Viagra and Contraception Viewed Inside and Outside the Dominant Paradigm

Hmmm...I'm not so sure that the critique is about who "benefits," (because clearly they do each benefit both if the relationship is heterosexual) but rather in what ways each person benefits; in other words, the issue is about the ability to be sexual, and in terms of insurance coverage, women's sexual freedom is more expensive than men's and men's sexual prowess is more authorized (valued?) than women's ability to have sex without worry of pregnancy. Men's inherent right to fuck and thee investment of masculinity in erections is supported, while women have to "pay" for their liberated sexuality up the nose.

[Hi Lindabeth. I agree that's the way it's presented to us (and echoed back from us) now. I'm just questioning *why* that's the framing. I mean... yes, of course you're absolutely right -- after all the first magazine ad I saw for Viagra showed a robust looking older man sort of half dancing, half dragging his smiling partner behind him through a field. And June Carter Cash had a huge hit in the early 1960s called, I think, "The Pill" that went on about how she too could now go paint the town red like her philandering husband did. So I totally agree that the *framing* is totally gendered. I'm just saying why not call bullshit on that? *If* you're heterosexual *and* you enjoy intercourse then an erection comes in handy. *If* you're heterosexual *and* you enjoy intercourse then contraception comes in handy as well. Handy enough in both instances, as far as I'm concerned, that when they're needed there either can or should be no intercourse without them. You'll notice that the partners of prostate-cancer survivors (of whom there are pushing a million) don't see Viagra in terms of male prowess. And do you *really* want to see birth control perpetuated as an issue only for women? And finally, what I'm saying is that *if* the issues are reframed as *couples* issues, as issue of equal relevance (or, for prudes, equal irrelevance) to *both* sexes, then that undercuts the nominally institutional basis for gendered treatment of medications. Because depending, especially, on age and health they're *both* important to those who appreciate intercourse. So, again, I'm agreeing with you that it's as you describe, I'm just disagreeing with you that it *should* be as you describe. Know what I mean? Thanks. --fl]

Lindabeth, I get the point that the framing of this issue reflects frustrations with women not traditionally having been allowed sexual freedom, and I agree that insurers bank on this tradition when they define contraceptive coverage as optional.

But there's a huge false dichotomy at work here. Partners of men with ED do suffer, and this is not just about "prowess," it's about the ability to have *any* sort of penetrative sex. That's only irrelevant to the female partner if she never liked to fuck in the first place. It's also a *huge* problem for many gay men who've undergone surgery prostate cancer, because an erection that's barely adequate for vaginal intercourse won't be firm enough for anal penetration.

While most private insurance plans cover some amount of ED drugs, their allowances are stingy. Fairly typical is six tablets per month. Patients recovering from a prostatectomy are supposed to take Viagra *daily* (or Cialis three times a week) in order to bring blood into the penis and prevent permanent fibrosis from occurring; this is not necessarily for fun. Do the math, and you see why many prostate cancer patients end up illegally ordering Viagra from a source in India. I believe they can get it for a dollar a pill - a mere fraction of what it costs in the U.S. Even if 2/3 of the shipments get confiscated at the border, they still come out way ahead.

This false dichotomy is a distraction. It keeps people from asking why the heck these medications are so much more expensive in the U.S. than anywhere else in the world. It pits men and women against each other. It keeps us from questioning the anti-sex attitude that shapes policy on both ED treatments and women's reproductive health care.

An old tourism motto for Michigan was "Yes, Michigan! The feeling's forever!" Now, when you have sex there, you'll probably have a reminder forever! Good job, home state! Ugh.

[It may help your hometown pride to know it's not just Michigan, the same crap price support differences show up all over. Thanks, TWG. --fl]

Drugs are bad, emck?

Your points are valid and if I had more time I could give this a proper reply but I really needed to leave a comment. Birth control costs me $48.50 a month, with insurance.

Now, if Viagra is "free" on an insurance plan or like the cost of antidepressants were on my old plan, a $300 med was only $20.

There must be some compromise especially since most people getting the Viagra are older, make more money and are likely not using it to have children.

Whereas those that are using birth control are likely younger, make less money and have not yet contributed to the gene pool.

So, maybe ....well, more on this later. I must think.

[The theoretical (and, by the way, unjustified) justification insurers use is that fertility isn't a medical condition but failure to have erections is. Technically that's correct and they evidently point to non-gendered examples of the same coverage distinctions. But... yeah, older people -- older *couples* -- tend to have more money, social standing, influence, *and* erectile dysfunction between them whereas younger people, single but *especially* couples, need contraception but get short shifted. And of course what's really irksome is that it's not like hormonal contraceptives are too new to have generic alternatives, nor is it like cost-of-goods is anything like two to three dollars a flipping pill... including the seven placeholders! But I'll just reiterate that *both* should be covered in equal measure, not just one, not just the other, and because they're important to responsible partners of *both* genders. Thanks, Demure. --fl]

I do get what you're saying...I stated that I agree with you that partners of those with ED suffer some too, and I think it's clarification that needs to be made by those making an argument out of their comparison. I don't think that those making the comparison intended to suggest that Viagara only benefits the user.

Coming from a hetero POV, don't forget that while many women enjoy penetration, many also physically don't (women who report not physically enjoying penetration often report enjoying the emotional aspect of it), and most women do not orgasm from penile penetration either. Also, the idea that gay men primarily have sex anally is also a wrong assumption. We very much have a cultural assumption that the penis is absolutely necessary for pleasing one's partner sexually, and to suggest otherwise (as I'm doing) typically amount to heresy. Indeed much of patriarchal masculinity is tied up in men's virility.

With all that said, Viagara is primarily for the purpose of men's sexual pleasure, even if partners would also benefit from it. I have no problems with insurance coverage of Viagara...rather, it's the huge gap between the way that Viagara and contraceptives are covered by insurance plans, as if male sexuality on demand is some sort of human right but women protecting themselves from unplanned pregnancies is not. Both drugs do benefit the partners, but they primarily benefit the user's ability to be freely sexual.

Thank you, lindabeth. Your last paragraph says exactly what I feel, and was too annoyed to state succinctly.

So yeah, what you said.

I actually think it's a male-centric assumption to believe that "partners of those with ED suffer some too." That's an understatement belied by people's experiences. Having listened to statements from a wide variety of people - male and female, gay and straight - who are dealing with ED in relationships, I think it's important to acknowledge that there are many *female* partners who are at least as troubled as their male partners, and perhaps more so. (Dealing with severe ED outside of a relationship presents different problems, which go beyond the issues figleaf raised, and I won’t address them here.)

It's true that many (most!) women don't come from PIV intercourse alone, or at least not reliably. But should orgasm really be the only measure? As you say, Lindabeth, quite a few women enjoy sex without orgasm - and of these, many enjoy not just the emotional but also the physical aspects of intercourse, even if they rarely or never climax from penetration alone. Let’s not leave them out of the discussion.

And no, I didn't assume that all women enjoy conventional PIV intercourse. I said that for those who enjoy fucking, it's a real loss not to be able to do it - or to have to go outside a long-term relationship for it. And frankly, polyamory is *not* something you can consensually negotiate when your partner has ED. So if you're a woman in a long-term monogamous relationship, you're faced with the choice of either doing without intercourse - and all too often, without *any* physical affection, as many men get depressed and discouraged and don't even want to *kiss* if they're suffering from major ED - or you can *cheat* on a partner who may be dealing with a serious chronic or life-threatening illness. This is not about virility. This is about intimacy and connection and trust and pleasure – for both partners - and keeping open the widest possible spectrum for expressing all of those things.

As for gay men - I am absolutely *not* assuming that anal sex is the be-all and end-all of gay sexuality. But if you listen to what gay men say, it's a major loss for many of them if they can’t even consider penetrative sex. This is an issue that's been sorely neglected by medical science. Gay men's issues with ED and particularly with the aftermath of prostate cancer treatment are vastly under-researched and poorly understood by urologists and oncologists. And yes, of course those gay men who previously enjoyed anal intercourse can still express themselves sexually in other ways, just as hetero partners can. People can be amazingly creative. But that doesn’t much mitigate the loss.

There's a painfully informative thread in the New York Times from last winter. It's worth reading. And it makes clear that I'm not just parroting masculinist assumptions, I’m arguing explicitly as a feminist. I don't think it's possible to understand how health care is gendered unless we attend to the experiences of real people, men and women alike. (The NYT article is not my only source on this, just the best publicly available one.)

I'm not in any way arguing that contraceptives should not be covered by insurance - of course they should! I'm just very leery of making this all about the Patriarchy when the situation is much more complex. And I think it’s politically short-sighted to pit men’s and women’s ostensible sexual needs against each other when, in fact, they much more often converge (assuming again a hetero context), and when too many policymakers would be happy to abolish insurance coverage for any and all treatments that enhance people’s sexuality.

BTW Sungold, it was actually you who stated "Partners of men with ED do suffer".

Those aren't really the terms I'd care to think of this scenario either, but I was trying to respond to your point and thus used your (simplistic) terms.

And I don't disagree with any of your points about sexual experience...your arguments just seemed to echo the cultural sentiments that considers penetration to be all that actually matters, and all other acts to be merely secondary.

And I think it’s politically short-sighted to pit men’s and women’s ostensible sexual needs against each other

This is what I was really getting at above: that your statement is not what's happening here with the feminist critique. No one's pitting one against the other. What's happening is that the one is covered and the other is not. We're not trying to say one's more important than the other or that both can't be covered insurance-wise. And they're different drugs: one is for sexual satisfaction and one is simply for the right to seek out sexual satisfaction.

So tell me, what does "enhancing sexuality" mean--of what value is it-- when women cannot afford to control their fertility, thereby not being free to be sexual in a penetrative way? To be crass, what good is his free boner then?

Lindabeth, we're totally on the same page when it comes to the need to cover all forms of birth control. In a fantasy world, I'd actually like to see it exempted from co-pays - which was amazingly the case with the insurance plan I had with my first job after college. I'm not sure what the rationale was for that, but I'm guessing a cost-benefit analysis - that is, the insurer realized that covering birth control was cheaper than covering a newly-born dependent! (It’s disheartening how much more weight such considerations carry compared to arguments that emphasize equity and the radical notion that health care ought to actually promote health.)

My beef was with the phrasing "partners ... suffer *some* too" - which seems to play down the issue as minor and secondary. Most partners (male or female) of prostate cancer patients would strongly dispute this. Most emphatically regard the ED resulting from treatment as a problem that affects both partners quite equally, and which puts massive stress on *relationships*.

I don't think anyone who regularly reads figleaf's blog would say that penetration is the only "real" sex; we all have better imaginations than that, I'm sure. :-) My point – which may be simple, but I don’t think simplistic – is that if the option of penetrative sex is taken entirely, permanently off the menu, many female partners feel this as a painful loss, no matter how inventive their partners may become.

I don't accuse *you* of pitting women’s and men’s needs against one another, but in a culture that's highly ambivalent about sexuality, that's where this frame too quickly leads. I don't think my critique of this frame is simplistic, either; it's one that acknowledges the real political context. And that context is one where *adequate* coverage for ED drugs is also rare and highly contested – a problem that this framing obscures.

A similar framing problem has emerged (with the genders reversed) in efforts to increase funding for prostate cancer. Too often, advocates frame this isue in terms of "Why is breast cancer so better funded?" instead of realizing that BCa funding is the result of women's hard work and tireless lobbying. And that gets in the way of forging alliances. I blogged about this a few weeks ago, so I'm not going to rehash it all here. But the point is, finding common interests - as figleaf argues in his points - makes you politically much stronger.

Interestingly, no one has responded to his question to male partners - but speaking for my past and present partners, there's no question: they enjoyed sex most when we both felt confident it wouldn't result in an unplanned pregnancy. We really should be able to enlist *most* men as allies when it comes to affordable contraception.

Adequate health care for both genders (including sexual health) is a basic feminist principle, to my mind, and I do think we're all agreed on that.