"I’ve got one client who’s so thrilled with Viagra, Pfizer ought to hire the guy. Not that they need to hire anyone," chuckles Oakland, California psychologist Bernie Zilbergeld. "He’s raving about how natural his erections feel, how terrific his sex life is. He still feels the effect the next morning, so he gets two hits for the price of one."

"But this man’s wife is singing a different tune," Zilbergeld adds. "She wants to know why he can’t get aroused just by touching her. She wants to know if her husband is turned by her or by a chemical. She wants to know what was causing this problem in the first place. He’s ecstatic. She has serious reservations. This is a dynamic I expect to see a lot of with this drug."

Ambivalent wives–and ten-dollar-per-pill price tag–notwithstanding, since its launch in early April Viagra, which acts on an enzyme prevalent in the penis to boost blood flow, has become the most successful prescription-drug introduction in history. Although it was intended for use by men with impotence caused by physiological conditions like high blood pressure, diabetes, and multiple sclerosis, Viagra is quickly becoming the drug of choice for a much wider range of men–and women. With up to 30 million American men suffering from erectile dysfunction and baby boomers turning 50 at a rate of 5,000 a day, sales of Viagra are now projected at $600 million to $1 billion in its first year. By the first week in May doctors were writing 215,000 prescriptions a week.

The frenzy of attention and debate that Viagra’s launch has sparked in the media and in the population at large has been mirrored in therapist’s offices from coast to coast. While clients clamor for prescriptions, therapists ponder the efficacy, the meaning, and the consequences of dispensing an ‘erection pill.’

"Viagra will be a godsend to millions and millions of couples. It will have the biggest impact on relationships since the birth control pill," says Evergreen, Colorado certified sex therapist David Schnarch. "Unlike the treatments of the past–penile injections, implants, the pump–which could give a man an erection regardless of how he felt about himself or his partner, Viagra requires ‘effective stimulation.’ The good news about that is, it challenges the couple, and the therapist, to do the relationship work that’s necessary for emotional, as well as physical contact.

"But there’s also going to be fallout because of what the drug won’t do," Schnarch says. "Viagra doesn’t make sexual desire bloom in a desert of alienation. In the same way that the power balance in a relationship can be upset when a woman becomes orgasmic or more erotic, a man’s new erection can destabilize the status quo. We know that women experience low desire when their partners expect sex on demand. Who’s to say this won’t happen to men when their wives start insisting that they take their Viagra?"

Pepper Schwartz, former president of the Society for the Scientific Study of Sexuality and University of Washington sociology professor, agrees that "Viagra might be a good drug for a man who’s gotten into a negative reinforcement schedule: I’ve failed, failed failed. He needs a few successes." But she also worries about the consequences of its use. "What Viagra will do is stop therapists from doing prolonged psychological work with patients whose reality is physiological. But we’re seeing liberal use of the drug by doctors who like to give their patients a magic pill without being concerned with side effects. The FDA trials show at high doses this medication can cause retinal dysfunction. We don’t know everything we need to know yet."

Although Pfizer has just started early trials of Viagra on 500 women in England, Schwartz says, "I’ve also run into doctors who are prescribing the drug for their patient’s wives, although the FDA hasn’t tested it for women. I was on a TV show recently with a doctor who told me, "I know it brings more blood into the area, so it’s bound to increase desire in older women." Besides risking women’s health, these doctors are confusing capacity with desire. If you have a wife who doesn’t want to make love with her husband, you don’t just give her a pill. You don’t artificially create desire."

Mill Valley, California sex therapist Lonnie Barbach cautions that ‘artificially creating desire’ can damage not only the relationship but the individuals in it. "I have great concern about using a pill to override an intuition that’s telling a person in an unhealthy relationship ‘You shouldn’t be here’," she says. "A man I’m working with is in a marriage that’s undermining who he is. This man is very out of touch with his feelings, so he doesn’t yet fully understand this. But his penis does. His erectile dysfunction is the main signal he’s getting. And it’s an accurate one. In another couple, the man has Viagra in hand but he hasn’t started taking it yet. The wife isn’t interested. To her, his erection problems are the tip of the iceberg. He’s violent. They have very little communication. If they don’t like each other, sex doesn’t make sense."

Many media reports have speculated that sex therapists might be replaced by this ten-dollar instant ‘cure.’ Are they worried? "On the contrary," says David Schnarch. "Viagra will probably send some therapist’s kids to college. Once the drug eliminates the physical explanation for their problems, couples are going to have to look in the next place: within themselves. I hope this will stimulate the evolution of our field–that therapists who know relatively little about the emotional dynamics of sex will seek training in the notion of using sex to grow, instead of seeing it as a collection of techniques and behaviors. Viagra will call upon therapists to help clients explore their sexual potential, rather than just ameliorating dysfunction."

"A lot of therapists are worried they’ll lose half their business," says Bernie Zilbergeld. "Maybe foolishly, I’m not worried. Although we are a pill-popping culture, most people see taking pills as temporary. They don’t want to be on Zoloft for the rest of their lives, and they don’t want to take a pill every time they want to have sex.

"Viagra will definitely tilt the balance more toward the physical solution. But I’m not worried about becoming obsolete. A lot of people are going to find out in short order that it was more than an erection that was missing. Then they’ll call me."

Zilbergeld sees a positive side-effect of Viagra–an effect he calls "revolutionary." "Thanks to Viagra and Bill Clinton and Monica," Zilbergeld says, "suddenly everyone’s talking about sex. There’s nothing you can’t say on TV anymore. Jay Leno’s talking about erections and impotence every night. On the evening news Peter Jennings said, "‘This is the first time I’ve said ‘oral sex’ on TV." Viagra has opened up our culture’s discussion of sex in a way that even the ‘Make Love Not War’ sixties didn’t.

"A lot of people think Viagra is going to put their marriages back together," Zilbergeld concludes. "Those people are going to be very disappointed. What this drug can do, at best, is give a man an erection. It’s not an aphrodisiac. It won’t make him a better lover. It won’t fix a relationship. That’s where therapy comes in."