The Magic Little Blue Pill

Not since birth control has a medication so seriously transformed America's sex life. I But why are VIAGRA's side effects more cultural than physical? j Before Viagra, you had tiger penises. Dried, boiled in soup or infused in brandy, the big cat's phallus was said to turn men into sexual tigers. Casa­nova slurped 50 raw oysters a day to fuel his sex life. The Marquis de Sade fed Spanish fly, a genital irritant made from ground beetles, to prostitutes who caught his eye. The Beastie Boys sang about doing the same. Men look­ing for the perfect aphrodisiac have tried rock salt, bulls' balls, monkey brains, sheep eyelids, blowfish, whale dung, snail dung, human menstrual blood and baboon urine, to name a few. Not to mention giant ants. Before Viagra, all the sexual-peiTormance-enhancing drugs in the world had one tiling in common: lliey didn't work. Then, in 1983, the country's leading urologists met in Las Vegas. At that point nobody was sure how erections happened. Urologists all knew that a penis is 70 to 75 percent muscle, but half of them thought all that muscle tissue had to contract for the organ to spring into action. The other half believed the tissue needed to relax, allowing blood to fill the muscle of love. Dr. Giles Brindley was in the second camp, and he planned to prove his point. Brindley, a former Olympic pole-vaulter, was a thin, bespectacled pro­fessor at the University of London known for taking his ideas to ex­tremes. "He'd stand on his head and drink water from a rubber hose to show that swallowing is a function of muscle contractions in the throat, not gravity," one medical blogger recalled. Brindley once tested the agility of rab­bits by tossing the animals around a car going 80 miles an hour. And he made an immediate impression at the 1983 American Uiological Association convention. While the hundred or so urologists in his audience at the Las Vegas Hilton wore suits and ties, he took the stage in a tracksuit. His lee- ture sounded like the usual stud" at first, with numbers and citations, but as he spoke, clicking through pholos of a fully erect penis, the crowd perked up. Had he really mentioned a "new approach" to male sexuality? "I can vouch for the veracity of these photos," Brindley said, "because that's my penis." (amtimwd mi page. 112) Sexual Healing Through the Ages THE MAGIC LITTLE BLUE PILL Continued from page 48 He explained that he'd used himself as a guinea pig, injecting his member with 17 different drugs in hopes of inducing an erection. Many of the drugs failed, but phenoxybenzamine, a muscle relaxant, worked wonders. And he had proof. "He'd gone to the men's room and in­jected himself before his talk," recalls Dr. Irwin Goldstein, who was there that night. "Now he stepped away from the po­dium," says Dr. Ira Sharlip, another prominent urologist in attendance, "to give us a view of the large bulge in his jogging pants." "At first he seemed frustrated that peo­ple weren't listening. They weren't get­ting the point that he'd used a relaxant," Goldstein says. "And maybe they thought he had an implant. So he said, 'Oh hell,' and dropped his pants," giving the urolo­gists and their wives a view of his long, thin penis, naked and fully erect. Brindley announced, "I'd like to give the audience an opportunity to confirm the tumescence." The conventioneers weren't expecting this. He wanted them to confirm the tumescence by hand. Ac­cording to Dr. Laurence Klotz's account, "The sense of drama was palpable. With his pants at his knees, he waddled down the stairs, approaching, to their horror, the urologists and their partners in the front row. As he approached them, erec­tion waggling before him, four or five of the women in the front rows threw their arms in the air and screamed loudly. The screams seemed to shock Professor Brindley, who rapidly pulled up his trou­sers, returned to the podium and termi­nated the lecture. The crowd dispersed in a state of flabbergasted disarray." "That night in Las Vegas," says Goldstein, "modern sexual medicine began." Brindley's drug worked by sending a mes­sage to the arteries in his groin: Relax. Blood flowed through widening arter­ies, inflating the erection chambers in his penis to money-shot hardness. Unfortu­nately, the effect had nothing to do with arousal. Phenoxybenzamine triggered a robo-erection: automatic, uncontrollable and likely to wear off before you got a chance to use it. (It also caused tumors in lab rats.) Still, it was better than giant ants. For the next 15 years, the standard treatment for erectile dysfunction, or ED (still known as impotence at the time), would be injection with muscle relaxants along with a technique called medicated urethral system for erections, or MUSE. To MUSE yourself, you used a miniature plunger to poke a medicated pellet an inch into your urethra, then waited for it to dis­solve and produce an erection. Although thousands of men with ED tried injections and MUSE, most people had never heard of either technique. Sexually capable men hoping for a pill to enhance their sex lives—to make a good thing better—were known as science-fiction fans. Until UK92480 came to Sandwich. Sandwich is a windswept ancient town in the county of Kent on the English Channel. It has played host to two major inventions, both having to do with injec­tions of beef. It was here that John Mon­tagu, fourth Earl of Sandwich, played marathon card games in the 1700s. The earl hated to skip a hand to eat lunch, so he had his servants place a chunk of roast beef between slices of bread, a delicacy that soon took his name. Two centuries later, Dr. Ian Oster-loh drove past stone buildings Montagu would have recognized. Osterloh, a bald­ing medical researcher, parked at a mas­sive steel-and-glass complex on the out­skirts of town. He passed through security on his way to a laboratory blazoned with the blue pill-shaped logo of Pfizer Inc., the pharmaceutical multinational. It had been a shitty year for Pfizer's research lab in Sandwich. The company had spent thousands of man-hours and millions of pounds testing UK92480, a promising blood-pressure drug. (UK is for "United Kingdom," site of the lab, where it was the 92,480th substance tested.) But like most experimental drugs, it flopped. Test subjects groaned about muscle aches. Their blood pressure fell too far. The drug was headed for the dustbin until 1992, when several of the test subjects— mostly policemen, firemen and students in their 20s—mentioned a side effect. "Doc, I'm getting erections," they'd say. "Very firm erections." As Osterloh wrote, "None of us at Pfizer thought much of this effect," which arose two or three days after a dose. "Even if it did work, who would want to take a drug on Wednesday to get an erec­tion on Saturday?" Still, they had little to lose. Reading urology papers, they found hints about biochemical pathways that led to erection. Like Brindley's phenoxy-benzamine, UK92480 was a muscle relax­ant. Why not see where this path led? To test the drug's effects, Pfizer re­searcher Chris Wayman filled a set of test tubes with penile tissue from volunteers. He gave each tube a jolt of electric cur­rent. Nothing happened. He tried an ar­ray of chemicals. Still nothing. Then Way­man added a drop of UK92480, chemical name sildenafil citrate. The disembodied tissue in the test tubes reacted like the corpse callosum in the Rolling Stones song "Start Me Up" ("You make a dead man come"), swelling before his eyes. As he recalls with British understatement in a BBC documentary, "We were onto something." In fact they had stumbled onto a substance that could change the future while making Pfizer richer than ever—if they could keep it a secret. "We had to be careful of how much we said, and how loudly," says Dr. Peter Ellis, another of the drug's developers. "If you're in a pub or public restaurant, you don't shout that you're working on a revolutionary drug." Clinical tests in 1993 and 1994 proved that UK92480 worked in pill form. "After that," Ellis says, "Pfizer made a major disclosure at the 1994 AUA convention. They shut the door behind the urologists and said, 'Guys, we've something to tell you.'" Three and a half years later, the FDA approved the first effective aphrodisiac. By then it was called Viagra, a name sug­gesting vitality and vigor delivered with the thunder of Niagara. But it would have sold if they'd called it cyanide. If you liked sex, this was the drug for you. "Sexual medicine was ready for a nuclear bomb," says Goldstein, "and Viagra was it." Few bombs ever landed at a better moment. Within months of approving Viagra, the FDA also okayed the first direct-to-consumer TV commercials, advising "Ask your doctor," spurring millions of men to do just that. Before 1998 doctors had served as a buffer be­tween big pharma and a drug-hungry public. Now it was pretty much drugs on demand. Pfizer's commercials star­ring Senator Bob Dole, who had lost the 1996 presidential election to Monica Lewinsky's favorite candidate, and Texas Rangers slugger Rafael Palmeiro, not yet tainted by his other favorite performance enhancer, steroids, helped destigmatize impotence. Educated consumers called it ED instead, and Viagra's capital V con­noted virility. Within months of its debut, Viagra was the best-known drug since penicillin. It became one of the top news stories of 1998, along with the Lewinsky-Clinton affair, the euro, the Unabomber and Clinton's impeachment. Lifestyle magazines began wooing advertisers with charts and graphs like the one headlined GOLF MAGAZINE IS #1 AMONG MEN WITH ERECTILE DYSFUNCTION. Satisfied customers also used chat rooms to spread the V word. You may re­member some of the jokes, which ranged from predictable ("Did you hear about the first Viagra death by overdose? A guy took 10 and his girlfriend died. Smiling") to predictable ("Doctor, can I get it over the counter?" "You have to take two to do that") to pretty good ("What happens to a lawyer who takes Viagra? He gets taller",). Before long, Viagra was the web's top topic, and not just on internet giants Netscape and AOL but at brand-new Google.com, where you could find a new sort of testimonial: "/ was hearing of guys younger than me in their 20s and 30s using 'Vitamin V so I decided that I needed that same edge. I have found that Viagra makes me a super stud and the girl rides me and always has an orgasm or two."—Pablo, 42, Texas "Before the pill I could usually stay hard for 15 minutes. Unfortunately it usually takes my wife longer than that to have an orgasm. After taking Viagra, I have full control of my penis and I am free to blow my load when I want!"—age 28, Vancouver Thanks largely to Viagra, Pfizer's profits jumped 38 percent, to $628 million, in the second quarter of 1998. From there, sales of Viagra rose and kept rising, reaching an annual $1 billion in 1999 and $2 billion in 2012. Just as crucial were the drug's effects on pop culture. One user's account be­came a Salon.com sensation in 1999. In his "Diary of a Viagra Fiend," Jayson Gal-laway told of ordering a pack of the "blue diamonds" online. Not because he needed firepower, exactly. "I'm a virile, healthy 29-year-old American male," wrote Gal-laway, a leather-clad San Franciscan with dreadlocks spilling from the top of his partly shaved head. "Sure, there's been a time or two when, for reasons ranging from disinterest to methamphetamine, little Tyson wasn't ready when the bell rang. Okay, yeah, so I recently acquired a 19-year-old girlfriend and maybe I've been feeling a tad insecure about not being capable of the erectile heroics I was capable of at 16." Online Viagra re­stored him. Soon his girlfriend, whom he called Lolita, doffed her Hello Kitty panties and beheld "the Erection of the Gods." Gallaway then started to enhance the festivities by crushing a blue pill and snorting the powder. "Viagra burns like nothing I've ever snorted. With the in­side of my head on fire, I curse myself for being an idiot. But guess what? Two min­utes later: Hi-yo Silver...I'm the Bone Ranger, and for the next 16 minutes, a physical congress occurs that is indeed the stuff of legend." Gallaway's comedy of eros climaxed with a cell phone call to his girl and a Viagra-plus-ecstasy sexstasy marathon that led to "felonious noise complaints" and a ceiling fan that broke under the weight of a naked Lolita whirling over their bed. This was not Senator Dole's Viagra. "The details of that evening are so carnal, so profane, so unspeakably dec­adent, that I can't think about them with­out becoming aroused," Gallaway wrote. "Of course, these days, now that I am eating Viagra pills like they are M&Ms, there is not much I can do without be­coming aroused. As a matter of fact, I am actually typing this with my penis." He was one of countless young men who believed Viagra wasn't just for ED. It was the food of the gods, the stuff men had hoped for since Adam's first blind date. But Pfizer wasn't about to market it that way. Admitting that Viagra might have recreational uses could invite fiends like Gallaway to sue if they came up with a problematic four-hour erection or if the pills failed and cost them their self-esteem. To sidestep such trouble, the manufacturer made it clear in the fine print that Viagra wasn't for fun; it was serious medicine for a clinically recog­nized dysfunction. In this way the blue pill joined Vicodin (for pain), OxyContin (for more pain) and Adderall (for finals) in the pantheon of medicines whose clin­ical uses kept them in play for off-label appreciation. The difference between Viagra and some of the others was that, with exceedingly few exceptions, Viagra didn't hurt anybody. Watch the ads, consult your doctor (or an online quiz or friends with prescriptions), pop the pill, and everybody's happy. Pfizer was legally protected, and Lolita was riding the ceiling fan. Beyond making vigorous sex possible for men with ED, Viagra fueled innumera­ble Gallaway-style sexathlons. With about 40 million Viagra users worldwide—most with prescriptions but many more knock­ing back mail-order, black-market or counterfeit pills—there's little doubt that men who should never have tried the stuff have been killed through off-label use. "There must be instances of guys' hearts just exploding during sex," Galla-way says. "But I suspect Pfizer would not want that known." Pfizer does what companies worth $200 billion do. It maximizes profits. Gallaway, meanwhile, did what brand-building bloggers do. After his Salon.com piece went viral, he says, "I was sud­denly the face of Viagra." And not only the face. Lolita wanted more. So did hundreds of readers who e-mailed him, asking for sex tips. "I heard from a lot of men in the Middle East, asking me to procure Viagra or women for them," he says. Gallaway wound up discussing his boners on ABC's 20/20, describing erec­tions "that could also be used for home defense." He wrote a Viagra Fiend book dedicated "To my penis, without which none of this would have been possible." And as you'd expect, he met women eager to meet the dedicatee, "women who wouldn't take no for an answer." He sent a few to ceiling-fan heights, but he sometimes felt like a piece of meat. Later, after a stint as a cage dancer in a San Francisco bondage club, he told his doctor he was feeling down despite his high-rise erections. "I'm going to prescribe an antidepres- sant. It has side effects," the doctor said. "You might lose some sexual function, so I'll also give you a scrip for " The patient was way ahead of him. "Viagra!" "It's very effective." "You don't have to tell me. I literally wrote the book." Gallaway's book was optioned by Seann William Scott, who was set to play the hero in a Viagra Fiend movie. But Scott opted out to star in The Dukes of Hazzard. Lolita of the Hello Kitty pant­ies got engaged to another guy. Gallaway lost his dreads, turned 35 and then 40 and acquired the edgy wisdom he blogs about at JaysonGallaway.com. "That Salon.com story was the first thing I ever wrote," he says. "I got $75 for it. It made me a worldwide expert on Viagra for a year or two, got me a movie deal and thenpffft.... I'm still waiting to hear from Seann William Scott." Gallaway wasn't the only one to capitalize. Sex and the City and dozens of other TV shows featured Viagra story lines. HBO's Big Love suggested in 2006 that Utah po-lygamists could use a little help in the hay. That same year, after TSA agents at Palm Beach International Airport found a stash of contraband Viagra in Rush Limbaugh's luggage, forcing a hapless public to pic­ture Limbaugh's righteous erections, the trail veered back toward polygamists. In a 2008 story, The Washington Post told of a CIA tactic unofficially dubbed Boners for Warlords. The Post reporter set the scene: "The Afghan chieftain looked older than his 60-odd years, and his bearded face bore the creases of a man burdened with duties as tribal patriarch and husband to four younger women. His visitor, a CIA of­ficer, reached into his bag for a small gift. Four blue pills. Viagra.... Compliments of Uncle Sam." American spies had spent decades bribing warlords with weapons, cash and first-world medicine, but guns could rust, run out of bullets or fall into enemy hands. Cash could get too flash­ily blingy. "You give an asset $1,000, he'll buy the shiniest junk he can find, and it will be apparent that he has come into a lot of money from someone," a CIA man told the Post. "Even if he doesn't get killed, he becomes ineffective as an informant because everyone knows where he got it." Better to bribe the warlord with some­thing more private. The aging chieftain in the Post story had four wives, the most allowed by the Koran. He had public and private duties. The CIA's gift, four tabs of Viagra, renewed what one operative called his "authoritative position" in his house­hold. Four days later the chieftain "came up to us, beaming. After that we could do whatever we wanted in his area." A trainer for a Bolivian pro soccer team, reasoning that his strikers could use a blood-uptake boost before playing Peru at high altitude, crushed Viagra tabs and slipped them into the team's fruit drinks. The Bolivians went on a winning streak. A scientist studying jet lag found that Viagra might help cure it—at least in hamsters. He hopes to test humans soon, since they take more international flights than ham­sters. Meanwhile, Chinese zoologists have tried feeding Viagra to captive tigers that have shown no interest in breeding. Thus does the arc of history bend forward, with humans finally giving tiger penises a boost instead of grinding and eating them. In 2010 Michael Douglas raved about his sex life with Catherine Zeta-Jones. "God bless her that she likes older guys," said Douglas. "Some wonderful enhance­ments have happened in the last few years—Viagra, Cialis—that can make us all feel younger." Cialis and Levitra, introduced in 2003, and faster-acting Stendra, which came out three years ago, dented Viagra's market share but not its pop-cultural dominance. In 2012 Chicago Bears wide receiver Brandon Marshall named Viagra the NFL's latest performance enhancer, putting tacklers on notice that low blows might put their eyes out. By then men were consuming more than 45 tons of Viagra every year. The drug had spent more than a decade as one of Google's most-searched terms, with hundreds of millions of searches, thousands upon thousands of raves and still more rips that amounted to raves: "Viagra seems to work too well. After one pill, I instantly become erect, increasing over nine inches in mere seconds. I also receive incredible stamina. Once in a Walmart, my shorts completely snapped, leaving everyone to stare at my massive 20-inch wang." Pfizer's marketers, monitoring the web with an eye toward possible legal action, gave that one a pass. If your critics gripe about aisle-spanning erections, you're ahead of the game. At every turn, the pharma-uro establish­ment dodged the issue of recreational use. This stance made sense for Pfizer, Eli Lilly and the makers of other ED meds. It's eas­ier to popularize a medicine that treats a dysfunction than promote a stimulant that might be abused by horny straight guys as well as gays, porn actors and others who don't fit the graying-golfer image in ED commercials. But why should urologists oppose penile recreation? "I'll tell you why," says Goldstein, one of the field's leading figures. "The whole idea that there are all these normal rec­reational users out there—it's a myth." Pointing out that the penile artery in the pelvis is subject to no end of insults and injuries, from bike seats and punting ac­cidents to YouTube crotch kicks and skate­board wipeouts, he wonders how many guys haven't endured a few ball-busting impacts. "Such a blow can cause a lasting problem—damage that narrows that ar­tery. After that, the erection's not what it used to be, but if you're young, you think it can't be ED because you're only 25. You take a pill, get a better erection and call it recreational. But here's the thing: If you let me study all the so-called recreational users, I'd show you that the vast major­ity have some degree of erectile dysfunc­tion." As for hard-partying men who pop a Viagra or three to offset alcohol and drugs, he says, "Is that recreational? Cocaine, ecstasy, methamphetamine—these drugs impair erectile function. That's not recre­ational; it's repairing self-inflicted ED." Urologist Sharlip has another concern. "Many so-called recreational users buy generic Viagra online. They may not know what they're getting. It could be fake, it could be contaminated. It could hurt you." While mentioning a Viagra virtue that sounds recreational—the drug can cut a man's refractory period in half, allow­ing him to get it up again in 10 minutes instead of the typical 20—Sharlip insists that online "Viagra" may be hazardous to your health. "You may want to be a sexual superman. You may want to save a little money while you're at it. But do you know what you're getting? Is it really Viagra? Is it dangerous? Who knows?" Matt Bassiur knows. A former federal prosecutor and ex-security chief for Apple, he now chases Viagra counterfeit­ers for Pfizer. Phony Viagra is a booming business, a worldwide multibillion-dollar industry backed by the yakuza in Japan, Mexican narcoterrorists, the Russian mob, what's left of the American Mafia and other opportunistic crooks in ev­ery corner of the world. "Some websites selling Viagra don't sell anything. They just take your info and steal your iden­tity," Bassiur says. "Some sell gray-market product that's near its expiration date, or past it. Others sell counterfeit Viagra laced with stuff you wouldn't believe." Four years ago Bassiur and his team set up a sting operation. They bought so-called Viagra from 22 online pharmacies, then tested the pills that came in the mail. "Eighty percent of them weren't Viagra," he says. "Some contained rat poison. Some contained antibiotics. We also found anti­freeze, road paint and printer ink—blue ink, of course." He has a gallery of scary photos: pictures of rat- and bug-infested third-world hellholes. "Would you take a pill that came from that filth?" he asks. According to Bassiur, anyone who does is playing Russian roulette with his penis. Even so, there are very few verified deaths due to counterfeit Viagra. There were several in Singapore in 2008, when bogus blue pills sickened hundreds of men, put dozens in comas and killed four, but that's it. Not a bad record for a chemi­cal that has been used, overused, begged, borrowed, stolen, passed around at par­ties and combined with every other drug you can name for 16 years and counting. Which doesn't mean the wrong kind of Viagra can't hurt or even kill a man. Take herbal supplements, for example. No, don't—the "male enhancement" tab­lets sold online or in convenience stores oc­casionally work like the real thing because they are the real thing. "But those products are totally unregulated," says Bassiur. "Yes, some of them work. They work because they contain the same sildenafil citrate you get in Viagra. But you have no idea what you're taking. You might not get enough sildenafil or too much." Too much can be lethal for men with low blood pressure or other risk factors—men whose doctors would never prescribe Viagra for them. Medical sleuths agree with Gallaway: It's possible hundreds if not thousands of men have died with healthy hard-ons they got from off-label or unlabeled sildenafil. To foil the makers of fake or danger­ous knockoffs, the National Association of Boards of Pharmacy came up with a seal of approval for legitimate online phar­macies: the VIPPS (Verified Internet Pharmacy Practice Sites) seal. Counter­feiters promptly forged the seal. Today, the best way to make sure you're getting the true blue pill is to buy directly from Pfizer at Viagra.com, a new joint venture with CVS pharmacies. Direct online sales are one way Pfizer hopes to bolster prof­its before its patent on Viagra expires in 2020. When Pfizer's patent on the cho­lesterol drug Lipitor, once the top-selling medicine in the world, expired in 2011, Lipitor sales fell from $5 billion one year to $932,000 the next. To avoid another tumble, Pfizer struck a deal with Teva Pharmaceuticals, an Israeli company that will pay royalties to Pfizer to make a generic Viagra. Pfizer also sells a version of Viagra in Mexico: a chewable tab. Can Gummi Viagra be far behind? "What's next?" asks Gallaway. "Penises want to know." Each generation tends to think its inven­tions are the last word in invention, but the road to the future is littered with Edsels, typewriters, VCRs and dried-up bits of jerky that turn out, on close inspection, to be tiger penises. Seventeen years ago Viagra was the atom bomb of sexual heal­ing, a blue diamond so potent and profit­able it made the Hope diamond look like a charcoal briquette. Gummi Viagra may be next, but it probably won't be the last penis helper of the early 21st century. Gallaway, for one, expects to see a pill that can give a man a more lasting relationship than the ones he's had with the blue pill, the Cialis "weekender" or any combination of the drugs on offer today. "For one thing, drugs get expensive. With Viagra, we're talking about a $30 erection," he says. "If you're on a tradi­tional date or just dealing with human fe­male moods, you can't afford to waste it. You're telling her, 'No, honey, we have to do it now. I'm invested here!'" Now in his 40s, the former Viagra fiend is looking for a longer-lasting chemical romance. "I'm looking for a cheaper, controlled-release sort of product—you take one every day and you're covered." Sharlip agrees. "We may see a lon­ger duration. One pill a week and you might be ready for a spontaneous sexual opportunity." Urologist Goldstein takes a still longer view. "We're just scratching the surface" of erectile liftoff, he says. "Thirty-two years ago, when Brindley dropped his pants in Las Vegas, we were still guessing about how erections happen. Now, 16 years into the Viagra era, the future is growing expo­nentially." Goldstein, the field's most origi­nal thinker since Brindley, has been work­ing on a topical sildenafil: You and/or your partner rub it on your penis, and boom, you get a bamming boner without muscle aches or the strange blue-tinted vision that afflicts some Viagra users. Goldstein has also pioneered a treatment known as the tissue genesis cell isolation system, which combines liposuction and erectile injec­tion. He takes fat cells from a patient, iso­lates stem cells and shoots them into the patient's penis. "It's pretty cool," he says. "If it works, it could be more than the latest treatment for ED. It could be a cure." Not satisfied with treating and possibly curing ED, Goldstein recently tried a novel Nip/Tuck approach to premature ejacula­tion. "Botox," he says. 'Just as Botox dead­ens the muscles that cause facial wrinkles, it can relax the ejaculatory muscle," he says. The ejaculatory muscle is a quarter-inch strip of meat between the scrotum and the anus. It spasms when you climax. Men who climax too soon sometimes shoot their loads half a minute into foreplay. An injec­tion of Botox in the ejaculatory muscle can help them last longer. All Goldstein has to do is find out how to deliver the drug with­out sneaking into his patients' bedrooms while they're having sex. "Timed-release Botox? That might be next." Unless next is the long-sought "female Viagra," the consummation of an era of sex research that began with Freud, stum­bled toward modernity with Masters and Johnson, the pill and the sexual revolu­tion of the 1960s, and found chemical fruition with Viagra. "But Viagra isn't the last word," Goldstein says. "Did you know that the FDA has now approved 26 drugs for male sexual dysfunction and zero for female sexual dysfunction? Why is that? I think it's gender bias. Billions of dol­lars have been spent on drugs that might help women who lack desire, aren't orgas­mic or can't have sex without pain, but the FDA turns them down. It approved a medication for Peyronie's disease, which causes scarring and curvature of the penis. That drug carries a risk of penile fracture that requires emergency surgery. But the FDA called that an acceptable risk and approved it." According to Goldstein, the future of sexual medicine features less sexual bias. And more sex. "It takes two to have sex," he says. "Female sexuality is the next frontier." (See So Where's the Little Pink Pill?, page 48.) In 10 years, men enjoying a weeklong or monthlong dose of next-generation Viagra may meet women tak­ing the first effective female aphrodisiac, with results that could spell trouble for the ceiling-fan industry. "Sexually, the future looks better than ever," he says. "And it all began at the Las Vegas Hilton, where Brindley proved that muscle relaxants were the answer, in the boldest possible way. Monday, April 18, 1983—that's the moment that started the real sexual revolution."