Erectile dysfunction (ED) is a common problem faced by men and refers to a spectrum of sexual dysfunction, including premature ejaculation, performance anxiety, and iatrogenic causes. Despite the millions of men who have discussed these issues with a physician, countless more suffer in silence. While still treated primarily as the patient's problem, ED also affects the partner in a profound manner. The recent direct-to-consumer pharmaceutical marketing campaign has instilled among the public a belief in the mystical powers of Viagra. For many individuals, Viagra has lived up to its larger-than-life image. However, less than 50% of prescriptions for Viagra are refilled. Hence, there is a need for this book, which explores the reasons people seek the medication, reasonable expectations regarding its efficacy in myriad situations, available alternative treatments, and some clues as to which treatment is most likely to be effective.
Although the book's cover art contains the obligatory pictures of the little blue pill, the book is not exclusively about Viagra. The author is a practicing Harvard urologist who has worked and published extensively in the area of sexual dysfunction. Through discussions with patients and their partners, he discovered a disconnect between their expectations regarding the medication and the reality of Viagra's accomplishments. Often, the sexual dysfunction was symptomatic of a larger problem in the relationship that could not be corrected with medication. Unfortunately, all too often this connection was not recognized, even by trained physicians, and patients were given prescriptions for Viagra. When this “surefire cure” then failed, it added even more stress to the relationship.
The book is aimed at the would-be consumers of Viagra and is written at a layperson's level. However, given the number of physicians prescribing Viagra and the book's premise that, for many men, Viagra is not the best solution, primary care physicians would be well advised to read the book. For physicians who are not comfortable in tackling the subject or are constrained by the reality of 15-minute clinic medicine, the book serves as a useful patient-education tool.
The foundation of the book is built around patient vignettes that illustrate key points about sexual dysfunction and the difficulty it causes both partners. In tackling the subject of sexual dysfunction, the book takes on an expansive landscape of specific complaints and breaks these topics down into concise chapters, allowing the reader to divine the relevant information without feeling bogged down in details or nonrelevant discussions. Moreover, Dr. Morgentaler has crafted the chapters as stand-alone components while providing sufficient material to properly understand the central thrust of the book. An obvious price of this approach is repetition when the entire book is read, but he does tell the story in a slightly different fashion each time. Each chapter has a list of salient points highlighted at the end as a way of ensuring that the reader receives the take-home messages that range from philosophical to medical in nature.
The central message of the book makes it clear that Viagra is simply a medication that works to increase the blood flow to the penis. For many patients suffering from sexual dysfunction, this medication is exactly what they need. However, many patients have falsely elevated ideas about what the medicine can accomplish, and after an erection is obtained, the real problem comes to light. It is the physician's obligation to help the patient define the difficulties and determine, in concert with his partner, whether the medication makes sense for their particular problem.
The value of the text is that it constantly refocuses the reader on how the true scope of the problem is larger than just the patient and shifts the focus toward how men and women perceive ED quite differently. Rather than simply touting Viagra as a cure-all or, conversely, focusing only on treatment failures, the book discusses the larger picture of sexual dysfunction and attempts to correctly characterize Viagra's role alongside counseling/therapy and other medical treatments.
In undertaking this topic and in creating a book aimed at the health care consumer, an obvious criticism is that at times the book is superficial and overly simplistic. For example, it often suggests “couples therapy” as a better solution to specific problems, but does not expand on what type of therapy, which professionals should perform it, expected course, or even to whom the patient should inquire about whether this is a potential solution. With little detail about therapy other than the blanket statements that it works, Dr. Morgentaler runs the risk of creating a myth that couples therapy can heal all sexual dysfunction woes not corrected by Viagra. As a practicing urologist, the author should have directed patients to their primary care physicians as a key resource, since the physician will often have an established rapport with both partners. However, with these minor criticisms aside, the book is easily read, contains useful information about a topic that is commonplace, and will certainly foster further discussions about sexual dysfunction between partners and their physicians.