When it was launched in 1998, it became the world’s most popular medicinal drug ever, outselling even fluoxetine (Prozac). Although Viagra is not yet approved for women by the US Food and Drug Administration, studies are evaluating its effects in women with arousal problems. Gynaecological surgery is also being harnessed to enhance female sexual pleasure and improve aesthet-ics (fig 4). So far, genital enhancement—the so called “designer vagina”—has had little impact in the United Kingdom, but it is routinely advertised in America. Procedures include: x Liposuction of oversized vulvas x Labiaplasty to “aesthetically modify” the labia x Clitoral repositioning x Tightening of vaginal muscles and support tissues x Reduction by laser of redundant vaginal mucosa. Some of these procedures grew out of traditional gynaecological surgery for urinary incontinence and episiotomies—the “extra stitch for the husband” famil-iar to gynaecologists. Laser pruning of unsightly or unsatisfying genital morphology is now carried out, however, expressly for sexual gratification. The application of medicine has considerable scope in this context (fig 5). In America, erectile dysfunction is estimated to affect 50% of men aged 40-70 and 70% of men > 70 years. 27 28 Thirty one per cent of American men and 43% of American women have reportedly had sexual dysfunction at some time in their lives. 29 These estimates explain, in part, the stampede to obtain Viagra. Yet whether people seek medical treatment is associated not only with the scale of a problem, but also with its perceived severity and the opportunities for treatment. The high
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