Twenty years ago, a little blue pill called Viagra unleashed a cultural shift in America, making sex possible again for millions of older men and bringing the once-taboo topic of impotence into daily conversation.
While the sexual improvement revolution it sparked brightened up the sex lives of many couples, it largely left out women still struggling with dysfunction and loss of libido over time. They have yet to benefit from a magic bullet to bring it all back, experts say.
About 65 million prescriptions have been filled worldwide for the blockbuster Pfizer drug approved by the US Food and Drug Administration on March 27, 1998.
It was the first pill aimed at helping men get erections.
Suddenly, talk of an amazing drug that could make an older man's penis hard again was all over television and magazines.
The Viagra boom also coincided with the rise of the internet, and the explosion of online pornography.
Ads for Viagra were designed to reframe what had been known as "male impotence" as "erectile dysfunction" or ED, a medical condition that could finally be fixed.
Republican senator, military veteran and one-time presidential candidate Bob Dole became the first television spokesman for Viagra, admitting his own fears about erectile dysfunction to the masses.
"It's a little embarrassing to talk about ED, but it is so important for millions of men and their partners," he said.
The strategy worked.
Before Viagra, men wanted to talk about their erectile problems, and did, but the conversations were awkward and difficult, recalled Elizabeth Kavaler, a urology specialist at Lenox Hill Hospital in New York.
"Now, sexuality in general is very out there," she added.
"Sex has become an expected part of our lives as we age. And I am sure Viagra has been a big part of that."
'Thanks, Viagra'
Viagra has had a "major impact" -- on a par with the way antibiotics changed the way infections are treated, and how statins became ubiquitous in the fight against heart disease, said Louis Kavoussi, chairman of urology at Northwell Health, a New York-area hospital network.
Viagra's release also came amid a "sort of a clampdown on physicians interacting with companies," he said.
