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The first time, Allard Gee popped the little blue pill in secret and then slipped into bed. At 59, after a three-year dry spell, he couldn't be sure it was going to work. Better not to start the night with big expectations.

"It was a very unexpected pleasure," giggles his wife, Joyce, taking over the story. "Afterwards, we got up and had a drink and made a toast to good health. Had we known, we would have gone to the doctor sooner."

Ten years ago this month, wine glasses were clinking in bedrooms across North America, as men joined Mr. Gee in hustling to their doctors for a brand-new sex elixir called Viagra — named for "the vigour of Niagara" and promising to get the job done without the dreaded stab of a needle or the drastic step of an implant.

The Gees, who live in the Eastern Ontario village of Gilmour, enjoyed an early supply as part of a clinical trial. Many of their fellow Canadians, forced to wait one more year for Health Canada approval, scampered across the border. In the first six months, American doctors wrote 5.3 million prescriptions for the drug, which works by increasing blood flow to the penis within about an hour of being ingested.

The blue pill rivalled Monica Lewinsky's notorious blue dress as the story of the year for 1998 — and together, arguably, they took the blush off the public discussion of sex once and for all.

A decade later, Viagra is a cultural phenomenon, the product of a brilliant sales job to an eager, ever-widening market — the Coca-Cola, as one urologist put it, of erectile dysfunction. By many accounts, the company behind it, Pfizer, created the thirst by spending many millions to embed the term erectile dysfunction ("ED") in the minds of men, through persuading their doctors.

Two other oral drugs, Cialis and Levitra, joined the lucrative ED market five years later, promising to do the job even better and for longer than their trailblazing counterpart.

According to the most recent figures, as of last autumn, more than 1.8-billion Viagra pills had been dispensed around the world; in Canada, 1.6-million men had used it. And that number doesn't include Cialis or Levitra, much less the guys who've used all these drugs without prescriptions, including a population in their 20s and 30s who pop it recreationally. Not bad for an elixir discovered when test subjects for an angina treatment reported an unexpected boost in the bedroom, a happy-accident tale now central to Viagra lore.

But for all its amorous fans, the cult of Viagra gives some sociologists and medical ethicists a cold shower for what it says about drug-company influence peddling, the marketing of a masculine ideal and society's definition of what's normal. Singling out Viagra for ushering in an era of designer "enhancement" drugs, critics suggest we pause our passion to consider what it means to stock our future medicine cabinets with drugs that imply that human nature, with all its ups and downs, needs fixing, like a disease.

Barbara Marshall, a Trent University sociologist who studies the impact of Viagra, calls it the MacDonaldization of sex: "We need to think about whether we want sexuality to be like ordering a Big Mac, where it tastes the same time after time."

'Singing in the shower'

On certain nights, Réjean Brunet's wife decorates his desert with a blue pill and serves it with a sly grin after dinner.

"I get the message," he laughs.

Mr. Brunet, a 65-year-old retired government manager living on the south shore of Montreal, has been using Viagra for five years.

The first time he'd complained to a doctor about trouble keeping an erection, the urologist sent him away empty-handed. "He told me, 'Well, spring is coming, you're going to see beautiful girls and things will come back to normal.'" A few months later, he went to a different urologist, and got Viagra.

He admits he was worried about the long list of side effects on the papers the pharmacist gave him, including headache, flushed face, blurred version and — rarely, but most alarming — erections that won't subside for four or more hours. "When you read that paper, it's a bit scary."

Like Mr. Gee, he chose not to tell his wife. He took the pill after they went out to dinner. They ended up stopping at a motel on their way home, just as they'd done in their younger days. "I wanted to surprise her," he says. "Just to see her reaction at my new vigour."

In fact, he waited a month before telling his wife, worried — needlessly, he says now — that she would be disappointed. "It was like I was back to 20 years old, it worked that well," he says. "The good thing about Viagra is that it's two-for-one: We would have relations in the evening, and in the morning I would still be up and willing."

Mr. Brunet and his wife were so enthusiastic that they agreed to be featured in a Viagra documentary aimed at physicians. A few years ago, Mr. Brunet was also part of a Pfizer print campaign in Quebec: In the ad, he wore a satisfied smile, punctuated by the question, "Are you singing in the shower?"

"Indeed, I am," he quips now.

The ubiquitous presence of Viagra bothers its critics. It is everywhere, turning up in knowing references on TV shows, stamped boldly across advertising space in sports stadium, with its prime-time commercials featuring joyful men, looking ever younger and dancing and singing "Viva Viagra!" à la Elvis.

Certainly, Pfizer hasn't had much difficulty rounding up celebrity pitchmen, beginning with presidential candidate Bob Dole, hockey legend Guy Lafleur and 37-year-old Texas Ranger slugger Rafael Palmeiro — though not American Idol's acerbic Simon Cowell, who reportedly turned down a $2-million contract to endorse Viagra recently, calling it "an insult."

Jack Nicholson, too old at 71 for Pfizer's target market, volunteered his own unpaid endorsement last month, though he told the interviewer, "I only use Viagra when I am with more than one woman."

As suggested by the proliferation of Viagra and Cialis email spam, as well as black-market imitations of the drugs, the demographic of users continues to expand. Viagra was originally intended for men with vascular problems caused by diseases like diabetes, but in practice it works on any guy, even with alcohol, as the Pfizer website helpfully explains.

Tyler, a 31-year-old writer in Toronto who did not want his last name used, says men his age tend to use Viagra as a security blanket, particularly on binge nights. "I know a couple of guys who had it in their medicine cabinet, so if things didn't go well, just a lick of it would boost their confidence."

For men without a prescription, Viagra is easy to find through street dealers or passed among nightclub patrons, says Nick Boyce, a provincial trainer with the Ontario HIV and Substance Use Training Program based at Toronto's Fife House, a housing facility for people living with AIDS. He says Viagra is often taken to counter the dampening effects not only of alcohol but of drugs such as ecstasy or crystal meth.

The problem with street drugs, though, is that the user can't be sure of the ingredients or the dose. With prescribed Viagra, side effects are rare and mostly short lived, but Mr. Boyce says that high doses (which could show up in black-market versions) raise the risk of stroke among certain men. Recent research has also linked its use among younger men to potential fertility problems.

"I thought it would be a good time," recalls Mark, 35, an IT worker in Toronto who shares his grim tale on the condition that his identity be concealed. At a party last year, Mark took a blue, diamond-shaped pill — he can't be sure it was a real Viagra.

Eight hours later, he was in the hospital with an erection that wouldn't go away. For a week, doctors tried to bring it down — an agonizing process that involved several needles and, finally, surgery under a general anesthetic. It took nearly a month for his penis to return to normal.

"The pain was unbelievable," Mark says. "I learned my lesson. There could have been permanent damage." He adds: "It was really embarrassing."

His case is an extreme example. But Pfizer's aggressive marketing campaign prompted the Los Angeles-based AIDS Healthcare Foundation to file a lawsuit against the drug company last year, alleging that its commercials and print ads encourage the perception of Viagra as "a safe, sexy party drug" — a recreational use that the group argues is not approved by the Food and Drug Administration, and carries its own health risks, such as diseases contracted through unprotected sex.

In particular, the group cited a newspaper ad showing a smiling man and the tagline, "What are you doing this New Year's Eve?" Another, running shortly before the 2006 Super Bowl, urged men to be "this Sunday's MVP" by asking their doctors about Viagra.

Some doctors will write prescriptions under fairly flexible circumstances. Mark, for instance, ran into his doctor socially not long after his mishap with Viagra. "He said, 'If you wanted them for play, I would have given them to you.' "

Manufacturing desire?

In 1998, Viagra benefited from excellent timing: It was the first drug to come on the market after the American FDA loosened rules on direct-to-consumer marketing. In Canada, the regulations are more strict, but given the cultural crossover it hardly matters — Viagra made the covers of most major magazines, and was the subject of breathless headlines, announcing that sex would never be the same again.

Watching it all from Trent University, Barbara Marshall recalls, "There was a quote from the publisher of Penthouse saying something to the effect that Viagra was going to reverse all the damage that feminism had done to men, and 'give them back their boners.' And I remember reading that and thinking, 'This is really interesting. How could a pill be attributed with all this power to restore masculinity?' "

Dr. Marshall and other sociologists have suggested that it was only in Viagra's wake that men suddenly were thought to be suffering from sexual problems in epidemic numbers. Consider, she says, the often-cited statistic, first published in 1999, that 43 per cent of women and 31 per cent of men suffer from sexual dysfunction: Those figures included anyone who told surveyors that there were periods in the previous year when they had felt anxious about their sex lives or lacked interest in sex.

"It didn't reflect whether there was ebb and flow to these things — some days you're horny and some days you are not," she says. "The creation of distress from that data was really the task of careful public relations." The impression, she says, was that "there's some kind of gold standard of sexuality, and if you deviate from that you've got a dysfunction."

At the same time, erectile dysfunction, the new official-sounding medical term for impotence, was recast, Dr. Marshall says, almost solely as a biological problem. Until then, impotence was thought to be all in men's minds — an equally limiting notion that failed to recognize the role of vascular problems and illnesses like diabetes. But with Viagra, she says, the trend swung too far the other way.

"Men had to be retrained to understand occasional erectile failure as a disease, a disorder that needs to be treated rather than something that happens once in a while in the normal course of events," she says.

And more than that, she argues, Viagra seems to remove partners from the equation (except to begin the campaign for a pink Viagra for women, she notes, "as if it was only fair that we should have one too"). In the months after Viagra was announced, Dear Abby published letters from wives, variously praising the drug, and grumbling about the new demands it placed upon them.

Janice Maloney, a sex therapist in Peterborough, Ont., says Viagra often becomes the subject of friction among her clients, when a man goes to his doctor and gets the prescription without talking to his partner first. "You get a lot of very angry women, saying, 'Who the hell does he think he is now? I wanted to talk about things for years, and it's not resolved just by him getting an erection.' "

The guys, for the most part, are baffled by the reaction: "They swallowed their pride and went to the doctor, and they're thinking, 'How could this have gone so wrong?' "

Studies show that roughly half of all Viagra prescriptions are not refilled. As doctors and therapists point out, the drugs don't create desire, and they don't work as well when men are tired, stressed or struggling with relationship problems.

Yet Viagra is billed, critics argue, as a cure-all that reduces sex to simple mechanics, failing to consider how age and lifestyles naturally influence sexual desire and activity among both men and women.

"Do we want 50-year-old men to behave like 20-year-men all the time?," asks Dr. Joel Lexchin, a drug-safety expert at York University. "When I was 20, to be quite frank, I'd hop into bed with just about anybody. Now that I am 60, I have more discriminating standards and my sexuality is different."

He says that Viagra is good for men suffering from neurological and vascular problems. "If that's all it was used for, it would be a modestly successful drug."

But Pfizer had other plans, he suggests, and the Viagra debate needs to be framed in terms of the resources invested to sell it, money that could otherwise be going into the development of new, life-saving drugs.

A recent study Dr. Lexchin co-authored found that American drug companies spent $57.5-billion (U.S.) on promotion in 2004, compared with $31.5-billion on research. In Canada, he estimates that drug companies earmark $4.5-billion a year for marketing, compared with $1.5-billion for research. The vast majority of those marketing dollars are spent pitching their products to doctors.

The heavy promotion of erectile-dysfunction drugs, as well as mood-altering pharmaceuticals such as Prozac and Paxil, raises a larger question about the impact of so many research dollars going toward pharmaceuticals that fix what may not even be truly broken, argues Dr. Lexchin.

"We're narrowing the definition of what's normal in human behaviour," he says. "Let me give you an extreme example: Suppose there was a pill that you could give people and it would change everybody's skin colour to grey. That would get rid of racial discrimination because everyone would have the same colour skin.

"But is that what we want to do? Do we want to make everybody homogeneous?"

Pleasure principles

If it means great sex every time, argues Hamilton urologist Michael Greenspan, why not? "It's a free world. If you want to come and get a better erection, that's up to you."

There's no law of human nature that says sex has to slow down with age, he argues, offering his own analogy: "You live in a house and stuff starts falling apart in your house — do you not fix it?"

Dr. Greenspan thinks Viagra's critics need to lighten up. The pill, he says, revolutionized treatment for his patients, who previously had to choose between penile injections or implants to solve their problems.

Since Viagra, he says, "I have never had my hand shaken or my back patted as much as I do when people leave my sexual-dysfunction clinic."

Dr. Greenspan, who also teaches at McMaster University, writes about 400 Viagra prescriptions a year, sits on Pfizer's advisory board and takes the drug himself. He accepts that the marketing campaign around Viagra — and its promotion to physicians — has been impressive, but he argues that it also taught doctors to raise the issue of sex with their patients, and made men more willing to talk about their problems.

And today, he argues, partners are more often part of the conversation.

The drug, which costs about $15 a pill, is not always covered by medical plans, and Dr. Greenspan says most of his patients use it about once a week.

He suggests that the high level of unfilled prescriptions happens because the drug is costly and men may not have been given proper instruction or follow-up by their physician. (Studies show that fewer than 5 per cent of patients quit taking Viagra solely because of side effects.)

Dr. Greenspan says his patient base for the drug has changed significantly in 10 years. At first, he only saw older men who could no longer have sex, or patients who were impotent because of health problems. Now he sees more and more younger men, seeking better sex.

The drug isn't a panacea — clearly, men have to take care of their lifestyle and relationship issues. But if a guy wants it to rev up his sex life, Dr Greenspan asks, who's to stop him?

"If you want to come in and get a better erection, that's up to you," he says. "There are very few studies that show that lack of sex in a relationship improves the relationship. It's just the contrary."

And Dr. Greenspan rejects the notion that there's anything morally questionable about an older man trying to recapture the stamina he enjoyed in university.

"I think there's nothing wrong if you're 50 with having an erection like when you're 20."

Overall, in fact, fans of Viagra don't seem that interested in debating its societal influences. They're having too good a time.

That includes 88-year-old Cliff Chadderton, the head of War Amps Canada, who led the campaign years ago to get Viagra covered for veterans, after Saint John MP Elsie Wayne declared that they didn't need to have sex.

Mr. Chadderton recalls that the issue was especially important for veterans who wanted to continue to be intimate with the women who had cared for them all their lives.

"I don't remember my amputees [ever] being as angry as they were about being denied Viagra," he says.

Today, Mr. Chadderton remains a beneficiary of that coverage. "It's been a success story for those of us over 80, who can still enjoy sex," says the veteran, just back from a 68-day cruise to Antarctica, where Viagra was an unabashed topic of conversation.

On the boat, he says, fellow male passengers liked to joke, "Of course I brought my Viagra with me — do you think I'm nuts?"

As for himself, Mr. Chadderton says: "My wife and I have a closeness I don't think we would have had without Viagra. It's been a real help to our relationship."

And back in Gilmour, Ont., Viagra is still in the Gee medicine cabinet and making regular appearances in the bedroom 10 years later.

If they hadn't been able to have sex again, says Mrs. Gee, now 69 years old, they would have survived: Their marriage is based first on love and respect.

"But don't get me wrong, I'm not knocking it," she laughs. "It's not quite as exciting as it used to be, because I have arthritis. I can't get into too many tricky spots like I used to. But it's still pretty good."

Erin Anderssen is a feature writer for The Globe and Mail