Flaccid theory and the geographies of sexual health in the age of Viagra

The discipline of geography is largely absent in discussions and debates about drug use practices and their relationships to sexual health. Given the important relationships among the use of drugs, performances of sexualized identities, and the practices of sex, it behooves medical and health geographers particularly, and social and cultural geographers more generally, to engage in the wider interdisciplinary debates about these relationships.

Through a discussion of one drug, Viagra, this brief intervention offers an agenda for studying the geographies of sex, sexuality, and drug use. It is argued that drug use is an inherently geographic practice that reshapes how places are resituated in relation to the fluid and dynamic meanings of sex, sexuality, and sexual health, areas of research and practice that medical and health geographers ought to consider more seriously.

A geography of Viagra™, that incredibly popular sexuopharmaceutical designed to make the penis erect in older men, might trace the global dynamics of its distribution and diffusion, focusing, in particular, on the diversity of places where this medical 'revolution' has been employed. A quick survey would demonstrate that Viagra, and other sexuopharmaceuticals, are finding markets throughout Asia and Latin America,1 although this drug's largest markets are among men in the North America and Europe.

In tracing these global distributions, geographers might interrogate the enormous monies invested by 'big Pharma' in fighting patent infringements on drugs such as Viagra in countries like China (Global Insight, 2006) as well as the possible use of these drugs as substitutes for herbal medications related to male sexual practice (e.g., Von Hippel et al., 2005). Medical geographers could also investigate the comparative global investment in this 'lifestyle' drug in relation to other drugs designed to curb infectious diseases, such as malaria, tuberculosis, or HIV/AIDS (Silverstein, 1999). In fact, a historical medical geography might trace the inequitable investment in research and development, which marginalizes studies of drugs to fight infectious diseases that impact people extensively in tropical world regions in the post-colonial period (Flory and Kitcher, 2004). This is evident in the minimal investment in the development and distribution of drugs to curb the debilitating effects of HIV, malaria, and tuberculosis in sub-Saharan Africa versus the massive investment in research and development and advertising of drugs, such as Viagra, in North America, Europe, and parts of Asia (Flory and Kitcher, 2004).

Taking a slightly different approach, health geographers could examine these drugs as part of a shifting and dynamic set of therapeutic landscapes, albeit in a way that we have yet to discuss: investigating the intersections between sexuopharmaceuticals and the reification of certain masculine identities and performances of/in certain places, such as bars, brothels, or bedrooms. Such studies might offer insight into the medicalization of masculinity and male sexual practices in both global and local context. In working through the therapeutic nature of sexuopharmaceuticals and the medicalization of erectile (dys)function as a disability, therefore, we might continue the important critique of the 'therapeutic landscape literature' (Wilton and DeVerteuil, 2006, for a summary of this critique) and ask how power operates in and through these spaces to legitimate this highly symbolic corporeality of male sexual desire as an apparently essential condition of human existence. This would further complicate the nature of 'therapeutic spaces', which might be seen as rehabilitating to some (e.g., men using Viagra) and debilitating to others (e.g., women who are partners of men using Viagra) (see discussion by Potts et al., 2003, for example). What this suggests is that any study of how drugs and their use re-organize certain spaces and places needs to consider, more generally, the complex intersections between drug use and the gendering of sex, sexuality, and sexual health.