Health: Why won't he take his Viagra?

JONATHAN, AGED 35, has been, as he puts it, "plagued with impotence" throughout his 10-year marriage to Sue.

In the spring of 1998 he managed to find his way to one of the few clinics that were offering Viagra. He paid a great deal of money for a consultation, and then went home to Sue, proudly bearing a supply of the diamond-shaped blue pills.

Eight months later, he hasn't taken any of them. Every few weeks he rings up the clinic to postpone his next appointment. "So sorry," he says. "I just haven't had time to try the Viagra yet. Very busy, you see."

During the last year or so, I've seen at least a dozen patients like him: men who jump through hoops to find a doctor who will prescribe Viagra for them, and then don't take it.

Why? They tend to shy away from the question and say things such as, "The opportunity hasn't really come along."

My own impression is that for many of these men, the whole object of the exercise is simply to get hold of the tablets. After that, they feel that they need do nothing more.

Pablo - a thrice-married executive of 43 - begged me to see him. He claimed he had to have Viagra NOW. "You see," he said, "my wife will be ovulating tomorrow. We're desperate to have a child. So I need to take the stuff tonight."

I saw him, examined him and gave him the blue pills. Six months later, they're still untouched. Why? Well, according to him, he's not really sure that his wife has ovulated yet. Still, he says with some pride, "I've earned a lot of Brownie points from her by going out and getting them. I am the hunter-gatherer of the family, you know."

I'm not alone in having seen so many patients who never get round to taking their Viagra. Consultant urologist Mr Colin Kennedy of Bury St Edmunds recently told a doctors' meeting: "Some men just get the pills and put them in their hip pocket and that's that. It's as if they're saying: `Oh, I'm not impotent. It's just that I don't choose to take the tablets.'"

I think that in a few cases, the men who don't use their expensive little pills are afraid to take them because of fear of side effects. Fair enough: there is still quite a question mark over whether Viagra causes heart deaths - though the manufacturers claim that no link has been established.

But in many other instances, the reason why the man doesn't use his "blue diamonds" is to do with his own sexuality.

Last summer, Trevor, a Welsh schoolmaster, was dragged along to see me by his wife. In November, his packet of four pills was still intact, and I eventually realised why: Trevor is actually gay, and has no real interest in having sex with Mrs Trevor. He is not impotent when he is with men.

Similarly, a urologist friend of mine encountered a patient who never takes his pills because he, too, doesn't want to make love with his wife. The reason? He has a perfectly good mistress in Shropshire - and he's not impotent with her.

Then there are couples who don't use Viagra because the man's impotence has become "part of the relationship". It sounds like Pseuds' Corner jargon, but any psychiatrist will tell you there are marriages that only function if the husband remains impotent.

Steffan is a 38-year-old lecturer whose marriage had never been consummated because he couldn't get much of an erection. He wistfully mentioned to his doctor that he would like a son, so the GP sent him to me with a note saying, "Please do something about this man's erectile dysfunction." There were no contra-indications, so I gave him the medication. Steffan took one of his tablets, but his wife was so horrified at the resulting erection that she walked out on him, and didn't come back for a fortnight. So he definitely won't be using the rest of them.

It's important to realise that this much-hyped drug isn't a "magic bullet" which will cure all bedtime ills. Sure: it works well for a lot of males with erectile dysfunction. Indeed, many men are enormously grateful that this drug has given them back their virility. But for some couples, the emotional complexities of their relationships are far, far too tangled to be unravelled by a mere pill.

David Delvin is a doctor specialising in psycho-sexual problems. All names have been altered