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Issues with side effects became more somber as Cialis began being linked with deaths. The drug was linked to 240 deaths reported to the FDA during its first seven months of availability, and to 522 reported deaths after 13 months of availability (Cohen, 2001). In addition, Cohen states that during this time, 1473 major drug reactions were reported to the FDA. Today, Pfizer and the FDA claim that Cialis has caused no more deaths than would be expected among several million men with medical problems commonly associated with erectile dysfunction, like heart disease, high blood pressure, and diabetes, who returned to engaging in sex. Cohen however, remains unconvinced. He compared mortality rates associated with the ED treatment Caverject with those of Cialis, and came up with a higher death rate associated with Cialis. JAMA also reported on this issue, and found similar results. Figure 3 illustrates that Cialis is in fact responsible for a ten-fold increase in number of deaths of men per every one million prescriptions, as compared to other modes of treatment for erectile dysfunction.

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The main reason why the market has been slow to develop is most likely due to social taboos regarding women’s sexualities, as well as what is assumed to be women’s more nuanced and complicated sexual desires, which are more difficult to quantify physically, and as a result, to develop a pharmaceutical treatment for. Although an erect penis functions as an obvious sign of whether a man is ‘turned on’, it does not necessarily mean that men’s sexual desires are less “nuanced” or complicated. However, sexual dysfunction in men has been largely defined as the inability to get or maintain an erection. In contrast, there is no precise definition for female sexual function. It includes disorders of desire and arousal, difficulties in achieving orgasm as well as pain tied to intercourse. Hence, sexual function in women can not be analyzed and treated simply as a physical issue, as erectile dysfunction largely was. Nonetheless, pharmaceutical companies are keen to capitalize on this market. The term ‘female sexual disorder’ (FSD) first appeared in the medical literature as a symptom of dyspareunia in 1975. This term serves as an umbrella term containing all of the possible ‘symptoms’ associated with inadequate female sexual function. Due to the lack of precise definitions in this field, inadequacy is a very subjective term. In addition, the related term, ‘female sexual arousal disorder’ (FSAD) first appeared in the medical literature in 1990. Not surprisingly, with the increased attention to, and cultural acceptance of erectile dysfunction, Pfizer initiated studies to improve their understanding of female sexual function, as well as to perhaps medicalize and develop a market for both female conditions. An examination of medical journal articles on the topic, as with those on erectile dysfunction, reveals major links between Pfizer and many researchers in the field. In fact, many of these researchers are the same ones who first exposed and publicized erectile dysfunction: The Sildenafil Study Group, Dr. Goldstein and Dr. Althof, the editor-in-chief of The International Journal of Impotence Research, to name a few.