Viagra was approved by the FDA 27 years ago. It changed how we talk about sex.
It was the little pill that could – a medical breakthrough that changed the way Americans thought and talked about sex and aging. Thursday marks 27 years since the U.S. Food and Drug Administration approved the sale of Viagra, the nation’s first oral medication for what’s now commonly known as erectile dysfunction.
At a time when ED-related medications are a regular feature of late-night TV, it might be difficult to recall that prior to March 27, 1998, the condition – with its inaccurate baggage of shame and even failure – was rarely discussed in public.
“If it was talked about at all, it was behind closed doors or joked about as part of the inevitable decline of aging,” said Alicia Walker, an assistant professor of sociology and anthropology at Missouri State University who studies sexual relationships, identity and behavior. “Viagra opened the door for these conversations.”
The introduction of and marketing around Viagra changed public and even medical attitudes, reframing sexual dysfunction not as a personal or psychological failing but as a legitimate and treatable medical condition, Walker explained.
“That may seem obvious now, but at the time, it was revolutionary,” she said.
How Viagra changed the sexual health conversation
As noted by History.com, Pfizer stumbled by accident onto the gold mine that would be Viagra after its chemists designed the compound sildenafil as a potential treatment for high blood pressure and the cardiovascular condition angina. While the drug’s effects on angina were negligible, chemists found it induced penile erections within an hour or less. With that, the pharmaceutical firm realized it had an economic opportunity on its hands.
Viagra was an immediate success: By the end of 1998, consumers nationwide had bought almost 100 million pills worth about $788 million.
While Viagra became the signature term for all such medications – and was almost immediately sprinkled in for laughs in sitcoms and late-night monologues – its approval by the FDA legitimized sexual health as a concern. Experts told Paste BN it helped open up discussions of intimacy issues among men as well as nonbinary people with penises and others.
“Viagra completely changed the way people talked about sex and impotence, both in doctor’s offices and around dinner tables,” Walker said. “It helped normalize the idea that sexual health is part of overall health, not something shameful or off-limits.”
That was an important cultural shift, said Pepper Schwartz, a longtime professor of sociology and sexology at the University of Washington, noting that erectile dysfunction can cause affected men to approach intimacy with anxiety rather than enthusiasm.
“An inability to have a dependable erection affects satisfaction and can change the mood and passion,” she said. “A penis that won’t cooperate is depressing and deflating. ... The importance of Viagra – and other drugs for the same purpose commonplace in the world now – cannot be overstated.”
Marketing played a major role
Among the reasons for Viagra’s cultural shift was its “surprisingly smart and strategic” marketing, Walker said, which tackled the stigma head-on without leaning into sex or innuendo. Instead, it focused on health, dignity and trust.
That started with the enlisting of former U.S. Sen. Bob Dole, a decorated World War II veteran and respected former presidential and vice-presidential candidate, as Viagra’s celebrity pitchman in its initial advertising.
“That ad changed how both doctors and the public approached the topic,” Walker said. “If Bob Dole could talk about it, anyone could.”
Viagra’s marketing shifted the language around the issue, redefining it as erectile dysfunction rather than impotence.
Where the latter term carried shame and stigma, “erectile dysfunction sounded clinical, treatable and rooted in biology,” Walker said. “It reframed the issue as a legitimate medical condition, something that could be discussed in a doctor’s office without judgment.”
The shift in language, she said, “changed the tone of the entire conversation. It allowed men to seek help without feeling broken and connected erectile dysfunction to broader health concerns like heart disease or diabetes.”
About 30 million men in the U.S. report dealing with erectile dysfunction annually, according to Harvard Medical School, with nearly half of those older than 75 experiencing difficulty getting and maintaining erection. While multiple factors can contribute – for instance, depression, obesity or tobacco use – the most common is clogged arteries, the school said, with one in three cases linked to underlying cardiovascular issues.
The recharacterization of ED as part of one’s overall physical and emotional wellbeing was crucial for both the public and medical establishment, neither of which had been previously inclined to take such issues seriously, Walker said.
While the issue for men encompasses identity, masculinity and self-worth, it can also signal serious health conditions such as cardiovascular disease, diabetes and high blood pressure.
“Treating ED can prompt men to seek medical care they might otherwise avoid, leading to earlier detection and treatment of potentially life-threatening conditions,” Walker said.
'It had a massive impact'
Viagra’s debut also offered a glimpse into “the gendered politics of health care,” Walker said. Its rapid cultural embrace and the insurance industry’s quick willingness to cover the drug offered a sharp contrast to the reluctance to seriously consider women or other people's sexual health issues.
“That tension still exists today, and it’s a vital part of the conversation,” she said.
Cynthia Graham, senior scientist at The Kinsey Institute and editor in chief of The Journal of Sex Research, said that while Viagra's influence has been largely positive, it also reinforced the idea of a quick fix when sexual issues in relationships may be more multifaceted.
"It had a massive impact in many positive ways, but some negative as well," Graham said. "There's a lot of focus on the erection without looking at the men attached to it. Viagra can be really helpful, but the idea that you take it and don’t change anything else or don’t discuss it with partners is not acknowledging how complex sexual problems are."
Viagra’s success revealed a huge market for sexual health discussion and aides, opening the floodgates for the development of other ED drugs such as Cialis and Levitra and prompting a slew of TV ads with what she describes as “that familiar soft lighting and couple-in-a-bathtub vibe.”
“It helped create the climate we have today, where sexual health products are marketed alongside blood pressure meds and allergy relief, and conversations about intimacy and aging are part of public health dialogue,” Walker noted.
Schwartz, of the University of Washington, said Viagra’s approval set the stage for the rise of companies like Ro, a telehealth company for which she is an adviser, that launched to offer such medications by mail and have since branched out to include other health products.
“This important sexual aid helped so many men who would have been miserable without it,” Schwartz said. “There’s no doubt that it made a lot of men and women emotionally, as well as sexually, healthier.”