Hieronymous Bosch

In March 1998 when Viagra was first approved, Maryland anesthesiologist Ken Haslam '56 was 64, single, and dating. "I was meeting lots of women. It was exciting. And for me, new relationships lead to great sex. I heard about Viagra, of course." But with all the novelty and adventure in his romantic life, he really didn't need any help.

A few years later, however, Haslam became concerned when sexual thoughts no longer were enough to cause physical arousal. Tumescence took vigorous manual or oral stimulation, and even minor distractions had a wilting effect. As a doctor, he recognized mild erectile dysfunction (ED), normal for men over 60, but still annoying. "So I tried Viagra, 50 mg. It worked. It worked well."

Today, at 75, Haslam still leads an active sex life, and he still uses Viagra—but for only about 10 percent of his lovemaking. "There's more to sex than an erection," he explains. "Erection is not the goal, shared intimacy is—a close, loving relationship. I've had wonderful sex and great orgasms without an erection. Occasionally it's fun to use Viagra. But most of the time, I don't even think about it."

Haslam's reaction is not what the experts predicted a decade ago when Viagra's launch became the most successful of any new drug in pharmaceutical history. Pundits proclaimed that older men would embrace the little blue pill enthusiastically as an indispensable part of lovemaking. Analysts forecasted sales of $4.5 billion a year or more as the male population aged, and as couples were continually reminded about the medications by advertising wars among what eventually became the three brands—Viagra, Levitra, and Cialis (the last two approved in 2003). Social commentators even coined a new word, "viagravation," to describe the distress women felt when partners using Viagra pressed for more frequent sex, or when men with revived equipment and confidence suddenly became interested in philandering.

However, through 2005, annual sales of the drugs reached only about half of the predictions, just $2.5 billion. That's still a great deal of money, but older men did not flock to the drugs in anywhere near the numbers anticipated by the experts. During the first month after Viagra's approval, U.S. doctors wrote more than 300,000 prescriptions. But seven months later, fewer than 100,000 of those men had obtained refills.

According to Pfizer, maker of Viagra, as many as half of men over 40 experience some ED, but only about 15 percent of them have even tried erection drugs, let alone become regular users. Recent research makes the Pfizer estimate look optimistic. In 2007, German researchers surveyed 3,124 older men. Forty percent of them had some form of ED. Of that group, 96 percent could name an erection drug, but only 9 percent had used one. And last year, researchers at Cornell's medical school published a survey of 6,291 men in 27 countries—48 percent of whom reported some ED. How many had tried medication? A mere 7 percent.

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