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How Tech Helped Create a New Erectile Dysfunction Crisis

Startups are exploiting the market Viagra created, but experts are wary

Photo: BSIP/UIG/Getty

InIn 1998, Pfizer hired Bob Dole to be a spokesperson for Viagra. The former senator and presidential candidate epitomized the target audience for the new erectile dysfunction (ED) medication: A 75-year-old prostate cancer survivor, Dole’s erectile struggles were brought on by advanced age and ill health. In a commercial for Pfizer, he notes that conditions like diabetes, high blood pressure, and prostate surgery can also result in erectile issues, solidifying the public image of ED as a problem primarily faced by the elderly and the infirm.

But lately, that long-standing image of erectile dysfunction is starting to change. According to the website for SKYN Arise, a brand-new telemedicine website backed by the condom brand Lifestyles, “40% of men experience erectile dysfunction symptoms by age 40.” Hims, one of the best-known names in ED telemedicine, has made similar claims about the rates of erectile woes among young people; a third site, Roman, pegs the ED rate among the under-40 set at 26%. It’s a stark change from the era of Bob Dole — and in conjunction with sensational headlines about sex recessions and porn-induced erectile dysfunction, these marketing claims can make it seem like we’re experiencing an epidemic of young men with malfunctioning dicks.

The truth, however, is a bit more complicated than that. For starters, the ED these new startups are talking about is a little bit different from the condition Bob Dole raised awareness about back in the 1990s. “ED is a spectrum disorder,” says Erika Jensen, founder and CEO of Giddy, the company behind an eponymous new wearable device that advertises itself as a non-prescription alternative to medications like Viagra and Cialis. A horseshoe-shaped piece of plastic, Giddy is basically a modified cock ring: It strategically applies pressure to the penis with the goal of enhancing blood flow, while leaving the urethra unencumbered.

As Jensen sees it, the ED we associate with men like Bob Dole is just one end of the spectrum. In younger men, the condition looks a little different. Those erectile disappointments that are often attributed to stress, exhaustion, or alcohol? Jensen sees them as a low-level form of ED — a definition that sites like Hims, Roman, and SKYN Arise seem perfectly happy to endorse.

“It’s the reverse of abstinence: It is 100%, all the time, your penis must work, and if it doesn’t, it’s broken.”

Sexual health professionals aren’t necessarily excited about this expanding notion of what is, and isn’t, ED. David Ley, a clinical psychologist and sex therapist who routinely works with men who are unhappy with their erections, dislikes the way words like “disorder” and “dysfunction” are now used to describe a wide range of erectile function. “It’s the reverse of abstinence: It is 100%, all the time, your penis must work, and if it doesn’t, it’s broken,” says Ley, who feels that this language can pathologize what is, ultimately, normal penis functioning.

It’s not hard to see why companies that sell pills might be eager to embrace it, too. As telemedicine platforms have become more robust, and generic alternatives to Viagra have enabled providers to offer relatively cheap medications, a lucrative business opportunity has opened up. It’s now possible to easily provide ED medications to men who are too ashamed to talk to their primary care physicians about their sexual issues, or anxious about picking up Viagra at their local pharmacy. And it’s far more profitable to promote an expanded definition of ED and capitalize on the insecurities of young men who assume they should be able to get an erection on command — especially if you can get those young men to commit to a monthly subscription package for the rest of their lives.

But there are quite a few problems with this business plan, at least on the consumer side. ED medications are “a quick Band-Aid that may actually get in the way of helping individuals and couples address more systemic issues,” says Ley. Men whose erectile difficulties are due to anxiety or relationship issues may be able to “fix” their lack of erection by popping a pill — but the underlying problems will remain unresolved. In some cases, relying on medication to get an erection can even create a cycle of dependence, increasing the anxiety that users feel and making it even harder for them to perform sexually without chemical assistance. And then, of course, there are serious side effects that come with overuse of these medications, including the potential for permanently losing erectile function.

It’s far more profitable to promote an expanded definition of ED and capitalize on the insecurities of young men who assume they should be able to get an erection on command.

Giddy, at least, is trying to offer an alternative to the medication route, using this broad definition of ED to spark a conversation about what healthy sexuality looks like, rather than further stigmatizing flaccid penises and presenting medication as the only reasonable option. When customers purchase a Giddy ring, they’re also given access to a 30-day regimen designed by a team of sexual health professionals, including ED specialist Dr. Chris Kyle and certified sexologist Shan Boodram. During the course of those 30 days, customers are given a comprehensive understanding of the many mental and physical factors that can contribute to ED, and they’re guided through an exercise program that can help improve their stamina and ability to get and maintain an erection.

They’re also encouraged to think about their sexuality more expansively, developing an understanding of sex and intimacy that encompasses more than just an erect penis and penetrative sex. It’s an ED treatment that rarely seems to enter the mainstream conversation but is highly endorsed by sex therapists. (Ley notes that his work with men who are struggling with erections often begins with the line, “Welcome to the world of sex that doesn’t involve your erection.”)

There’s no question that sexual performance is a sensitive and uncomfortable topic for many of us, and that reducing the stigma around something like ED is an important part of creating a healthy conversation around sex and sexuality. But a conversation that pathologizes a routine and normal part of having a penis, or that positions a medication with potentially dangerous side effects as the sole solution to a disappointing erection, is one that sets a dangerous precedent. Our sexual wellness products need to be defined by our actual sexual health needs. And those needs, along with the idea of healthy sexuality, shouldn’t be shaped by companies out to make a quick buck.

OneZero columnist, Peabody-nominated producer, and the author of Faking It: The Lies Women Tell About Sex — And the Truths They Reveal.

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