The age of majority is termed the threshold of transition from adolescent to adulthood, which is conceptualised in law. This is a momentous landmark for most of us, when the chronological age ceased to recognized a person as minor, when they assume control over their actions, thereby terminating the legal control and responsibility of their parents.

For most countries, the age of majority is set at eighteen, and not necessary correspond to actual mental or physical maturity of an individual. In many societies, the age of eighteen also considered appropriate for the marriageable age, alcohol-drinking age, school leaving age, smoking age, voting age and the age of sexual consent. Although a person may attain the age of majority, there may still be a great variability in opinion in what is permissible and what is not.

Looking back, I personally could not recall ever having that compelling desire to immediately leave school, contemplate marriage and crave to binge in alcohol, cigarette and sexual mischief at the strike of midnight on my eighteenth birthday all those years ago!

One of the greatest American writers of the 20th century, whose works are the paradigmatic writings of the Jazz Age, F. Scott Fitzgerald once said: “At Eighteen our convictions are hills from which we look; at forty-five they are caves in which we hide.” On the day of the eighteenth birthday of the blue diamond pills, we explore whether the doctors and patients looking at sexual health and its treatment from the hill or still hiding in the cave in the 21st century.

Dear Dr. G,

My name is Teck, I am 48 years old and would like to consider myself as a liberal.

I admit, many years of indulgence in life such as good food, smoking and alcohol consumption will finally catch up on my health. Sadly, it is my erection that gets affected first.

After months of failed attempts to get erections to have sexual intercourse with my wife, I began to get worried.

I initially thought the ED was due to stress at work, and will recover with time. It is now apparent the rigidity is not returning to its former glory.

I have read up quite a great deal on the blue pills and ready to see my doctor to face the music. I am worried my doctor might think I am too young for the pills.

I am also concern he may ask me to get permission from my wife before consuming the medication. By the way is that necessary?

Incidentally, has the pills been around long enough for us to understand the efficacy and long-term effects.

Please advice.

Teck

On the 27th March 1998, exactly eighteen years ago today, Sildenafil (commonly known as the blue diamond pills) was approved by FDA as the first oral treatment for erectile dysfunction in United States. The drug initially termed compound UK92,480) was synthesized by a group of Chemist in England, for the use in hypertension and angina. In the first phase clinical trial, the drug was noted to have minimal impact on the hard, but tremendous response on the hard-ons. For the last eighteen years, sildenafil and a group of medications called phosphodiesterase 5 inhibitors (PDE5-I) has become the first line therapy for men with Erectile Dysfunction (ED).

Before the 1990’s, the understanding of the physiology of erection was deficient, and the treatment such as penile prosthesis; vacuum pumps and injections directly into the penis were the only treatment options for men with ED. The emergence of the blue pills did not just transform the treatment modality for ED; it also reduces taboos in sexual medicine, facilitated research and changed the landscape of Men’s Health.

The reality is, there are not too many medications still warrant such scrutiny, induces myth and cause controversy like the blue pills, eighteen years after its arrival. Needless to say, it is because sex itself is too “hard” to talk about, and the sense of “guilty pleasure” will always raise the questions that too much of a good thing surely is bad for you?

So, exactly how bad is this pill? In the last eighteen years, it is now obvious the initial fear of sudden death, stroke and heart attacks following the consumption of the blue pills, is completely myth and unfounded. The most common adversity of sildenafil includes headache, flushing, indigestion and nasal congestion. Another unique, but common side effects is also cyanopsia or blue vision is often a strange experience, that users may associate with the “punishment” of the over consumption of the “blue materials”. Despite having minimal adversity, the use of sildenafil should still seek medical advice before therapy.

If not so bad, how good are the pills? The overall reported efficacy of the pills is estimated to be around 80% returning to “normal” erectile rigidity. Obviously, such high success rates may not be achievable in individuals with serious ED.

If the effectiveness of the medication is good and the side effects are minimal, what is the problem? The ugly truth is, despite the modern mentality of the 21st century, popping a pill for sex is still have a moral barrier to be overcome. If a grown man like Teck is asking whether he needs “permission” from his wife to take a pill to improve the sexual relationship, then the taboo of sexual health is still a major barrier for ED men to accept therapy.

Albert Einstein once said: “Common sense is the collection of prejudices acquired by age eighteen”. Eighteen years after the introduction of the blue pills, I really hope the acquired knowledge will unravel the good, the bad and the ugliness of the blue pills. Lets hope this will also built up more common sense and have fewer prejudices on sexual health. On that note, I wish the Blue Diamond a great Blue Birthday!

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