From Dr. Jane's Notebook


Days of Wine and Roses. . . and Viagra, In Depth.


For many decades, Marriage Researchers have searched for a better understanding of marital relationships. Researchers have battled against time in recent years, while the divorce rates soared. As a result, many families now suffer the fall-out from divorce and have learned the hard way that when kids are involved, divorce is only the end of the marriage. It does not end the family relationships; it does not end family responsibilities.

Long-term result: Research shows that children from divorced families are more likely to consider divorce as a solution to their own marital problems. Sadly, the divorce solution has wreaked havoc with people’s lives in too many cases, and replaced "family loyalty" with "family civil war" and a host of emotional problems. So, while divorce is sometimes the healthier solution, it is generally an unhealthy experience.

As we search for ways to help couples maintain their happiness and prevent divorce, the latest chemical miracle drug, VIAGRA, makes its entrance into the marriage arena raising certain questions: Will a better sex life make couples happier? Is a satisfying sex life a key to marital satisfaction? If VIAGRA improves the sex life of the couple, can it save a marriage? Well, that depends on the answers to the following questions.

1. Why is sex so important? When couples marry, they are making a commitment to make love with each other. Marriage is a relationship where sex is both legally sanctioned and encouraged. Beyond the function of procreation, the act of making love is a bonding exercise between mates which reaffirms their commitment to the relationship, and reduces the threat of interference by outsiders. Research confirms that couples who remain sexually active report higher levels of marital satisfaction.

Case Study #1. Joe and Nan were both in second marriages when they called to request marital counseling. Joe’s first marriage lasted 17 years and ended in great bitterness. He and his first wife had not engaged in sexual relations for the latter 10 years of their marriage. Nan left her first marriage after a series of fights over her husband’s infidelity. She entered her second marriage still filled with anger from the first, but confident that a man like Joe, who could go 10 years without sex, was a safe choice for a husband. She didn’t realize that sex itself, was enough to rekindle her anger.

Joe and Nan agreed to abstain from sex for the first few months of their marriage, but sought my help when they found themselves at a stalemate. Nan still didn’t want to have sexual relations, and Joe’s confidence in his own sexual prowess was diminishing by the day. A few unsuccessful tries caused the couple interpersonal stress, and Joe was soon caught in a cycle of self-consciousness and erectile dysfunction.

This couple was informed that after a course of marital therapy, which included resolution of anger from their previous marriages, they would essentially have to start over again in their attempt to achieve sexual intimacy. To regain his sexual confidence, Joe’s physician prescribed VIAGRA as an adjunct to our therapy.

2. Are we over-estimating the importance of sexual problems?. No! Marriages without sexual satisfaction often lack intimacy and a sense of completeness. Without a satisfying sex life, spouses are more prone to blame each other, argue, compete, and consider whether they might be better loved and appreciated by someone else. In order to feel their best, men and women must feel confident in their sexuality and natural ability to be a loving sexual partner.

Case Study #2. Paul and Marie were about to end their marriage because neither could tolerate the frustration they faced. For some time, Paul had been depressed. Depression ran in his family of origin, so like other members of his family, Paul was placed on a selective seratonin re-update inhibitor (SSRI) anti-depressant medication. As his depression lifted, Paul’s interest in life and interest in sex slowly returned. However, while the anti-depressant reduced his depression, it also reduced his ability to achieve orgasm during sex.

At first, Paul noticed some difficulty in achieving sufficient arousal for orgasm. Over time, frustration made the problem worse, and he developed erectile dysfunction. That’s when Marie became upset, fearing that her husband was no longer sufficiently attracted to her. This couple was soon caught in a vicious cycle which moved them further and further apart in the bedroom.

3. Why are sexual problems so difficult to fix? In marriage, there are individual problems and there are relationship problems. While sexual problems may appear to be individual problems, they are not. Since marital sexuality is a process which takes place between two people, it can only be corrected through the combined effort of both people.

A change in one’s sexual functioning may be a symptom of disease (such as, diabetes), a side effect of certain medicines (such as, anti-depressants), unresolved relationship problems, or normal changes associated with the aging. While relationship problems must be resolved directly, a doctor’s prescription of Viagra has allowed many men to regain confidence in their sexual functioning, which in turn, has rejuvenated flames of passion in their marriages.

Case Study #3. Bill and Debbie had enjoyed a very satisfying sex life for several years prior to Bill’s diagnosis of multiple sclerosis. In addition to this physical strength and vitality, MS soon robbed Bill of his sexual desire. During the initial phases of his illness, Bill had become very worried about his health, and also very sensitive to physical touch. As is true of many illnesses, the diagnostic procedures alone can leave you feeling like a pin cushion.

In the effort to cope with physical pain, Bill was unconsciously avoiding as many physical sensations as possible. Without realizing it, Bill was also avoiding the physical sensations associated with touch and sex. In response, Debbie’s sympathy for Bill’s discomforts was soon replaced by her own pain from loss of their love life.

What started off as a health problem for Bill, soon evolved into a relationship problem for both. As a result, treatment was also needed to mend the recent scars added to their sexual relationship. Through therapy, Bill learned to minimize his physical pain and was given VIAGRA to jump-start his sexual response system. P.S. It worked!

4. What does Viagra do? Pfizer Labs, the company which developed VIAGRA describes the chemical action of VIAGRA, whose generic name is sildenafil citrate, as follows. During sexual stimulation, the naturally-occuring substance, nitric oxide is released into the corpus cavernosum ("the inner-tubes") of the penis. Erection occurs which when the penis becomes filled with or engorged with blood. Nitric oxide (NO) is vitally important for achieving and maintaining a state of erection.

The main effect of VIAGRA is to enhance the effects of nitric oxide, while inhibiting the chemical substances which will later serve to reverse the process of erection after orgasm. Contrary to popular belief, in the absence of sexual stimulation, VIAGRA has no physical effect. As such, when men report feeling "17 years old again", we know that VIAGRA alone is not responsible for this miracle. In order for sex to really improve, a man needs a willing partner who will join him in the love-making experience with enthusiasm and pleasure.

Sex expert, Virginia John Masters, recently described sex as a mind/body/spirit experience, saying "Never presume that sex is only physical. Recognize your partner’s need to be needed spiritually and emotionally." She adds, "Keeping sex exciting requires that each partner feels the other is truly involved. Don’t think ‘sex’ but rather sexual intimacy" (Parade Magazine, March 1998).

Case Study #4. Lee and Barbara had always found it extremely difficult to discuss sex. Like so many other couples, remnants of shame and embarrassment had followed them from childhood into marriage, making it difficult to discuss their sexual needs. When Lee began to develop erectile difficulties, Barbara thought it was best to remain silent.

Over time, both Lee and Barbara began to avoid sexual encounters with one another in the effort to prevent further embarrassment about their sexual functioning. However, their ‘politeness’ soon back-fired, as each began to feel emotionally abandoned and sexually rejected. Over time, Lee and Barbara began to grow apart because of their misguided assumptions and feelings of sexual rejection. Faulty guess work like this almost broke up their marriage.

5. VIAGRA requires a new communication protocol. Couples who have tried VIAGRA report that it not only improves sexual functioning, it also improves communication because it forces them to talk about sex. Since VIAGRA should be taken in advance of sexual activity, a wise husband (before taking VIAGRA) might ask his wife if this is good night (or day) to take VIAGRA. If communicated romantically, this is a little like being asked out on a date. If they agree, both are making a commitment to having a sexual rendezvous in a little while. In the course of discussing it, the verbal foreplay has already begun.

Case study #5. Ken and Louise decided to try VIAGRA in the effort to combat the effects of Ken’s diabetes. While both were delighted with the results initially, they soon began to panic over the increased number of arguments which took place between them. The sudden resurgence of sexual activity between them was accompanied by a number of unexpressed concerns.

In his enthusiasm at reclaiming his former prowess, Ken began making sexual overtures on a continuous basis. Apparently, underlying Ken’s enthusiasm was a fair amount of guilt over his waning erections in recent years, and his fear that Louise might leave him. On the contrary, Louise had learned to cope with their changing sexual relationship by making sex a less important factor in her life. When Ken discovered VIAGRA, Louise was overwhelmed by this turn of events. In response to these changes, both needed to discuss their renewed sex life and decide together how to reintegrate sexual intercourse into their lifestyle and relationship.

Sex Therapist, Dr. Barbara DeAngelis reminds men that women love to be seduced, women get turned on in their heads first, women don’t like to be rushed, and women need to feel emotionally secure in order to become fully aroused. The moral of this story: Even the man who feels he is making up for lost time, must be sensitive to the needs and feelings of his partner.

6. But what about spontaniety? In the past, one argument against using condoms for safer-sex and birth control, has been the argument in favor of total spontaneity. However, while spontaneity includes the element of surprise, we also live in the enlightened age of avoiding mistakes!

Gone are the days when couples stay together in unhappy marriages. Gone are the days when sexual satisfaction is for men only. Gone are the days when we can rely on spontaneity and expect the other person to keep sex exciting. Some events lend themselves very well to planning.

As an amateur photographer, I have often had my film developed and been disappointed to find out that those great candid shots I took turned out to be duds. Apparently, my still-life camera is better designed for still-shots. So, at family gatherings, I am the one who makes people line up, stand together, or pose. At first, they grumble and moan, and blame me for interrupting the spontaneity of the occasion. For this, I am guilty as charged.

By asking people to look at the camera, I am asking for their consent and participation. It is important that they agree to be in the photo. In return, before I take the picture, I give "my subjects" the time they may want to comb their hair or otherwise get ready to have their picture taken. As a result, the photos come out clear, people look their best in the photos, and their requests for copies suggest they are likely to cooperate again in the future.

Like I said, some events are even better when they’re planned!

A few ways that VIAGRA can change your sex life:

1. For men, few events are as frustrating as a penis that won’t respond. When effective, VIAGRA restores natural functioning and self-confidence.

2. For women, few events are as frustrating as a penis that won’t respond. When effective, VIAGRA restores natural functioning and self-confidence.

3. Both men and women enjoy a sense of sexual prowess. The completion of a "successful" sexual encounter allows both partners to feel like winners.

4. Couples grow closer when they are able to solve problems together. VIAGRA may offer an important step toward the solution of a sexual problem.

5. By addressing their sexual problem together, couples are acting in the best interest of their relationship and demonstrating to each other that they care!

6. Sex is like a bridge between spouses, which allows them to achieve an ultimate state of closeness. When attempting to fix a broken bridge, VIAGRA may offer a vital ingredient in the repair.

7. By addressing sexual issues early, fewer compounding problems are likely to develop. As the old adage goes, "a stitch in time saves nine".

8. A healthy sexual relationship provides insurance for a marriage. While insurance does not prevent problems from occurring, it does help with the recovery.

9. While not all problems can be fixed with a pill, some can! When effective, VIAGRA can restore and support normal sexual functioning.

10. When spouses support each other through difficult times, they achieve greater levels of intimacy. Overcoming their problems brings them even closer together!

ęCopyright, 1998, 1999, Jane R. Rosen-Grandon. All rights reserved.

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Last Updated February 27, 1999 by Gary M. Grandon, Ph.D.