As an andrologist — a doctor specializing in male diseases — I frequently encounter people who ask me about erectile dysfunction. One recent patient had no quibbles about coming straight to the point. A somewhat bossy man in his 40s or 50s, he strode straight into my consultation room and demanded a prescription for ten boxes of Viagra. When I asked why he needed so much, he replied straight-faced that he was planning a party with a few friends and needed pills to “liven things up a bit.”

Fortunately, most of the time, I’m spared mental images of my middle-aged patients’ more orgiastic maneuvers. Another recent patient was a much more typical case: He ostensibly came to see me about a routine semen analysis, and after the initial consultation — right as he was walking out — he turned back and asked what we in the medical profession call a “doorknob question.” These are often the true reasons for the patients’ visit, and in andrology, it’s often when men confess that all’s not well in the bedroom.

Naturally, I’m not in the business of prescribing industrial amounts of Viagra to just any guy who asks for it. As with everything in medicine, I have to follow certain procedures before putting patients on a course of treatment. In the latter patient’s case, I used an internationally recognized questionnaire to evaluate the extent of the man’s erectile dysfunction and determined that it indeed required treatment. However, just as I was writing him a prescription, the man adopted a serious expression. “Doctor,” he said, “I’ve heard that Viagra has a number of side effects and is even addictive. Would it be possible to give me something else?”

To me, the contrasting attitudes of these two recent patients sum up China’s relationship with medications that treat sexual function — especially frontline medicines like Viagra and Cialis. Some men take them recreationally, even in excess; others regard them with suspicion and don’t dare touch them.

In Chinese, erectile dysfunction is colloquially called yangwei. It’s one of the language’s more visual euphemisms: Yang means “masculine energy,” and wei means “to wilt.” Although attitudes toward sex are becoming more open, it remains taboo to talk about sex in China. Society has historically viewed male sexual dysfunction as shameful, and even though media outlets and internet forums help to promote discussion about the topic, many patients remain ignorant or suspicious of existing medical treatments.