than it is of uniformity (Hird 2004). As feminist critics have rightly pointed out, the standardisation of sexual function central to sexual pharmacology pathologises the heterogeneity of sexual bodies and experiences (see e.g.Koch et al. 2006,Potts et al. 2004,Tiefer 2006a).

Simon Williams has suggested that a productive point of departure for those thinking through the biological/social nexus might be ‘to deconstruct the apparent unity of ‘biology’ as a disciplinary matrix and to think instead of anatomy, physiology, neurobiology, endocrinology, genetics and so on, thereby reducing the risk of simplistic resolutions or realignments of biology and sociology’ (2006: 15). Yet such deconstructions, already the stock in trade of scientific medicine, may be enfolded into marketing logics of unending frontiers of discovery, as fungible aetiologies are promoted for loosely bounded and vaguely defined disorders. Leonore Tiefer, for example, has traced how endocrinology quietly replaced vascular biology as the presumed explanatory paradigm for female sexual dysfunction, illustrating well how ‘the effort to match up some drug with FSD moved freely among symptoms and labels’ (Tiefer 2006b: 439). Treatments for sexual dysfunctions in ageing men have also seen shifting, and more precise justifications, as erectile function and libido become tied to different physiological anchors variously conceptualised as vascular or hormonal (Marshall 2007,Watkins 2008) and increasingly, genetic (Kendirci et al. 2006). All of these demonstrate the varying ways in which sexual dysfunctions and the sexual bodies that suffer from them are materialised and accorded facticity and explanatory power. Furthermore, these shifting aetiologies have visceral effects: understanding one’s sexual experiences as vascular or neurochemical or hormonal has implications for the way they are experienced, and the steps that might be taken to try and change them. One does not need to actually use pharmaceutical remedies to experience this aetiological shift: revised standards of sexual functionality, premised on biotechnical possibilities, reconstruct sexual lifecourses in such a way as to set new expectations and create new sites for anxiety about our ability to meet them.

Sexy technogenarians?

  1. Top of page
  2. Abstract
  3. Introduction: sexualising seniors
  4. Sexual medicine and the sex/age problematic
  5. Virility surveillance
  6. Sexual function and biomedicalisation: tales from the pharmaceutical imagination
  7. Sexy technogenarians?
  8. Conclusions
  9. Acknowledgements
  10. References

It is widely recognised that ‘[A] massive and growing market for drugs and devices to treat sexual problems targets older adults’ (Lindau et al. 2007: 762). Thus, age still matters when it comes to sexuality, but the meanings and practices associated with ageing sexuality have been radically reconfigured. Revised standards of functionality have reshaped norms of ageing, and biomedical interventions are integral to this reconfiguration and reshaping. Since these very standards are premised on drug effects, then drugs are deemed to be ‘what works’. Normality becomes fluid, defined by the pharmaceutical possibilities for optimising function, fuelled by the optimism of limitless potential.

Pharmaceutical industry reports continue to see a large global market for treating both men’s and women’s sexual dysfunctions (Spectra Intelligence 2006). In the wake of Pfizer’s market success with Viagra, competing pharmaceutical companies have brought their own erectile drugs to market – Levitra and Cialis. Lilly, the makers of Cialis, has begun marketing a once-daily version of their medication as an alternative to the current on-demand version now available, transforming erectile capacity into a continually biochemically modifiable state (Berenson 2006). While erectile drugs continue to dominate the market, new multi-million dollar market opportunities are seen in treating hypoactive desire disorder in women and androgen deficiency in ageing men. A 2005 report in Science suggested that two dozen companies have sexuo-pharmaceuticals for women in development (Enserink 2005), and commentators continue to predict a growth market for treatments for ‘andropause’, premature ejaculation, and erectile difficulties (Biotech Week 2003). Underlying this optimism is an assumption that more knowledge about the physiology and neurochemistry of sexuality will advance the linear model of scientific progress that underpins the pharmaceutical imagination. And, as noted above, as populations age, the corresponding markets for biotechnologies aimed at enhancing their sexual function grow ever larger.

There is an urgent need for more qualitative research to provide some narrative resources that can broaden our understanding of ageing and sexuality beyond the crudely reductive ‘use it or lose it (and ask your doctor to provide our remedy so you can use it)’ script provided by pharmaculture. While there are now a number of studies exploring the meaning and experience of sexuality in the lives of older people which provide a richer, more complex perspective on sexuality and ageing (Gott 2004,Kleinplatz et al. 2009a, 2009b,Loe 2004b,Potts et al. 2006,Vares et al. 2007), there is still much to be learned. For example, about half of Viagra prescriptions are not renewed (Nehra et al. 2003), but little is known about why those prescriptions are not renewed. Some practitioners of sexual medicine speculate that the reasons for ‘non-compliance’ with such drug therapy might include inadequate patient instruction on how to use the medication (Gruenwald et al. 2006), and low success rates due to complicating factors such as ‘androgen deficiency’, requiring co-treatment with testosterone (Shabsigh et al. 2008). Assumptions are made about ‘unmet needs’ as the basis for future sexuo-pharmaceutical development. 5 However, what qualitative research is available with older men and women, including Viagra users, suggests that they have not entirely bought into the decline/anti-decline narratives offered by the pharma-script (see for example Potts et al. 2004,Potts et al. 2006,Vares et al. 2007). For example, as Potts et al. summarised the findings from their research:

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 (2006: 325).

Another study by Canadian psychologist Peggy Kleinplatz and her colleagues (2009a, 2009b) onfirms that for many older men and women, sex improves with age and experience. Based on interviews with men and women over the age of 60 who had been in long-term relationships, they found that conventionally defined sexual ‘function’ (i.e. intercourse to orgasm performed by erect penises and lubricated vaginas) is neither necessary nor sufficient for ‘great sex’. Instead, such factors as communication, connection, intimacy and fun were repeatedly stressed as defining optimal sexual experiences (2009a). Participants in their study told them that ‘the quality of their sex lives had changed over time as well as perceptions of what sex might be or could become’ (2009b: 16). Such accounts remind us that, despite the best efforts of pharmaceutical marketers, technologies will never be taken up uniformly or without active engagement on the part of users, and that ‘technogenarians’ are no exception.

Conclusions

  1. Top of page
  2. Abstract
  3. Introduction: sexualising seniors
  4. Sexual medicine and the sex/age problematic
  5. Virility surveillance
  6. Sexual function and biomedicalisation: tales from the pharmaceutical imagination
  7. Sexy technogenarians?
  8. Conclusions
  9. Acknowledgements
  10. References

In this paper, I have suggested a recent and significant shift in understandings of the place of sexuality in the biology of ‘healthy’ ageing. Whether sexual function is seen as an indicator of overall health and/or a warning sign of disease, the enfolding of compulsory sexual activity into health promotion signals a new regime of virility surveillance. The question is no longer whether or not changing sexual capacities are an aspect of normal ageing or a health problem requiring intervention: contemporary sexual medicine suggests they are both.

While a more positive image of elder sex than has held sway in the past is certainly welcome, implicit is an underlying assumption that those who choose to opt out of conventionally-defined sexual activity as they age are victims of a pathology. Subtly reiterated is the message of risk and decline in the absence of appropriate intervention. The emphasis on reliability and standardisation of sexual function promoted by sexual medicine pathologises the heterogeneity of sexual experiences and sexual bodies, especially where age is concerned. Everyone wanting or being able to ‘do it’ in the same way, for all time, hardly seems to acknowledge a diversity of experience across the lifespan. As long as being sexualised means adhering to youthful norms of sexual attractiveness and prioritising sexual intercourse as the gold standard of sexual function, ‘it is not old age that is being sexualised but rather an extended middle age. The incompatibility of sexuality and old age is hence reinforced’ (Gott 2004: 2). On the contrary, as Kleinplatz et al. (2009b: 15) suggest, ‘it stands to reason that individuals and couples…who have developed the capacity over the years to experience optimal sexuality have much to teach the rest of us’.

Against the backdrop of work on the biomedicalisation of ageing, I have used the concept of the ‘pharmaceutical imagination’ to explore how drug effects, either existing or just anticipated, are implicated in the production of knowledge about sexual function and sexual bodies. As the ageing population represents a critical and growing biotech market, the meaning of ‘normal’ ageing, including sexual ageing, stands to be radically reconfigured. The discursive shape of that meaning, as circumscribed by the clinical research, media reports, and health promotion literatures that I have reviewed here, is also shaped by the embodied, lived experience of ageing men and women, and I endorse Clarke and colleagues’ call (among others) for ‘case studies that attend to the heterogeneities of biomedicalization practices and effects in different lived situations’ (2003: 185).

In 2006, an article on the potential applications of gene therapy for treating erectile dysfunction concluded that:

Although preclinical studies have highlighted the application of local gene therapy as a viable treatment option for ED in diverse pathologic conditions including diabetes, ageing, hypercholesterolaemia, and cavernous nerve injury, this therapeutic approach still requires more clinical studies in humans (Kendirci et al. 2006: 1218, emphasis added)

What is remarkable here is not the extension of gene therapy into the treatment of sexual performance problems – that has been on the horizon for at least a decade – but the explicit inclusion of ‘ageing’ itself as a generalisable ‘pathologic condition’. As sexual medicine and biogerontology join forces, the remarkable disassembling and reconstitution of ageing, sexualised bodies that has occurred over the last 150 years seems headed for some new frontiers. A key task of critical studies of science, health and ageing is surely to open up to scrutiny the stories about sexuality and ageing narrated by the pharmaceutical imagination.

Footnotes
  • 1

    This study is the source for the infamous and widely repeated ‘fact’ that 43% of women suffer from sexual dysfunction. For a good critique, see Bancroft, Loftus and Long (2003).

  • 2

    While the National Health and Social Life survey excluded people older than 64, despite its explicit ‘life-course’ perspective, the British National Survey of Sexual Attitudes and Lifestyles focussed on sexually transmitted diseases, particularly HIV/AIDS, which influenced the age profile of the sample.

  • 3

    Early coal miners would take canaries down into the mines with them, as these birds were particularly sensitive to the dangerous gases which could accumulate. As long as the canary was singing, they could be assured of their safety. If the canary died, it was a harbinger of serious risk to the miners, and prompted their evacuation.

  • 4

    The International Society for Sexual Medicine includes affiliated regional societies in Africa, Asia-Pacific, Europe, Latin America and North America (http://www.issm.info, last accessed May 14, 2009).

  • 5

    David Healy (2008: 221–31) draws on Kalman Applbaum’s (2004) argument that the concept of ‘unmet needs’ is the lynchpin of marketing, including pharmaceutical marketing. While Healy is writing in the context of psychotropic medications, his insights regarding market segmentation and the extent to which ‘anthropological’ rather than therapeutic research underpins drug development and marketing are equally applicable to sexuo-pharmaceuticals.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction: sexualising seniors
  4. Sexual medicine and the sex/age problematic
  5. Virility surveillance
  6. Sexual function and biomedicalisation: tales from the pharmaceutical imagination
  7. Sexy technogenarians?
  8. Conclusions
  9. Acknowledgements
  10. References

I’d like to thank the editors and anonymous referees for their helpful comments on an earlier draft, and the Social Science and Humanities Research Council of Canada for financial support. I’m also grateful for the insights of my colleague Stephen Katz, with whom I originally developed some of the ideas elaborated in this paper

References

  1. Top of page
  2. Abstract
  3. Introduction: sexualising seniors
  4. Sexual medicine and the sex/age problematic
  5. Virility surveillance
  6. Sexual function and biomedicalisation: tales from the pharmaceutical imagination
  7. Sexy technogenarians?
  8. Conclusions
  9. Acknowledgements
  10. References
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