Question of the Week #5

Does Viagra improve relationships?

Psychologists have long taken comfort in believing that unhappiness in relationships is one of the few problems they face that is unlikely to be fixed by the simple act of taking a pill. Sildenafil citrate, better known as Viagra, might claim some of this turf, however, at least for those couples who are unhappy in their relationship because of erectile dysfunction (ED).

Viagra was not developed to improve relationships, of course, but from the research I have read it does what it does – improve male sexual functioning – very reliably and consistently. Partners of men taking Viagra also report improved sexual satisfaction. Score this as one real advance for medical science!

The randomized experiments used to examine the effects of Viagra can be used to determine whether relationships also benefit. Given the importance of sex to relationship functioning, and given the tension that can arise when sexual intimacy is disrupted, I expected to see clear evidence that couples using Viagra to treat ED would be happier than they were before treatment – and happier after treatment than those receiving a placebo. I was surprised to learn that this is usually not the case, and a quick review of the evidence on this point sheds some light on sex and close relationships.

(If you think that it is pretty easy to guess accurately whether you or your partner is in the Viagra or placebo group in these studies, you are correct. This means that the comparisons of people to their own baseline measures of relationship functioning are more informative than Viagra-placebo comparisons.)

A 2007 study of 180 men and their partners reported by noted researcher Julia Heiman and colleagues showed that reports of relationship satisfaction did not improve through 12 weeks for those couples taking Viagra. However, sexual satisfaction at the end of treatment with Viagra was better for women who were happier with their relationship at the start of treatment. Like investment bankers, the rich do tend to get richer. But the opposite happened for men: greater sexual satisfaction was achieved by those with lower baseline relationship satisfaction scores – perhaps because of new found confidence in the bedroom. Something about the relationship affects the pill, not vice-versa.

Another 2007 study, this one involving 108 couples, suggested that female partners of men taking Viagra were happier at the end of treatment than the partners of men taking the placebo (Hundertmark et al., 2007). A ray of hope? Not really, because the placebo group dropped in relationship happiness ratings while the Viagra group held steady. Overall, couples in which the man was taking Viagra changed very little in relationship satisfaction.

Why doesn’t Viagra improve relationships in more obvious ways? One possibility is that the people who seek help are already pretty happy in their relationships, leaving little room for improvement. But even in those couples where there is room for improvement, taking Viagra does not seem to boost relationship satisfaction. It may be that by the time couples reach their mid-50s or 60s, their happiness is already pretty stable, wherever that might be, and little can change it. Another possibility is that Viagra really improves some relationships but creates new conflicts in others, leaving the overall or average effect something of a wash.

Perhaps the most interesting finding in this small set of studies comes from another report Heiman and colleagues published just last year (Aubin et al., 2009). This team compared a group of 24 couples receiving only Viagra for 12 weeks with another group of 27 couples receiving Viagra for 12 weeks and 8 sessions of sex therapy. Neither group changed much in relationship happiness, but in the group receiving sex therapy, 88% of all men and 79% of their partners reported that the sex therapy was a very important or extremely important influence on their response to the medication. Again, the dynamics within the relationship seem to play a crucial role in how couples respond to the medication itself.

So what do we learn? Surprisingly, relationships may influence Viagra more than Viagra influences relationships. Or more memorably: the affection to erection path might be more reliable than the erection to affection path. Not only are psychologists’ jobs safe for now, the evidence indicates they might actually enhance the benefits that Viagra provides.

Aubin, S., Heiman, J.R., Berger, R.E., Murallo, A.V., & Yung-Wen, L. (2009). Comparing sildenafil alone versus sildenafil plus brief couple sex therapy on erectile dysfunction and couples’ sexual and marital quality of life: A pilot study. Journal of Sex and Marital Therapy, 35, 122-143.

Heiman, J.R., Talley, D.R., Bailen, J.L., Oskin, T.A., Rosenberg, S.J., Pae, C.R., Creanga, D.L., & Bavendam, T. (2007). Sexual function and satisfaction in heterosexual couples when men are administered sildenafil citrate (Viagra) for erectile dysfunction: A multicentre, randomized, double-blind, placebo-controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology, 114, 437-447.

Hundertmark, J., Esterman, A., Ben-Tovim, D., Austin, M., & Dougherty, M. (2007). The South Australian Couples Sildenafil Study: Double-blind, parallel-group randomized controlled study to examine the psychological and relationship consequences of sildenafil use in couples. Journal of Sexual Medicine, 4, 1126-1135.

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