There's A Drug For That: P.E., Menopause, And The Medicalization Of Sex

Two articles in Saturday's New York Times — one about premature ejaculation and the other about menopause — shed light on how the pharmaceutical industry treats men and women's sexual "problems."

Natasha Singer writes in the Times that premature ejaculation (abbreviated PE, also a setting in which it would be especially embarrassing) is the new erectile dysfunction, a male sexual issue with a drug to match. In this case there are two drugs — a pill called Priligy, and an aerosol dudes are supposed to spray it on their dicks if they have trouble lasting more than a minute. Neither is approved in the U.S., yet. In a study, the spray increased penetration-to-ejaculation time to an average of 2.6 minutes — not a huge difference, but maybe enough to feel like an improvement for some men. Singer points out that "there is no doubt that some men are distressed about their inability to control their orgasms," and for those who are deeply dissatisfied with their sex lives, medication may provide some help. But the maker of the spray, Sciele Pharma, claims that one in three men have PE, and this may be exaggerated.

Dr. Wayne Hellstrom tells Singer that somewhere between 20% and 30% of men have PE at some point — but he doesn't say how many of these cases clear up on their own when, say, the guys hit nineteen or so. And psychiatry professor Leonore Tiefer says,

Rapid ejaculation as opposed to slow ejaculation is common, but there is slow and fast everything in the world: slow and fast walkers, slow and fast eaters, slow and fast breathers. When you tell someone they are a fast ejaculator, it makes it sound like there is a right time to ejaculate and, if you ejaculate before, it's a medical problem.

Tiefer's words highlight a contradiction in Sciele Pharma's marketing: if one in three men really has PE, couldn't it be considered a normal variation, rather than a disease? The question is even more apt in relation to menopause, which every woman who reaches middle age undergoes. Singer also wrote the Times menopause article, along with Duff Wilson, and the two writers note that before allegations about cancer risk tainted the drugs' reputation, hormonal treatments were marketed as an almost necessary response to menopause. They cite a commercial in which Lauren Hutton "runs down a beach and warns of the health risks of estrogen loss," saying, "My doctor said if you don't replace estrogen that you lose at menopause, your risk for certain age-related diseases could increase." Since the breast cancer connection was posited, estrogen for menopausal symptoms has been rebranded as "menopausal hormone therapy," rather than "hormone replacement therapy," downplaying the idea that hormones need to be "replaced." Yet hormone advocate Suzanne Somers (pictured) continues to prescribe hormones as "the juice of life," and menopause as a disorder requiring treatment — and she's not alone.

The pharmaceutical industry likely cares far more about money than about gender, and the diseasification of both PE and menopause show drug companies turn to both men and women when they want to make a buck. Their appeals, however, are different in character. Treatment for PE seems to imply that men are insufficiently virile if they can't last "long enough," and that they need help in aerosol form. Of course, jokes about premature evacuation are ancient, and Sciele Pharma didn't invent male performance anxiety. But they are capitalizing on it, by implying that the solution to fast ejaculation isn't a change in sexual practices (last time I checked, a dude's hands and tongue still work even after he comes), but a spray to make him just like every other guy. Or rather, just like the Ideal Male as defined by restrictive social norms and eagerly reinforced by profit-minded executives. The Ideal Female, by contrast, is forever young. Lauren Hutton may have talked about health in her commercial, but the anti-menopause forces have long focused on sexiness and femininity, which are apparently the exclusive province of women with dewy faces and equally dewy vaginas. The idea that bodies change as we get older, and that sex might change along with them — that it might include more lube, more oral, or more imagination — seems anathema to an industry with a big financial stake in promulgating a single, difficult-to-achieve standard.

Of course, menopausal hormone treatments provide real relief to some people — and premature ejaculation spray may as well. The problem comes when people feel that they should take drugs because their bodies are inadequate in some way. One of the healthiest things in our culture could do would be to accept variations in both the way we look and the way we fuck, whether these variations are inborn or arrive with age. But that acceptance might lead to a corresponding acceptance of aging itself, of wrinkles and fat and hair loss and, eventually, death. And were we to truly embrace senescence for what it is — a natural part of life — we might buy a lot less shit. Which, of course, would be bad for the many companies clamoring to bring our penises and vaginas up to code.

Sure, It's Treatable. But Is It A Disorder? [NYT]
Menopause, As Brought To You By Big Pharma [NYT]