Edition: U.S. / Global

The Second Sexual Revolution

By Jack Hitt
Published: February 20, 2000

It was only two years ago that Bob Dole went on ''The Larry King Show'' to discuss his prostate-cancer operation. During a commercial break, so the story goes, King leaned over to ask his old friend, confidentially, how he was dealing with the operation's grimmest side effect, impotence. Dole cheerfully informed the talk-show host that there was a new drug, Viagra, and miraculously, it had cured the problem. King asked Dole if he would discuss it on the air, and Dole said sure, why not?

The world was about to become a very different place. Viagra would cycle through the expected paces of pop-culture acceptance with stunning speed. Leno and Letterman got an entire summer's worth of monologues off the subject. For a while the papers regularly pumped out clowning (and possibly true) stories about the drug -- there was Frank Bernardo, 70, who left his wife, declaring, ''It's time for me to be a stud again''; there was also Gen. Sani Abacha of Nigeria, who died in the midst of a Viagra-fueled encounter with two women in his magisterial bed.

But the jokes are over. Viagra's sales topped $1 billion in the first year, and Pfizer is now the second-largest drug company in the world. The drug's use has leveled off, but consider the

level: nearly 200,000 prescriptions are filled each week, and 17 million Americans have used the drug. Viagra has been embraced by the well off (4 percent of the total population of Palm Beach County has a prescription), but not only by the well off. Not long ago, Wal-Mart and Kmart had a Viagra war that drove the per-pill price down from $10 to $7.80.

And so, no one talks about it anymore.

Welcome to the lull. It's as if a freak 20-foot swell crashed on the beach, leaving a few new gullies. It's over. Go back inside. Everything is back to normal. Everything except that tsunami on the horizon.

At this moment, there are at least a dozen new Viagra-like medicines and devices currently in clinical trials. Many of these drugs are for men, but this time around, there are just as many for women -- specifically, for a new phylum of illness, female sexual dysfunction, which will soon cycle through the same paces as ''erectile dysfunction,'' setting the word ''frigidity'' alongside impotence in our dictionary of merry old archaisms. ''Our knowledge of sexual health is in revolutionary mode,'' says Dr. Irwin Goldstein, a Boston University urologist and pioneer in the field.

With $1 billion in sales for Viagra, the research pressure is intense, yielding paper titles like ''The Ejaculatory Behavior in Sexually Sluggish Male Rats. . . . '' Scientists, doctors and pharmaceutical companies are racing to discover newer and better drugs. Who doubts they will improve the lives of those who suffer from the newly discovered sexual disorders now showing up in the medical journals? But these drugs will also have, some say, an ''enhancing'' effect on normally functioning people. More important, the temptation for anyone to obtain these drugs will be more easily satisfied than ever before, since the family of pharmaceuticals inspired by Viagra is entering the market at a time when medicine is decentralizing, slipping the reins long held by doctors. There is already telling evidence that these new sex drugs may well do for medicine what porn did for the Internet -- constitute the killer ap that reshapes the industry in an age of patient choice and turboconsumerism.

Though most of us are inculcated with the belief that the totality of sex is unknowable, maybe even divine, once you've spent some time with the new sex researchers, you learn that the actual mechanics of it all aren't that lofty. Compared to a kidney or a lung, our genital rig is basic stuff, the corporeal equivalent of a 1968 VW Beetle engine. Ensure that the ''hormonal milieu'' is properly gauged and that there is enough blood flow, and the engineering work is pretty much done -- for men and women alike. (Then there needs to be passion, romance and love perhaps, but urologists continue to leave these areas of research to poets and musicians. So far.)

''Not to discount psychological aspects,'' said Goldstein, who was a member of the team that treated Bob Dole, ''but at a certain point all sex is mechanical. The man needs a sufficient axial rigidity so his penis can penetrate through labia, and he has to sustain that in order to have sex. This is a mechanical structure, and mechanical structures follow scientific principles.'' Goldstein, seated in his office at Boston University Hospital's Sexual Health Clinic, poked his forefinger into the palm of his hand and explained that the ''typical resistance'' posed by the average vagina is a measurable two pounds. The key is to create an erection that doesn't ''deform'' or collapse when engaging that resistance.

''I am an engineer,'' noted Goldstein, who in fact collaborated with Boston University's department of aerospace engineering in formulating his theories. ''And I can apply the principles of hydraulics to these problems. I can utilize medical strategies to assess, diagnose and manipulate things that are not so straightforward in psychiatry.''