What's Up with China's Erectile Dysfunction Problem?

This article originally appeared on VICE UK.

"Hard like a cucumber" or "soft like tofu"—these were the two main options to describe an erection in a study known as the"China Ideal Sex Blue Book," which went viral at the end of last year. Sadly for the respondents, almost 50 percent of them said they were closer to tofu. China, growing in most aspects, is apparently shrinking here. The nation's men are overworked and overstressed, the study reported.

It's a very modern problem, and it needs a modern solution. Namely, Viagra. Dr. Jiang Hui, an author of the study (supported by Pfizer, the manufacturer of Viagra), concludes as much. For Jiang, Chinese men present a toxic mix of being too reluctant to seek support and too misinformed about sexual problems. They need help, ideally from the infamous blue pill. But is this merely an attempt by Pfizer to drive sales, or are Chinese men actually suffering from a severe sexual setback?

Concern about impotence in China first left the bedroom and entered broad daylight in the 1980s, when nanke (men's medicine) arose as a new division of Chinese medicine specializing in impotence and other issues. It was just what the doctor ordered. In the decades that followed, China witnessed a huge increase in the number of men seeking treatment for impotency. Clinics offering nanke mushroomed. These clinics provided traditional Chinese medicinal treatments alongside Western remedies—including Viagra, which made its Chinese debut in 2000.

The industry continues to grow. New drugs and companies enter the market regularly, such as Guangzhou Baiyunshan Pharmaceutical Company, which recently introduced an herbal product called Tiema, Mandarin for "iron horse."

Enter Everett Yuehong Zhang, who has spent around 15 years researching what is going on, or rather off, in China. In 1999 Zhang found himself inside a Beijing TV studio during a one-hour show on the "contagion," as erectile dysfunction was then being referred to. The show featured three prominent urologists fielding calls from the general public. The lines were jammed. One of the camera operators in the studio turned to Zhang and exclaimed, "ED is becoming an epidemic!"

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His comment clearly influenced Zhang, who published a book this March called The Impotence Epidemic: Men's Medicine and Sexual Desire in Contemporary China. In the book Zhang interviewed 350 men and their partners from Beijing and Chengdu, who were seeking treatment for impotency. They ranged fro 18 through to 81. Zhang found countless reasons for their issues, some of which were unique to China: trauma from famine and political violence; social anxiety especially for those who lost stable jobs as a result of recent economic reforms. And, of course, China's seedy business culture, which can literally demand men to have sex in front of their bosses.

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But what Zhang did not find were statistics painting a picture decisively worse than before. Despite his book's title, Zhang does not think China has gone limp. "I don't know if there has been an increase in the incidence of impotence," says Zhang, "just that there has been an increase in reporting it, which shows a change in the public view of sexual desire."

For Zhang, what we are witnessing now is actually "a positive phenomenon." It is part of modern China's movement away from the collective towards the individual. This individual is increasingly daring and pleasure seeking. "They are taking actions to satisfy desire and to strive for a good life," Zhang says. "The epidemic is a story of change in China over the past 30 years."

Zhang's theory rings true. For China's youth at least, sex now serves a dual purpose of recreation and procreation. The strict moral codes that for centuries painted lust as negative have dissolved since the death of Mao in 1976. Today, sex is everywhere in China, from adult stores on urban streets to endless hair salons, massage parlors, and karaoke joints which, for an extra price, will provide extra services.

In the words of one young man, Viktor, who's in a local punk band in Beijing called Bedstars ("because it sounds slutty"): "When you walk down the street, everyone looks like a virgin, but they all have sex. I did a survey of a porn site and discovered many career people doing kinky, perverted things." Viktor's setting up an online sex toy company on the side to capitalize on these increasingly daring tastes.

It's not just in shadowy corners that sex is on the menu, though. In 1989, eminent sexologist Li Yinhe conducted a survey that showed just 15 percent of the population had premarital sex. Today, according to local figures, it has risen to 71 percent.

Chinese people are talking as much as they're doing. Despite government aims to control vice, China's blogosphere overflows with it. Muzi Mei, a female journalist who once uploaded a 25-minute video of herself making love, actually managed to knock Chairman Mao off the number one most searched spot for a while. Then there was Lady Cat, whose blog contained essays like "An Orgasm a Day," a chronicle of her discovery of masturbation. These are just two examples in a long list of lasciviousness.

It's no coincidence that increases in the reporting of erectile dysfunction are in tandem with gains in female sexual liberation—the two are really different sides of the same coin. Behind every strong man is a powerful woman? More like behind every impotent man is a woman pushing him into a clinic. For this reason, Zhang has a chapter on women. As he writes: "This book is about male impotence. But women played such an important role in the experience of impotence and the production of desire that this book is surely about women as well."

As people talk more about sex in all its various manifestations, the shame associated with erectile dysfunction has been reduced. The Chinese even joke about it. "Nowadays, a man relies on drugs to do "homework"—i.e., have sex with his wife—and he relies on feelings or sensations to do "outside work"—i.e., have affairs or see prostitutes," one business man joked to Zhang, who labels the sharing of these "erotic jokes" a "veritable fad" in his book.

Put simply, Chinese people are getting more into good sex and less into bad, and nothing kills the mood more than a flaccid penis. "There's an increasing public concern about male sexual function," adds Zhang. That said, China has a long way to go before it can call itself a sexual Mecca. It remains deeply conservative, with a degree of shame still attached to topics of a sexual nature, not least ones as sensitive as erectile dysfunction.

This might explain why China, a country which represents around 20 percent of the world's population, records under 8 percent of Viagra sales, though Zhang is keen to highlight this could result from other factors. "The Chinese understanding of impotency is different to other societies," he says. "They approach Viagra in a different way." Namely, plenty of Chinese still rely on traditional Chinese medicine (TCM), which is a billion-dollar industry, officially funded and sanctioned as part of the state medical system.

Viagra has won over a large chunk of men who previously used TCM and, with this, the price of seal penises—one of the most popular traditional ED remedies—has dropped. But it hasn't won everyone over. A view that herbal is best (or at least more affordable, as is often the case) continues. Add to this a plethora of health and safety scandals pegged to chemicals and you can see why not all are won over by Viagra.

According to the traditional Chinese outlook, sexual health also requires longer term cures, rather than quick fixes. If that be the case, those who are closer to tofu might have to wait a while before they become cucumbers. But at least they can now talk about it. Sort of.

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Jemimah Steinfeld is author of Little Emperors and Material Girls: Sex and Youth in Modern China, which will be published in the US on April 28.