They always had a passionate marriage. When it began, three decades ago, they made love every day--for years. Then, like all record-breaking athletes, they slowed down, but they still maintained a several-times-a-week sex life. When he turned 70, however, he started having difficulty getting erections. Judith (not her real name), who was in her mid-50s, wondered if she was losing her attractiveness. Her husband assured her that wasn't the case. His doctor told him he was just getting older and would have to accept it. It was frustrating advice. "He felt bad on two counts," she says. "For himself and because he couldn't satisfy me."

Two years later, in 1998, Viagra came on the market, and they both got satisfaction when he went to a new doctor and got a prescription. "We can be playful again," Judith says. "We make a date. We'll say, 'Let's go out to dinner and have sex.'" The medication (he's now on Levitra, a similar drug) has even enhanced his unaided erections. "We'll be going to sleep, and he's aroused," she says, "and that's lovely."

It's been seven years since Viagra became available. Nearly a billion dollars' worth of it was sold the first year--one of the most successful drug launches in history. Since then about 16 million men have been helped by it. Such sales have spawned competitors Levitra (which works slightly faster) and Cialis (whose effects last longer). The commercials for these medications variously portray men who develop a mysterious new confidence around their coworkers or become frisky new mates for their wives.

But how do the wives and girlfriends of the men who are taking these drugs feel about their partners' pharmaceutically enhanced erections? The responses are as varied as women's sexuality. Some women, like Judith, are thrilled. Some wish their rock-hard geezers would just lose their prescription and leave them alone. Some have discovered that a pill-aided erection messes with the rules of attraction, losing its erotic appeal. And some young women, whose sexual encounters are of the casual sort, easily accept the notion that their young bedmates take a potency pill just to ensure a good time.

Aline Zoldbrod, Ph. D., a Lexington, Massachusetts sex therapist, says it's important for a woman to understand her partner's relationship to his penis. "Whatever we would like men to feel, there is nothing more important to them than having an erection," she says. "If they can't get an erection, they feel broken." That sense of sexual failure can permeate the whole relationship. Often such men become depressed. "Lots of times men's depression comes out as anger," Zoldbrod says, adding that they sometimes shut down and withdraw all affection. "They won't kiss, hug, or caress. They don't want to start something they can't finish." These men, defeated, dejected, distant, are most unpleasant to live with. "So Viagra is wonderful for them," Zoldbrod says. "This is millions of people!"

But not all women are in relationships as sexually satisfying as Judith's. "Women who didn't want to have sex are ticked off because they can't use the lack of an erection as an excuse," says Sallie Foley, a sex therapist at the University of Michigan Medical Center. She has female clients who hoped their sex lives would just fade away and are now confronted with the threat of sex continuing into their 90s. She asks these women if they can "have sex in a neutral but pleasant way because it matters to him"--like watching the play-offs on TV. If the woman can't, then that is a couple in crisis, Foley says, and they will have to address the underlying issues.

One thing Viagra did for women was help free them from blame for their men's uncooperative penises. As described in The Rise of Viagra, by Meika Loe, Ph.D., an assistant professor of sociology and anthropology and women's studies at Colgate University, from the 1920s to the 1950s a man's impotence was usually attributed to the sexual unresponsiveness or "frigidity" of his wife. In the 1950s, Loe reports, the American Medical Association declared three-quarters of American women frigid. It was a cold decade.

But even as the notion of the frigid wife faded, men's problems were seen as almost purely psychological until the 1970s and '80s. That's when medical interventions like pumps, implants, and injections allowed a man's penis to enlarge without having to shrink his head. With the arrival of an erection in a pill, impotence--now known more clinically as erectile dysfunction, or ED--was transformed from a mostly psychological malady to a physical one.

The pharmaceutical companies originally believed that the Viagra market consisted mostly of men like Judith's husband, people whose problem was the consequence of aging, or the result of a medical condition. But in recent years, there has been a transformation, with ED drugs marketed to younger men and the pills perceived as a way of enhancing the sexual experience.

Leslie (also not her real name) and her husband are both in their mid-50s and enjoy a satisfying sexual relationship. As she says, "He doesn't have problems." One night, after he initiated lovemaking, she looked down at her tumescent husband and asked, "Did you take Viagra?" It was "the density of the hard-on that made me realize it," she says. He acknowledged that he had and was gleeful at the results, she recalls. "There was a look of prideful delight: 'Wow, look what I have.'"

Some Viagra critics say that as a man ages, his slowness to become erect can benefit his partner. There's more time for sensual exploration and less exclusive focus on penetration. The critics say that when an older man takes an ED drug, foreplay can be shortchanged in his desire to get the most for his prescription dollars.

Leslie sees some truth in that. She says that after they both admired his erection, he was eager to use it. "Let's get in there!" is how she playfully describes his attitude. It wasn't the best sex of her life. Because she's postmenopausal, she says, "I have problems going at it the way I did 15 years ago." Her husband is a considerate lover, so he didn't press his advantage. Nor did they care to repeat the experiment. She says it's nice to know the pills are there if he ever needs them, but why use them if he doesn't.

And while we're talking about women and Viagra, what about women taking Viagra? When Leslie realized her husband had popped a pill, she asked if he had an extra for her. He did and she swallowed it. She says it did nothing. This confirms Pfizer's gloomy conclusion about Viagra's efficacy for women. Viagra works in men by increasing blood flow to the genitals, allowing an aroused man to get an erection. Viagra also increases the blood flow to a woman's genitals, so in one sense it works. But in clinical trials, most women simply didn't experience the effects of the drug as arousal; apparently female libido requires the brain, as well as the genitals, to be engaged. The search for a female Viagra-like drug hit a roadblock late last year, when an advisory panel for the Food and Drug Administration, citing concerns about the lack of long-term safety data, turned down Procter & Gamble's request to market a testosterone patch for women.

Sallie Foley says phallocentrism isn't inevitable when a man takes an erection drug. After Viagra first came on the market, people teased her that it would kill her therapy practice, but it's been just the opposite. Now that there's a reliable way for men to feel sexually capable, she sometimes sees older couples who want to enhance their love lives. "If the male partner feels good about his erectile quality," she says, "then the female partner can say, 'Let's work on the rest of it.'" Foley recalls one such couple: "She wanted a sex life that included more eroticism and less focus on intercourse. Now that he felt more competent, he was willing to entertain more variety."

If having reliable erections makes men feel good about themselves sexually, what makes women feel good about themselves sexually? For one thing, knowing that they're the cause of those erections, says urologist Abraham Morgentaler, MD, associate clinical professor of surgery at Harvard Medical School, and author of The Viagra Myth. "Women feel like great, sexy people if the man in their life gets turned on easily," he says. But what happens when it's not the sight of you in a negligee but swallowing a tablet that gets him going?

Morgentaler recalls the case of one attractive couple in early middle age who had to face the man's impotence because of prostate cancer surgery. Viagra didn't work for him, but a pump did. Still, his girlfriend eventually left him because even though he said she turned him on, there was no physical evidence that she did. "It's the same idea that if he needs a pill, her lifelong belief that she's sexy is out the window," Morgentaler says. "For some women, that's hard to take."

In his practice, Morganthaler also sees plenty of younger men seeking ED drugs because, they say, the women in their lives are so aggressive, in a Sex and the City kind of way, that the men feel they need help to keep up. Ian Kerner, PhD, sex therapist and author of She Comes First and Be Honest--You're Not That into Him Either, sees men in their 20s who take the drugs for a different reason: to help them get physically intimate while staying emotionally distant. These are young men who will consume a lot of alcohol, then have casual sex with an acquaintance. The pill helps make sure they can complete the act.

"It's mostly a party drug," Kerner says. He fears that in addition to training a generation to assume it's normal to take a pill to have sex, Viagra keeps young men from exploring ways to satisfy their partners. Because many women, particularly young ones, don't necessarily achieve orgasm through intercourse, Viagra-fueled sex can leave them frustrated. Says Kerner, "I hear a lot of women saying, 'Shame on me for not enjoying his erection as much as he does.'" Kerner has also talked to women who fake orgasm in these situations. "There's a level of guilt because he has problems, so she doesn't want to be coldhearted by saying, 'I'm not satisfied,'" he says.

There's another school of thought that says we're losing sight of how unnatural it is to turn to a pill to fix our sex lives. Sociologist Meika Loe worries that we're being marketed a sexual ideal, and people who don't meet it will think they need a drug to fix themselves. "Throughout our lives, we've got to serve it up fast and hot. Where's the humanity?" she wonders.

But Foley says plenty of things that are natural are also lousy. She points out that it used to be considered natural to lose your teeth as you got old. "What has driven civilization forward is the unwillingness to accept the bad blows of nature," she observes. If impotence is one bad blow, then how lucky we are that Viagra can fix it. "To lead a life where you have pleasure and a tactile connection to another person," she says, "is to be healthier in your body." Judith certainly thinks so. For her, Viagra and its spin-offs aren't a pharmaceutical quick fix. The pill that her husband takes is a way to maintain the physical and emotional intimacy that they've built over decades. "There are losses we have to go through," she says. "If we don't have to go through this particular loss, it's wonderful."

Emily Yoffe is a contributing writer to Slate.com and the author of What the Dog Did (Bloomsbury), out this June.

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