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Little Blue Pills: Viagra Use And Gay Men

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Let's Take a Few Steps Backward
Like many prescription drugs, Viagra was discovered by accident. In the late '80s, male volunteers in trials for an experimental angina treatment reported a peculiar side effect—increased erections during sexual arousal. Researchers were more than happy to take a second look at the compound, called sildenafil citrate, since it was looking pretty useless in preventing heart attacks. They found instead that it was remarkably effective at prolonging erections. It increases blood flow into erectile tissue by blocking an enzyme called phosphodiesterase type 5 that would otherwise cause all those spongy muscle cells to deflate. (That's why Viagra, and its competitors, Cialis and Levitra, are known as PDE5-inhibitors.)

A new drug that extends erections had blockbuster written all over it, and Pfizer wasted no time in winning approval for the first-ever impotence treatment in 1998. But "impotence" being a downer of a word, the company renamed the medical condition "erectile dysfunction" for labeling purposes. Then it flooded the market with bright blue, diamond-shaped pills that bore the subliminally suggestive name of Viagra ("vital" plus "Niagra" promising the ultimate orgasm), topped off with a TV ad blitz featuring the losing presidential candidate, former Sen. Bob Dole; a 77-year-old Pelé, the Brazilian soccer phenom; and other famous seniors. Sales topped $1 billion in its first year. Who knew erectile dysfunction was such a neglected diagnosis?

Of course, a growing number of prescriptions were for guys, like Justin M., who were neither old nor impotent. The little blue pill fast became a mainstay in the medicine cabinets of gay men with HIV, many of whom suffered under a load of libido-killing symptoms ranging from low testosterone to the side effects of antidepressants. Some HIV-negative guys, who tend to have the same gay docs as their poz brothers, soon got in on the act. The most common reason given, when one was required, for why they needed a script was condoms—and how hard they make it on hard-ons. At a time when condom fatigue had been fingered as a cause for the rise in unsafe sex in the gay community, there was a certain logic to the idea that widespread use of Viagra among gay men just might turn the anti-latex tide.

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