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Null and Void

SAN DIEGO -- Of all people, you might think that urologists would be among the least susceptible to the penis joke in all its variants. But you would be mistaken.

A meeting here of the

Society for the Study of Impotence

-- a satellite of the

American Urological Association

annual meeting -- was notable for a number of things: the undying euphoria over


(Still? It's been like, what, three months?), the enthusiasm for the potential to treat female sexual dysfunction, the future of combination therapy for impotence. But the periodic explosions of laughter at almost every nonclinical mention of sex and the male sexual organ were perhaps most startling. These guys are doctors, professionals,


; it's not a seventh grade sex-ed class. Though maybe it's not so surprising from doctors who talk about "voiding."

At one point in the Sunday afternoon session, Beverly Whipple, a sex researcher who is credited with discovering the "Grafenberg spot," reassured the audience that stimulating the g-spot, which is inside the vagina and still a controversial concept, didn't take something large and thick. It could be done with something as modestly sized as a tampon. "That's a nice thought," said Dr. Irwin Goldstein, the Boston University urologist who is the incoming president of association and the nation's chief spokesman for those who can't get it up. "I have to tell my wife that."

While this seems like the point at which one suggests to Goldstein that a gig at the

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isn't in the offing, the urologists let forth peals of guffaws.

Another moment of high hilarity to the doctors who deal with human sexual organs every day: Dr. Ira Sharlip, the secretary of the society and a urologist from the

University of California San Francisco

, suggested that if given a choice between heart medicine and Viagra, 99.9% of men would choose the impotence pill. He had his audience tittering. Dr. Tom Lue, also of UCSF, did a little comic duo and put 'em over the edge with his summation of how he denied Viagra to heart-drug patients: "You may die. You may have a good erection, but you may die." This got belly laughs, no kidding.

Jokes aside, this indicates that these are the giddiest, headiest times in years for urologists. Their concerns now have a lot to do with "capturing" patients and even with the stock market. Len Yaffe, the big-pharma analyst for

NationsBank Montgomery Securities

, gave a talk at the session titled, "When Does a Securities Analyst Recommend Investing in an Emerging Biotech/Pharmaceutical Co.?" Asked why he hadn't left to watch the Bulls game, a Chicago-area urologist said, "I think this will be more important to me." (For those watching for signs of the apocalypse, he was in a distinct minority: Many of the doctors and all of the Wall Streeters had left by the time Yaffe took the podium.)

The surprising thing is that the enthusiasm over Viagra is undiminished. In this case, familiarity hasn't bred contempt. Doctors clearly feel the drug works in seven of 10 patients, matching the efficacy rates in the


clinical trials. Usually, in the real world a drug works less well. Doctors don't believe patients are developing tolerance to the drug. Goldstein took an informal survey and perhaps a fifth of the doctors in the packed room had prescribed Viagra to women.

It's a new world for urologists, who are thinking about how to keep impotence patients and not forfeit them to primary care docs. The president of the society, Dr. Arnold Melman, said gynecologists had "captured" women and become the family doctor for women. Melman urged the doctors in the room not to become just pill-prescribers, but seek to do the same for their patients.

For these giggly doctors, Viagra is no laughing matter.