Part III: Latin America
In this chapter, the author discusses the gendered experiences of older, urban, working-class Mexican men as they navigate changes in their bodies, cultural ideals of masculinity, and the available array of sexual medical interventions as they seek to be good men in later life. The author explores how the “macho” stereotype, now widely critiqued in Mexican society, is seen as a form of masculinity that thwarts national modernization. Older men come to accept their erectile dysfunction as a natural part of the aging process and an alternative form of masculinity that counters the macho stereotype.
- Define key terms including “medicalization,” “masculinity,” “companionate marriage,” “machismo,” and “erectile dysfunction.”
- Understand that cultural ideas about masculinity determine what kinds of erectile function people define as healthy and normal.
- Explain how cultural ideas about race, gender, and age influenced Mexican men’s understandings of decreasing erectile function.
If you were born in the 1990s or later, throughout your life you’ve heard ads for pills like Viagra define not being able to get firm enough penile erections as the medical problem “erectile dysfunction” (ED). However, the concept of ED was actually created fairly recently and is only one of many ways to understand men’s changing sexual function over the life course. In different times and places, people have understood the inability to get desired erections as variously as a consequence of witchcraft, as a punishment for “bad” sexual behavior earlier in life, and as a psychological issue called “impotence” (McLaren 2007; Wentzell 2008). In the United States in the 1990s, psychotherapists, psychologists, urologists, and other kinds of professionals were debating both the causes of erections that did not meet social ideals and which professionals should treat this issue. Since the then-common term impotence had become stigmatized, some of them decided to rename this issue .
While the goal of this terminology change was to destigmatize this experience by framing it as a medical pathology rather than a personal failing, this renaming also enabled medical professionals to claim expertise over the condition (Tiefer 1995). At the same time, drug companies were developing the first oral pills that could enhance erectile function. The first of these, Viagra, came on the global scene in 1998. These developments enabled a worldwide of less-than-ideal penile erection. Medicalization is a social process in which areas of life previously understood in other ways (for example, as social, religious, or other kinds of issues) come to be seen as medical concerns to be treated by doctors (Tiefer 1994). Examples of medicalization range from reframings of bad breath as halitosis (a shift engineered by the marketers of Listerine mouthwash in the United States), to more recent reconceptualizations of shyness as social anxiety disorder and period-related mood changes as premenstrual dysphoric disorder. The medicalization of erectile difficulty into ED has now become so prevalent that people who grew up after 1998 might not question the idea that this issue could be understood in any other way.
However, understanding ED as a simple biological fact has significant social consequences. The medical definition of ED is “the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance” (Lizza and Rosen 1999, 141). Yet what counts as “sufficient erection” and “satisfactory” sex are actually profoundly personal and variable. Failure to acknowledge that variability in ED drug marketing and prescription suggests that there is a single norm for healthy erections and sexual practice.
Since the concept of ED was developed in the United States, that norm comes from the US cultural ideas about sex, sexuality, and . It is the idea that penetrative (penis-in-vagina), heterosexual sex is what counts as “real” sex and is the kind of sex that is healthy and normal (Rubin 1992). This idea also relates to particular cultural ideas about masculinity, which anthropologist Matthew Gutmann (1996, 17, italics in original) defines as “what men say and do to be men.” ED drugs thus function as “masculinity pills,” enabling men to conform to the idea that healthy and normal men should want (and be physically able to have) penetrative sex whenever possible—despite aging, illness, conflict with their partners, or other life issues (Loe 2004a, 58; Marshall and Katz 2002).
The ability to use ED drugs to attain more firm or frequent erections can ease the emotional pain of men who wish to live out this kind of masculinity. However, casting penetrative sex-oriented manliness as the only healthy or normal way to be a man also creates more suffering. It does so by promoting narrow norms for masculinity and sexuality that exclude those who want anything other than lifelong, penetrative, heterosexual sex as abnormal (Loe 2006; Tiefer 1994; Potts 2000; Mamo and Fishman 2001).
Further, the globalization of this ideology through the worldwide marketing and prescription of ED drugs has pitfalls. Drugs like Viagra are huge sellers, with 2017 global sales reaching almost five billion (Zion Market Research 2018). The worldwide diffusion of the ED concept that those sales reflect has been achieved by promoting specifically Euro–North American cultural ideas about what counts as normal and healthy sex, sexuality, and masculinity as if they were universal, biological facts. Framing such culturally specific ideologies as objective descriptions of the nature of men’s health, bodies, and ideal behaviors both promotes the problematic dominance of one culture over others and reduces the set of possibilities men have for understanding themselves and their bodies.
Yet despite the worldwide popularity and marketing of ED drugs, many men and their sexual partners do not accept these norms. Even among heterosexual couples, people often value or prefer nonpenetrative forms of sexual interaction (including the many women who experience greater pleasure from nonpenetrative sex acts) (Potts et al. 2003; Potts et al. 2004; Loe 2004b). In contexts as diverse as rural Ghana and urban Sweden, people often understand focusing on nonsexual forms of intimacy and interaction in later life as more respectable, age-appropriate, and emotionally fulfilling than continuing the kinds of sex they had as youths (van der Geest 2001; Sandberg 2013). Further, even two people married to each other might disagree about what kinds of sex or intimacy are desirable at particular life stages (Moore 2010).
My aim in this chapter is to analyze a specific case—the experiences of older, working-class men in urban central Mexico—to demonstrate how people might draw on cultural ideals different from those made to seem natural in ED marketing to understand men’s changing erectile function. After discussing the study site and methods, I present data from interviews with over 250 older Mexican men receiving medical treatment for urological issues other than ED. Despite the popularity of ED drugs in Mexico, these particular men overwhelmingly rejected the idea that decreasing erectile function was a medical problem. Instead, they understood decreasing erections in later life in relation to changing local cultural ideals of masculinity and marriage, as well as to local understandings of respectable manhood in older age. By analyzing how they came to these understandings, I show that people’s ideas about what kinds of sexual function are healthy, manly, and age-appropriate reflected context-specific cultural ideologies rather than a universal biological truth about what constitutes a normal erection. This analysis reveals how medical treatments for gendered ailments both reflect and reproduce gender ideals specific to particular places and times.
Urban central Mexico is a particularly interesting site for studying masculinities because it has been the site of long-standing and heated debate about what it is to be a good man. The notion of figures prominently in such discussions. This is the idea that Mexican men are inherently predisposed to “macho” masculinity, which involves emotional closure, violence, womanizing, and dominance over women (McKee Irwin 2003). Mexican public intellectuals popularized the concept of machismo in the 1950s, defining it as an inheritance from coerced reproduction among Spanish Conquistador forefathers and Indigenous foremothers (see Paz 1985). Importantly, this notion is based on elite critics’ interpretations of the behaviors attributed to lower-class men, rather than any actual sociological or biological data. It is also based on ideas about race—specifically, the idea that Mexicans form a unique race generated by this Conquistador/Indigena mixing and thus are biologically and culturally susceptible to forms of behavioral backwardness, like machismo, but are also capable of advancing beyond them through “modern” health and social practices (Alonso 2004).
Neither this idea of race nor the concept of machismo it includes are biological truths about Mexican people. It is crucial to note that racial ideologies are not scientifically valid accounts of biology. They are instead cultural ideas that have the social power to influence people’s behavior in ways that then influence people’s health and well-being (Ackermann et al. 2019). Nevertheless, the idea that machismo exists caught on in Mexican and global popular cultures.
However, people in Mexico today generally discuss machismo as both a reality of life and a problematic barrier to desired social change. Amid calls for more equal gender roles, local ideas of marriage have shifted dramatically in recent decades, most visibly in urban areas (Amuchástegui and Szasz 2007). While women and men were once expected to occupy fairly separate spheres, in Mexico, as in many parts of the world, people now value . This is a form of marriage based on emotional fulfillment rather than the traditional foci of economic production and social reproduction (Hirsch 2003; Wardlow and Hirsch 2006). While men were once expected to provide economically for their families but also to demonstrate virility through extramarital sexuality, being a good and modern Mexican man now involves being purposefully different from that model, meeting ideals of fidelity and emotional engagement with one’s spouse and children (Ramirez 2009; Wentzell 2013a).
Given the rise of companionate marriage, Mexican people as diverse as feminist activists and male gang members now critique machismo as a problematic, regressive form of masculinity (Gutmann 1996; Ramirez 2009; Sverdlin 2017). However, while some people decry machismo as a racist stereotype, critiques more often focus on the need for good men to fight against their inherent macho impulses, thus keeping this idea of Mexican male nature alive even while deploring it (Amuchástegui Herrera 2008). This meant that both the cultural idea of machismo as a natural trait among Mexican men, and the major changes in local ideas about what constitutes good marriage and masculinity, fundamentally influenced experiences and perceptions of the research participants I worked with.
These participants were urology patients in the central Mexican city of Cuernavaca, a growing metropolis near the nation’s capital with a largely mestizo-identified population that utilizes biomedicine much more frequently than traditional forms of healing. The outpatient urology clinic these participants attended was based in the regional flagship hospital of the federal Instituto Méxicano del Seguro Social (IMSS) system. The IMSS provides care to privately employed workers and their families, or about half of the Mexican population. While the care at the research site was of high quality, waits were long: so IMSS-eligible patients with enough money often sought private treatment. This meant that most men in my study were working class. It also meant that although in some contexts physicians experience economic incentives for diagnosing ED and prescribing ED drugs, the resource-strapped IMSS setting posed a disincentive to medicalizing new conditions. In 2007–2008 I held Spanish-language, semistructured interviews with over 250 of these men, about 50 with their wives who had accompanied them to the clinic. They ranged widely in age, but most were in their fifties and sixties and considered themselves “older” after a lifetime of hard work.
About 96 percent of the men invited to participate in this research did so; despite stereotypes they themselves voiced about Mexican men being unwilling to discuss these issues, they often said they “enjoyed the chance to talk” about intimate issues with an interested stranger. My identity as a white, North American woman researcher facilitated this interaction. Being a foreigner helped, since many men said they felt able to tell me potentially embarrassing information they kept from other men or their social circle (since I didn’t know any of their friends or relatives). Being a white woman from the United States helped in that some men admitted being reluctant to talk about sexual issues with a woman but then voiced beliefs that Anglo-American women were more comfortable talking about such things than Mexican women, hence they felt comfortable discussing these topics with me. Finally, my status as a researcher aided our interactions, as many participants voiced respect for education and said they felt grateful to be included in an academic study.
Despite men’s willingness to participate, they presented the partial and context-specific narratives of their lives that characterize all interview data. For example, none mentioned same-sex sexuality, which was statistically likely to have happened in such a large group of men but was a stigmatized topic among them (see, for context, Carillo 2002). Further, while they did not appear to shape their statements in relation to preconceived ideas they expected me to have about Mexican men, they often took it upon themselves to provide context for a foreigner, such as explaining who Mexican men are in the abstract. This focus reflects the role my own positionality played in data collection.
Men’s Experiences of Decreasing Erectile Function
Most research participants referred to the concept of machismo when discussing their experiences of being a man. They often described it as a fundamental if negative quality of Mexican men—sometimes including themselves—which would shape those men’s understandings of sexual issues. For instance, as one man explained, “Here in Mexico, [infidelity is] something normal. They say the Mexican is passionate. They say the man is polygamous by nature.” Others discussed the “hot” constitution of Mexican men as an innate biological impetus to have a lot of sex. Some described machismo as a cultural inheritance that was prevalent but problematic. One man noted, “A lot of machismo exists. . . . They’re afraid that if they let their guard down, they’ll become whipped. That’s the closed psychology of the macho man” (interview by author).
Yet even the men who described some of their own actions as “macho” noted that this form of masculinity was problematic and that men would “have to change” to keep up with the times. For example, one participant noted that he and other men his age had been taught that “the woman needs to be behind” but now needed to realize that “the wife isn’t a thing—she’s a person, she’s a comrade” (interview by author). Thus, men who had always practiced fidelity—as well as those who had conformed to “macho” stereotypes in their youth—described the need for men “today” to be faithful and emotionally engaged with their wives and families. One participant even identified himself as an “ex-machista” who had changed his ways in later life.
This idea that good, modern men should reject macho sexuality fundamentally influenced participants’ responses to decreasing erectile function. Despite often identifying themselves or their peer group as predisposed to the kind of male sexuality that would be aided by ED drugs, participants overwhelmingly rejected medical ED treatments. Despite the fact that all the men were aware of (and knew how to get) ED drugs, and that 70 percent of participants reported decreased erectile function, only 11 percent of men even considered seeking medical intervention for decreasing erectile function—and very few of those actually did so. This was because they drew on local cultural ideals of change over time in masculinity and marriage to interpret this bodily change in ways other than as a biological problem.
Men understood ED drugs to enable youthful and macho forms of sexuality in later life, which were now age (and societally) inappropriate. They expected to live out a specific form of male life-course change as they aged, which they frequently termed the “second stage” or “other level” of life. One man said that after his retirement he would change focus and “dedicate myself to my wife, the house, gardening, caring for the grandchildren.” He described this shift as so common that he considered it “the Mexican classic” (interview by author). This second stage was focused on the kinds of emotional engagement with family that had more recently become ideal for men more generally and study participants saw as particularly key for living out respectable masculinity in later life. One man explained, “Erectile dysfunction isn’t important. When I was young, it would have been, but not now.” Another laughed while noting, “Here in Mexico, we have a saying: ‘After old age, chickenpox’ . . . it means that some things become silly when one is older” (interview by author). He saw older men chasing youthful sexuality as silly in this way.
This was the case both for men who had focused on extramarital virility in their youths and those who had always lived out masculinities closer to current ideals of companionate marriage including fidelity. One man who had always been faithful to and emotionally close with his wife described his decreasing erectile capacity as part of “my nature. I never sought a medical solution to this problem—I just thought that my sex life was ending.” He continued, “In our married life, we were very happy. When the sex life ended, okay, we knew it would end one day. So, there wasn’t treatment—I never tried anything. I really didn’t have a problem with it” (interview by author).
A different participant who noted that he was a “womanizer” in his youth said that his changing body had enabled him to alter his behavior and relationship. He explained, “The truth is, now I don’t have the same capacity. I’m fifty-five, I know what I am. I don’t want problems with my wife. Like I deserve respect from her, she deserves it from me as well” (interview by author). Both men understood decreasing erectile function to be a “normal” and “natural” part of aging; one felt able to incorporate it into his already close marriage, while the other saw it as an aid for relating to his wife in a more respectful way.
Participants often identified decreased erectile function as both a prompt to start acting more maturely and as a way of overcoming bodily urges to now-inappropriately youthful and macho sexuality. One man noted that his generation of Mexican men had confused machismo with manliness, defining the former as seeking to “restrict” one’s wife and children and the latter as being “responsible” for them. He understood machismo as an innate biological urge, for example, explaining that in his younger days, “I saw a pretty prostitute, with a really nice body. In such cases, the macho comes out of us. So I slept with her” (interview by author). However, now that his erectile function had diminished, he believed he was free from such overwhelming urges and felt more able to be the kind of husband he now thought he should be.
It often took wives’ encouragement to help men embrace this change. Women who accompanied their husbands in our interviews reported defining decreasing erectile function change in later life as “natural,” “normal,” and acceptable to them as men’s sexual partners. In an interview with a couple who had not previously discussed the issue, the husband revealed that he worried his wife was unhappy with their decreased sex life. She reassured him, “It wasn’t the same, but it’s not serious, it happens with age and health problems” (interview by author). This exchange was mirrored by a less happy couple, with a husband who had pursued frequent affairs and a wife who had not enjoyed their sex life in part because of his behavior. When the man remarked somewhat wistfully that “the machinery of erection has broken down,” she shouted the qualifier, “Now we don’t want any more!” (interview by author).
As these example demonstrate, men’s interactions with a range of other people influenced their understandings of decreased erectile function. For instance, some men’s adult children encouraged them to be different kinds of men in older age. In an extreme example, one couple said that their children had saved up to buy their mother a separate residence so that she could leave their father if he did not change his ways. IMSS urologists’ attitudes also influenced men’s experiences of decreasing erectile function. Importantly, the urologists did not try to medicalize this bodily change, even though they reported that they did treat ED as a medical problem in their private practices with younger and wealthier patients. This was partly because they shared the same views about respectable male aging as the interviewees (who they saw as older than wealthier men of similar ages—including themselves—because the IMSS patients often appeared older after lifetimes of physical labor). It was also partly because the IMSS system did not offer economic incentives for departing from this ideology to promote medical treatment for ED.
For all these reasons, study participants saw ED drugs as so inappropriate for older men that they were likely to do physical harm. Some saw their aging bodies as increasingly vulnerable to the dangerous side effects of pharmaceuticals. One of the few men who initially sought ED treatment decided not to use it for this reason. He explained that “I was prescribed pills, but I haven’t used them. As a diabetic, I could have a heart attack” (interview by author). Many others saw the drugs as dangerous for older men because they would induce artificially youthful sexual behavior that would be physically taxing. A participant noted, “I don’t like to use things that aren’t normal. I don’t like to force my body” (interview by author). Participants often voiced concerns that ED drugs would inappropriately “accelerate” their bodies. One explained that they could “accelerate you to your death. Many friends have told me, they will accelerate you a lot, then you’ll collapse, that stuff will kill you” (interview by author). The idea that “people are dying of Viagra” was common, illustrating just how normal participants saw the “Mexican classic” form of male life-course change to be and how abnormal and potentially damaging they saw the use of ED drugs to resist this change to be. So, while many men reported that it took time for them to accept their decreased erectile function and come to terms with their older selves, even those who felt unhappy at first still rejected ED drugs, instead often trying gentle interventions like exercise or vitamins to avoid “unbalancing” their bodies.
Overall, a range of factors influenced older, working-class Mexican men’s rejection of the globally prevalent idea that decreasing erectile function was a medical pathology to be treated with drugs. These included local cultural changes in ideals of masculinity and marriage, specifically the rise of companionate marriage and critiques of machismo, which emerged over the courses of older men’s lives and made them want to be different kinds of men as they aged. This goal of change reflected another key cultural factor: the idea that good Mexican men should live out a specific life course, which included shifting one’s focus from work (and for some, extramarital sexuality) outside the home as a younger man to a later life emphasis on being present with one’s family. Interpersonal interactions, especially with wives and doctors who understood decreasing erectile function in older age to be “natural” and “normal,” were crucial for helping men decide that it was time for them to mature in this way.
This case demonstrates that people can understand changing erectile function in varied ways. Thus, it can help readers to understand how cultural ideas about things like gender, race, and aging influence what people define as healthy, normal bodily functions. The example here reveals that the physical attributes people define as fundamentally “natural” and “normal,” and those they define as abnormal states to be treated medically, are in fact determined by cultural ideologies rather than reflections of a universal biological truth. As such, they incorporate local ideals and prejudices into seemingly objective medical statements. Readers can keep these takeaways in mind as they seek to make their own decisions about what counts as normal human variation versus medical pathology. This will help them to think critically about the phenomenon of widespread medicalization in which bodily and behavioral difference is increasingly defined as disease rather than diversity. It will also help them to identify the range of ways that people come to view culturally specific ideals of gender, sexuality, and aging as inherently “natural” or universal, and the suffering that this can cause for people who do not conform to those ideals.
- How and why did older men’s ideas about ideal male sexuality change over their life courses?
- What is “machismo,” and how did ideas about it influence older men’s understandings of respectable sexual practice?
- How did other people, like wives and doctors, influence men’s understandings of their changing erectile function?
- Why did most men in the study reject erectile dysfunction treatment?
- What are examples from your own society of bodily traits or changes that have been medicalized based on cultural ideas about normal and healthy gender, sexuality, or aging?
companionate marriage: a marriage based on emotional fulfillment rather than the traditional foci of economic production and social reproduction. It has become the ideal type of marriage in many parts of the world.
erectile dysfunction (ED): the idea that penile erections that do not meet cultural ideals are a medical pathology, defined clinically as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance.
machismo: a widely critiqued form of masculinity characterized by violence and womanizing, often attributed to Latin American men’s cultural inheritance from Spanish Conquistadors. The idea of machismo is rooted in unfounded assumptions about the nature of Latin American men; however, these ideas have social consequences that then affect people’s bodies and behavior.
masculinity: the culturally specific traits, behaviors, and discourses expected of men.
medicalization: a social process in which areas of life previously understood in other ways (for example, as social, religious or other kinds of issues) come to be seen as medical concerns to be treated by doctors.
- AAPA Statement on Race and Racism: http://physanth.org/about/position-statements/aapa-statement-race-and-racism-2019/.
- Amuchástegui, Ana, and Ivonne Szasz, eds. 2007. Sucede que me canso de ser hombre. Mexico City: El Colegio de Mexico.
- Gutmann, Matthew C. 1996. The Meanings of Macho: Being a Man in Mexico City. Berkeley: University of California Press.
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- Wentzell, Emily A. 2013. Maturing Masculinities: Aging, Chronic Illness, and Viagra in Mexico. Durham, NC: Duke University Press.
I am grateful to the people who so generously participated in this research, as well as the IMSS physicians, nurses, public health researchers, and staff members who made it possible. This research was funded by Fulbright IIE, the Wenner-Gren Foundation for Anthropological Research, and the American Association of University Women.
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the idea that penile erections that do not meet cultural ideals are a medical pathology, defined clinically as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance.
a social process in which areas of life previously understood in other ways (for example, as social, religious or other kinds of issues) come to be seen as medical concerns to be treated by doctors.
the culturally specific traits, behaviors, and discourses expected of men.
a widely critiqued form of masculinity characterized by violence and womanizing, often attributed to Latin American men’s cultural inheritance from Spanish Conquistadors. The idea of machismo is rooted in unfounded assumptions about the nature of Latin American men; however, these ideas have social consequences that then affect people’s bodies and behavior.
a marriage based on emotional fulfillment rather than the traditional foci of economic production and social reproduction. It has become the ideal type of marriage in many parts of the world.