Jeremy Laurance: Are we expecting too much from medicalised sex?

The launch of Viagra in 1998 was a landmark. Within weeks it became the world's fastest-selling drug, within four years it was being used by 20 million men worldwide, and within a decade it had spawned a dozen rivals.

As the first oral treatment for impotence, it promised the possibility of an active sex life to thousands of men who could previously only dream of it. The Government was so alarmed at its potential appeal that it heavily circumscribed those who would be eligible to receive it, in the first open acknowledgement of rationing on the NHS.

It was not only patients with impotence who benefited. At its launch, young, presumably virile, journalists queued up to test the drug – and wrote glowing reports of its effects. For a while it was in demand at nightclubs alongside the more familiar party drugs.

But more than a decade on, the picture is less rosy. Viagra enjoys a global reputation and millions of men remain keen to try it. But the rate of repeat prescriptions is low, doctors say. Curiosity drives couples to experiment, but having done so they revert to what they were doing – or not doing – before. The one thing you can say about Viagra is that it ain't habit forming.

The huge interest in the drug and the embarrassment that still attends its purchase across the counter has led to a thriving internet trade. But as the world's No 1 counterfeited medicine, with hundreds of thousands of fake tablets seized each year, it is a case of caveat emptor (buyer beware) for those who choose to buy over the web.

Viagra has also triggered searching questions about modern mores. The medicalisation of sex has made it the world's most popular medicinal drug. But does this reflect a genuine need or people's increased expectations in our sexualised culture?

Some light is thrown on this question by the sex lives of older people, which surveys suggest are better than ever. The so-called Viagra generation is supposedly having better sex, and more of it, than ever before. But whether they are actually having it more than previous generations, or just talking about it more, is unclear. Sexual liberation for the over-seventies may be no more than a state of mind, and satisfaction can come from saying no and not feeling inadequate about it.

In terms of chemical sex aids, the scales have been unfairly weighted, medically speaking, in favour of men for the last decade. But it has not been for want of trying on the part of pharmaceutical companies. They have raced to develop pills, creams and patches intended to do for women what Viagra has done for men – but so far with notably less successful results.

Fibanserin could be the answer but don't hold your breath.