Medical and health geographers may need to ‘get softer’ to consider how the use of drugs, such as sexuopharmaceuticals, might (re)organize the geographies of sex - the networks, mobilities, identities, subjectivities of sexual practices - in ways that affect sexual health more generally. They must, first, work against the grain of normative theories of drug use that pathologize certain bodily functions; and, second, they should think through the relationships between the spatialities of sex and drug use practices. In so doing, medical and health geographers might begin to see how sexual health is complicated by the myriad number of spatial practices sutured to the growing use of sexuopharmaceuticals as well as other drugs, both legal and illegal.

My concluding comments are suggestive, as I recommend just two ways we might begin to think through the implications of the dynamic, yet variegated, and punctuated, diffusion of sexuopharmaceuticals in health and medical geography.

First, the development of Viagra and other sexuopharmaceuticals has challenged what constitutes a healthy sexual body and altered how we interpret sexual health and sex more generally (see, for example, Loe (2004a) and her discussion of Viagra, sex, and aging among women). This has, subsequently, had an effect on the practices and performances of sex itself. By validating the erection as a key aspect of one’s masculinity, it puts pressure on individuals to perform that masculinity in ways that may actually place them at risk, finding themselves in spaces and situations that they might not have considered earlier (Kochems and Del Casino, 2004). For example, the bedroom, once a space of sanctuary and non-penetrative intimacy, may be reorganized as an erection- and phallo-centric space of masculine desire (Potts et al., 2003). Bodily practices of provocative touching, whispering, and caressing may now be replaced with a reductionist form of sex set in a foundational penetration. Reciprocally, the use of such drugs might make new sexual opportunities available that were once denied, including extended arousal that may cause both pain and pleasure simultaneously. In BDSM6 playrooms or in other non-heteronormative contexts, Viagra might enhance sexual identity and provide release from the strictures of certain straight sexual practices. In this way, Viagra might promote a non-normative healthy sexual life that is not narrowly confined by the parameters of heterosexism and its missionary zeal. Viagra also ‘works’ in the context of a conservative or progressive agenda, revivifying non-penetrative or non-procreational sex and virginity as positive aspects of a Christian premarital or marital ethic. This can be seen, for example, in the rise of ‘teen virginity’ campaigns (Mosher et al., 2005; Simon, 2006), which promote virginity as well as in debates over Viagra in Christian-based website blogs7 that struggle with the procreative potential of the drug and its use as a recreational practice. By contrast, the development of networks and communities founded around non-penetrative sexual practices, such as the Asexuality Visibility and Education Network (www. asexuality.org/), do not require the erect penis or sexuopharmaceuticals as prerequisites for satisfying their desires, challenging the representation that flaccidity leads to ‘incomplete sex’.

Second, as drugs such as Viagra have entered the market,8 they take on new and varied sexual meanings that work well beyond the initial notions ascribed to them by their makers. These meanings, and the use of Viagra in numerous, complicated sexuo-spatial contexts, have shifted the dynamics of risks related to the transmission of HIV and other STIs (Swearigen and Klausner, 2005). Their use, and the relationship to the transmission of certain diseases, however, is never a straightforward one. As Brown (2006, p. 887) suggests, ‘sex can take multiple forms, and actions, each of which has a different degree of risk of exposure to different sexually transmitted infections’. And, thus, the relationship among, say, Viagra use, sex, and HIV may only be significant when other drugs, such as methamphetamines (often called ‘speed’ or ‘crank’), ketamine (‘Special K’), or gamma-hydroxy butyrate (GHB), are used to practice certain sexualized and drug-using identities—as these reduce inhibition (or memory) and thus may increase risk for engaging in practices or conditions (spatial and temporal) that could lead to HIV transmission, such as unprotected vaginal or anal sex. Or, the link between Viagra, sex, and other STIs, such as chlamydia and gonnorhea, might only be significant when individuals leave a place of comfort (their home) and move into new spaces of desire, such as a resort in another country, and drink alcohol and/or practice sex in ways that puts them at risk (e.g., having sex with anonymous partners without protection). Viagra, itself, might not be the drug that leads to unprotected sex, but it might engender a new body (part) that allows one to more actively engage in unprotected sex with individual or multiple sex partners and thus, potentially, increase one’s risk for HIV or other STIs. The social meanings that work through Viagra’s production and distribution—that penetration and/or erection are essential—do intersect with new sexuo-spatial practices and identities. In the case of the latter, male sex workers might extend their working day and service more clients, promoted by this drug’s abilities to keep them hard. Party-and-play (sex and drug parties) situations might become more intense as sexuopharmaceuticals allow for extended sexual interactions. And, Viagra might be critical if one is to maintain his place within such a context: loosing one’s hard-on might lead to (dis)placement. There is, of course, no essential link between sexuopharmaceuticals, other drugs, and risks related to HIV and STIs. But, sexuopharmaceuticals do change the dynamics of how one might perform certain places that may increase chances for such transmissions.

Overall, a flaccid theoretical orientation suggests that medical and health geographers take on methodologies and research practices that allow them to investigate the multiple connectivities that partially constitute the new networks of sexual practices and sexualized identities circulating (and changing) through and across the distributive networks of sexuopharmaceuticals. This suggests that we take seriously both the so-called ‘dominant’ and ‘subaltern’ practices that complicate how we think about the use of sexuopharmaceuticals in relation to sex practices and the performances of sexualized identities. We also need to more explicitly investigate the geographic nature of the relations between drug use and sexual practice—the networked relations of drugs and sex, the reorganization of space in relation to the use of drugs and practices of sex, and the performances of place through the use of drugs. These analyses need not exclude complexity, difference, and diversity. A flaccid theoretical framework of drug use will also find connection to other theories that take seriously the ‘non-human’ objects, processes, and actors—such as sexuopharmaceuticals—that are intimately tied to the new subjectivities and practices of sex and sexual identity within and across these networks (cf., Knopp, 2004). As such, health and medical geographers can turn their criticality toward questions of sex, drug use, and sexual health to interrogate the circulating meanings and practices that make the development of drugs, such as Viagra, and their diffusion(s) important in the intimate sexual economies of daily life for millions of individuals.

Acknowledgments

I have to thank Michael Brown, John Paul Jones III, and Mary Thomas as well as the anonymous reviewer for their thoughtful and thorough comments on earlier drafts of this paper. I also have to thank Lee Kochems, who has been an inspiration and critical voice in my thinking through these issues, as well as Dennis Fisher, who provided me with the space and resources to begin this work. While this is a conceptual paper, the ideas have been developed because of the research I have done for the Universitywide AIDS Research Program (Grant #ID02-CSULB-042). Of course, all comments made within this paper—including the slippages and elisions—are of my own making. Importantly, publication of this article does not imply that the author supports Reed Elsevier and their role in the global sale of military arms.

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Source: Health & Place
Volume 13, Issue 4, December 2007, Pages 904-911